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. 2023 Jan 4:13:1041770.
doi: 10.3389/fpsyt.2022.1041770. eCollection 2022.

Analysis of the screening and predicting characteristics of the house-tree-person drawing test for mental disorders: A systematic review and meta-analysis

Huibing Guo  1   2   3 , Bin Feng  1   3 , Yingqiao Ma  1   4 , Xueyi Zhang  1   5 , Huiyong Fan  6 , Zaiquan Dong  7 , Taolin Chen  1   4   5 , Qiyong Gong  1   8   9
Affiliations

Analysis of the screening and predicting characteristics of the house-tree-person drawing test for mental disorders: A systematic review and meta-analysis

Huibing Guo et al. Front Psychiatry. .

Abstract

Background: The house-tree-person (HTP) drawing test has received growing attention from researchers as a common projective test. However, the methods used to select and interpret drawing indicators still lack uniformity.

Objective: This study aims to integrate drawing indicators into the process of screening for or classifying mental disorders by conducting a systematic review and meta-analysis of the application of the HTP test.

Methods: A search of the following electronic databases was performed in May 2022: PubMed, Web of Science, Embase, EBSCO, CNKI, VIP, and Wanfang. Screening and checking of the literature were performed independently by two researchers. The empirical studies published on the use of the HTP test in mental disorders and studies providing specific data on the occurrence frequency of drawing characteristics were analyzed. A total of 30 studies were included in the meta-analysis, including 665 independent effect sizes and 6,295 participants. The strength of the association between drawing characteristics of the HTP test and the prevalence of mental disorders was measured by the ratio (OR) with a 95% CI. Publication bias was assessed using a funnel plot, Rosenthal's fail-safe number (N fs), and the trim and fill method.

Results: The results revealed 50 drawing characteristics that appeared at least three times in previous studies, of which 39 were able to significantly predict mental disorders. The HTP test can be divided into the following four dimensions: house, tree, person, and the whole. These dimensions reflect the structure, size, and other characteristics of the picture. The results showed that the greatest predictor of mental disorders was the whole (OR = 4.20, p < 0.001), followed by the house (OR = 3.95, p < 0.001), the tree (OR = 2.70, p < 0.001), and the person (OR = 2.16, p < 0.001). The valid predictors can be categorized into the following four types: item absence, bizarre or twisted, excessive details, and small or simplified. The subgroup analysis showed that the affective-specific indicators included no motion, leaning house, and decorated roof; thought-specific indicators included excessive separation among items, no window, loss of facial features, and inappropriate body proportions; and common indicators of mental disorders included no additional decoration, simplified drawing, very small house, two-dimensional house, and very small tree.

Conclusion: These findings can promote the standardization of the HTP test and provide a theoretical reference for the screening and clinical diagnosis of mental disorders.

Keywords: aiding diagnosis; house-tree-person drawing test; mental disorders; meta-analysis; screening.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of the identified studies.
FIGURE 2
FIGURE 2
Funnel plot for the study of the relationship between drawing characteristics and mental disorders.
See this image and copyright information in PMC

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