The clinical and cost effectiveness of group art therapy for people with non-psychotic mental health disorders: a systematic review and cost-effectiveness analysis

BMC Psychiatry

Anthea Sutton¹  Andrew Rawdin¹  Alison Scope¹  Matt Stevenson¹  Lesley Uttley¹ 

[1] School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK

关键词: Cost-effectiveness;    Health technology assessment;    Systematic review;    Psychological therapy;    Mental health disorders;    Art therapy;   

Others  :  1217893
DOI  :  10.1186/s12888-015-0528-4

 received in 2015-01-15, accepted in 2015-06-12,  发布年份 2015

【 摘 要 】

Background

The majority of mental health problems are non-psychotic (e.g., depression, anxiety, and phobias). For some people, art therapy may be a more acceptable alternative form of psychological therapy than standard forms of treatment, such as talking therapies. This study was part of a health technology assessment commissioned by the National Institute for Health Research, UK and aimed to systematically appraise the clinical and cost-effective evidence for art therapy for people with non-psychotic mental health disorders.

Methods

Comprehensive literature searches for studies examining art therapy in populations with non-psychotic mental health disorders were performed in May 2013. A quantitative systematic review of clinical effectiveness and a systematic review of studies evaluating the cost-effectiveness of group art therapy were conducted.

Results

Eleven randomised controlled trials were included (533 patients). Meta-analysis was not possible due to clinical heterogeneity and insufficient comparable data on outcome measures across studies. The control groups varied between studies but included: no treatment/wait-list, attention placebo controls and psychological therapy comparators. Art therapy was associated with significant positive changes relative to the control group in mental health symptoms in 7 of the 11 studies. A de novo model was constructed and populated with data identified from the clinical review. Scenario analyses were conducted allowing comparisons of group art therapy with wait-list control and group art therapy with group verbal therapy. Group art-therapy appeared cost-effective compared with wait-list control with high certainty although generalisability to the target population was unclear; group verbal therapy appeared more cost-effective than art therapy but there was considerable uncertainty and a sizeable probability that art therapy was more cost effective.

Conclusions

From the limited available evidence art therapy was associated with positive effects compared with control in a number of studies in patients with different clinical profiles. The included trials were generally of poor quality and are therefore likely to be at high risk of bias. Art therapy appeared to be cost-effective versus wait-list but further studies are needed to confirm this finding in the target population. There was insufficient evidence to make an informed comparison of the cost-effectiveness of group art therapy with group verbal therapy.

Trial registration

HTA project no. 12/27/16; PROSPERO registration no. CRD42013003957.

