Effectiveness of art therapy practices in children and adolescents with chronic diseases: Systematic review and meta-analysis

This systematic review and meta-analysis aim to evaluate the impact of art therapy applications on the quality of life, anxiety, pain, and depression levels in children and adolescents with chronic illnesses. Databases including Google Scholar, APA PsycNet, Cochrane Library, CINAHL, EBSCOHost, ERIC, Medline, PsycINFO, PsycARTICLES, PsycBOOKS, PubMed, ProQuest, ScienceDirect, Springer Link, ULAKBIM, YÖKTEZ, and Web of Science were systematically searched, resulting in 2352 records from studies conducted between 2000 and 2023. Of these, 12 randomized controlled trials with 584 participants aged 0-18 were included in the analysis. The effectiveness of art therapy in the included studies was calculated using the Hedges' g effect size value, and a meta-analysis based on standardized mean differences was performed using the random effects model in R and R Studio programs. Effect sizes, heterogeneity, sensitivity, and publication bias evaluations were conducted for each variable. Two separate assessments for quality of life were conducted based on parent and child scales. The quality of the studies was assessed using the Cochran Risk of Bias 2 (RoB2) tool. Moderator variables influencing effect sizes were examined through subgroup and meta-regression analyses. The results indicated that art therapy had a moderate and significant effect on the quality of life evaluated from the perspective of children and adolescents (Hedges' g = .40, 95% CI [0.27; 0.53], p = .001). A positive but not statistically significant effect was observed on the quality of life based on parent evaluations (Hedges' g = .43, 95% CI [-.03; 1.20], p = .21). The differences in child-parent perspectives were discussed from clinical and methodological viewpoints. Art therapy was found to have a statistically significant and large effect on pain levels (Hedges' g = -.63, 95% CI [-1.19; -0.07], p = .03). There was a positive but not significant effect on anxiety levels (Hedges' g = -.71, 95% CI [-2.24; 0.82], p = .23). Due to insufficient studies on the depression variable, no analysis was conducted. Sources of heterogeneity for quality of life and anxiety were investigated and discussed. Publication bias evaluations revealed no significant publication bias in the meta-analysis findings. The findings suggest that art therapy could be a potential tool for improving the quality of life and reducing pain levels in children and adolescents with chronic illnesses. These results have implications for clinical applications and future research. However, due to limitations such as the small number of studies in the field, high levels of heterogeneity, and risk ratios of the studies to evaluate this potential effect better further research is needed.