ABSTRACT
Objective
To evaluate the effectiveness of art therapy in improving depressive and anxiety symptoms among adults with depression.
Design
A systematic review and meta-analysis.
Methods
Seven databases were searched from inception to November 14, 2025. Randomized controlled trials (RCTs) and quasi-experimental studies evaluating art therapy for adults with clinically diagnosed or screened depression were included. Two reviewers independently performed study selection, data extraction and quality assessment using Cochrane Risk of Bias 2.0 (RoB 2.0) and the Joanna Briggs Institute (JBI) checklist. Standardized mean differences (SMDs) were pooled using random-effects models, with subgroup and sensitivity analyses conducted to explore heterogeneity.
Results
Fourteen studies (861 participants) were included in the systematic review, and 13 contributed data to the meta-analysis. Art therapy produced a significant reduction in depressive symptoms compared with control conditions (SMD = −0.69, 95% CI: −1.04 to −0.35; z = 3.92, p < 0.001). Effects on anxiety symptoms were small and not statistically significant. Exploratory subgroup analyses suggested larger effects in older adults, interventions lasting > 6 weeks, story therapy, individual formats and community settings. However, substantial heterogeneity and the inclusion of trials at risk of bias warrant cautious interpretation. Sensitivity analyses indicated stable results across model specifications.
Conclusion
Art therapy appears to be a promising intervention for improving depressive symptoms among adults with depression. In contrast, the result regarding anxiety outcomes is limited, with only three studies contributing data. High-quality studies with large samples, multiple centres and long follow-up durations should be performed to further reliably assess the treatment effects.
Trial Registration
PROSPERO registration number: CRD420251229306