【 授权许可】

   
2015 Uttley et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

【 参考文献 】

• [1]WHO. The global burden of disease: World Health Organization, Denmark; 2004. 2008.
• [2]Department of Health: No health without mental health: a cross government mental health outcomes strategy for people of all ages. 2014.
• [3]Layard R: How mental illness loses out in the NHS a report by the Centre for Economic Performance’s Mental Health Policy Group. CEP special papers. 2012.
• [4]Reynolds MW, Nabors L, Quinlan A: The effectiveness of art therapy: does it work? Art Therapy 2000, 17(3):207-13.
• [5]Ruddy R, Milnes D. Art therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database Syst Rev. 2009;1:1-30.
• [6]Slayton SC, D’Archer J, Kaplan F: Outcome studies on the efficacy of art therapy: a review of findings. Art Therapy 2010, 27(3):108-18.
• [7]Gilroy A: Art therapy, research and evidence-based practice. 2006.
• [8]Nicholson RA, Berman JS: Is follow-up necessary in evaluating psychotherapy? Psychol Bull 1983, 93(2):261.
• [9]Lambert MJ. Bergin and Garfield’s handbook of psychotherapy and behavior change. 2013;1-256.
• [10]Cooper M. Essential research findings in counselling and psychotherapy: the facts are friendly. 2008;1-32.
• [11]Sportel B, de Hullu E, de Jong P, Nauta M: Cognitive bias modification versus CBT in reducing adolescent social anxiety: a randomized controlled trial. PLoS One 2013, 8(5):e64355.
• [12]Van der Ploeg H: Handleiding bij de Examen/Toets attitude vragenlijst ETAV: Een nederlandstalige bewerking van de spielberger test anxiety inventory [A Dutch version of the Spielberger Test Anxiety Inventory TAI]. Swets En Zeitlinger. 1998.
• [13]Broome ME, Maikler V, Kelber S, Bailey P, Lea G: An intervention to increase coping and reduce health care utilization for school-age children and adolescents with sickle cell disease. J Natl Black Nurses Assoc 2001, 12(2):6-14.
• [14]Thyme K, Sundin EC, Stahlberg G, Lindstrom B, Eklof H, Wiberg B: The outcome of short-term psychodynamic art therapy compared to short-term psychodynamic verbal therapy for depressed women. Psychoanal Psychother 2007, 3:250-64.
• [15]Kim SK. A randomized, controlled study of the effects of art therapy on older Korean-Americans’ healthy aging. Arts Psychother. 2013;40(1):158–164 February.
• [16]Monti DA, Peterson C, Kunkel EJ, Hauck WW, Pequignot E, Rhodes L, et al.: A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psycho-Oncology 2006, 15(5):363-73.
• [17]Monti DA, Kash KM, Kunkel EJ, Brainard G, Wintering N, Moss AS, et al.: Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer. Stress Health 2012, 28(5):397-407.
• [18]Lyshak-Stelzer F, Singer P, St. John P, Chemtob CM: Art therapy for adolescents with posttraumatic stress disorder symptoms: a pilot study. Art Therapy 2007, 24(4):163-9.
• [19]McCaffrey R, Liehr P, Gregersen T, Nishioka R: Garden walking and art therapy for depression in older adults: a pilot study. Res Gerontol Nurs 2011, 4(4):237-42.
• [20]Rusted J, Sheppard L, Waller D: A multi-centre randomized control group trial on the use of art therapy for older people with dementia. Gr Analysis 2006, 4:517-36.
• [21]Greenwood H, Leach C, Lucock M, Noble R: The process of long-term art therapy: a case study combining artwork and clinical outcome. Psychother Res 2007, 17(5):588-99.
• [22]National Institute for Health and Care Excellence. Guide to the methods of technology appraisals. National Institute for Health and Care Excellence, London; 2013.
• [23]Dakin H: Review of studies mapping from quality of life or clinical measures to EQ-5D: an online database. Health Qual Life Outcomes 2013, 11:151. BioMed Central Full Text
• [24]Hattori H, Hattori C, Hokao C, Mizushima K, Mase T: Controlled study on the cognitive and psychological effect of coloring and drawing in mild Alzheimer’s disease patients. Geriatr Gerontol Int 2011, 11(4):431-7.
• [25]Ara R, Brazier J: Deriving an Algorthm to convert the eight mean SF-36 Dimension scores into a mean EQ-5D preference-based score from published studies (where patient level data are not available). Value Health 2008, 11:1131-43.
• [26]Rowen D, Brazier J, Roberts R: Mapping SF-36 onto the EQ-5D index: how reliable is the relationship. Health Qual Life Outcomes 2009, 7:27. BioMed Central Full Text
• [27]Derogatis L: SCL-90-R: administration, scoring and procedures manual. 3rd edition. National Computer Systems, Inc, Minneapolis; 1994.
• [28]Curtis L: Unit costs of health and social care 2013. Personal Social Services Research Unit, Canterbury, Kent; 2013.
• [29]Beebe A, Gelfand EW, Bender B: A randomized trial to test the effectiveness of art therapy for children with asthma. J Allergy Clin Immunol 2010, 126(2):263-6.
• [30]Gussak D: The effectiveness of art therapy in reducing depression in prison populations. Int J Offender Ther Comp Criminol 2007, 51(4):444-60.
• [31]Monti DA, Peterson C: Mindfulness-based art therapy: results from a two-year study. Psychiatr Times 2004, 21(8):63-5.