Effects of Visual Art Therapy on Positive Symptoms, Negative Symptoms, and Emotions in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis

Abstract

Schizophrenia is characterized by psychiatric symptoms and emotional issues. While pharmacological treatments have limitations, non-pharmacological interventions are essential. Art therapy has the potential to enhance emotional expression, communication, and health; however, the effectiveness of visual art therapy remains uncertain. This systematic review and meta-analysis synthesizes the findings of randomized controlled trials (RCTs) of visual art therapy on positive symptoms, negative symptoms, and emotions in patients with schizophrenia. This study reviews RCTs published prior to February, 2024. The PubMed, Embase, Cochrane Library, CEPS, CNKI, Wanfang, and Yiigle databases were searched, and three independent researchers screened the studies. In this meta-analysis, standardized mean difference (SMD) was employed as a measure to calculate effect sizes for continuous variables using a random effects model, while the meta-regression and subgroup analyses were performed with patient and intervention characteristics. A total of 31 studies revealed visual art therapy had a significant small-to-moderate effect on positive symptoms (SMD = 0.407, 95% CI 0.233 to 0.581), a moderate effect on negative symptoms (SMD = 0.697, 95% CI 0.514 to 0.880), a moderate effect on depression (SMD = 0.610, 95% CI 0.398 to 0.821), and a large effect on anxiety (SMD = 0.909, 95% CI 0.386 to 1.433). The subgroup analysis revealed painting and handcrafts had significant effects on positive symptoms, negative symptoms, and emotions. Combined Chinese calligraphy and painting had significant effects on positive symptoms, depression, and anxiety. Better improvement was noted among the Asian population, and a longer weekly treatment duration was associated with better improvement in positive symptoms. Female participants tended to have more improvements in negative symptoms and anxiety through visual art therapy. The results indicate that visual art therapy has positive effects on the psychiatric symptoms and emotions of individuals with schizophrenia. We recommend future research further investigate art therapy modalities and durations.

Keywords: emotions; meta-analysis; psychiatric symptoms; schizophrenia; visual art therapy.

Figure 1

PRISMA flow diagram.

Figure 2

(a) Risk of bias graph. (b) Risk of bias summary for the included studies. Cao 2006 is the Ref. [65]; Chen 2005 is the Ref. [63]; Chen 2016 is the Ref. [37]; Chen 2020 is the Ref. [64]; Chen 2021 is the Ref. [62]; Cheng 2021 is the Ref. [61]; Crawford 2012 is the Ref. [35]; Dong 2013 is the Ref. [60]; Huang 2020 is the Ref. [59]; Huang 2022 is the Ref. [38]; Li 2010 is the Ref. [55]; Li 2017 is the Ref. [56]; Li 2020 is the Ref. [58]; Li 2022 is the Ref. [57]; Liang 2009 is the Ref. [46]; Liang 2016 is the Ref. [54]; Meng 2005 is the Ref. [53]; Montag 2014 is the Ref. [39]; Qiu 2017 is the Ref. [52]; Richardson 2007 is the Ref. [36]; Tong 2019 is the Ref. [51]; Utas-Akhan 2023 is the Ref. [40]; Wang 2005 is the Ref. [50]; Wang 2012 is the Ref. [49]; Wang 2020 is the Ref. [47]; Wang 2021 is the Ref. [48]; Xiong 2016 is the Ref. [45]; Xu 2022 is the Ref. [44]; You 2023 is the Ref. [43]; Yuan 2023 is the Ref. [42]; Zhou 2010 is the Ref. [41].

Figure 3

Forest plot of visual art therapy effects on positive symptoms in individuals with schizophrenia. Chen 2021 is the Ref. [62]; Crawford 2012 is the Ref. [35]; Dong 2013 is the Ref. [60]; Huang 2020 is the Ref. [59]; Huang 2022 is the Ref. [38]; Li 2010 is the Ref. [55]; Li 2017 is the Ref. [56]; Li 2020 is the Ref. [58]; Li 2022 is the Ref. [57]; Meng 2005 is the Ref. [53]; Montag 2014 is the Ref. [39]; Qiu 2017 is the Ref. [52]; Richardson 2007 is the Ref. [36]; Tong 2019 is the Ref. [51]; Utas-Akhan 2023 is the Ref. [40]; Wang 2005 is the Ref. [50]; Wang 2012 is the Ref. [49]; Wang 2020 is the Ref. [47]; Xiong 2016 is the Ref. [45]; Xu 2022 is the Ref. [44]; You 2023 is the Ref. [43]; Yuan 2023 is the Ref. [42]; Zhou 2010 is the Ref. [41].

Figure 4

Forest plot of visual art therapy effects on negative symptoms in individuals with schizophrenia. Chen 2005 is the Ref. [63]; Chen 2020 is the Ref. [64]; Cheng 2021 is the Ref. [61]; Crawford 2012 is the Ref. [35]; Dong 2013 is the Ref. [60]; Huang 2020 is the Ref. [59]; Huang 2022 is the Ref. [38]; Li 2010 is the Ref. [55]; Li 2017 is the Ref. [56]; Li 2020 is the Ref. [58]; Li 2022 is the Ref. [57]; Liang 2009 is the Ref. [46]; Meng 2005 is the Ref. [53]; Montag 2014 is the Ref. [39]; Qiu 2017 is the Ref. [52]; Richardson 2007 is the Ref. [36]; Tong 2019 is the Ref. [51]; Utas-Akhan 2023 is the Ref. [40]; Wang 2005 is the Ref. [50]; Wang 2020 is the Ref. [47]; Wang 2021 is the Ref. [48]; Xiong 2016 is the Ref. [45]; Xu 2022 is the Ref. [44]; You 2023 is the Ref. [43]; Yuan 2023 is the Ref. [42]; Zhou 2010 is the Ref. [41].

Figure 5

Forest plot of visual art therapy effects on depression in individuals with schizophrenia. Cao 2006 is the Ref. [65]; Chen 2021 is the Ref. [62]; Dong 2013 is the Ref. [60]; Huang 2022 is the Ref. [38]; Li 2010 is the Ref. [55]; Li 2020 is the Ref. [58]; Li 2022 is the Ref. [57]; Meng 2005 is the Ref. [53]; Montag 2014 is the Ref. [39]; Qiu 2017 is the Ref. [52]; Wang 2020 is the Ref. [47].

Figure 6

Forest plot of visual art therapy effects on anxiety in individuals with schizophrenia. Cao 2006 is the Ref. [65]; Chen 2016 is the Ref. [37]; Dong 2013 is the Ref. [60]; Huang 2022 is the Ref. [38]; Li 2020 is the Ref. [58]; Qiu 2017 is the Ref. [52].