Wigham Sarah, Watts Patricia, Zubala Ania, Jandial Sharmila, Bourne Jane, Hackett Simon
Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Teapot Trust, Edinburgh, United Kingdom.
Front Psychol. 2020 Sep 25;11:1771. doi: 10.3389/fpsyg.2020.01771. eCollection 2020.
Children with physical health long-term conditions (LTCs) have increased risk of mental health difficulties relative to healthy peers. However, availability of psychological support integrated into pediatric physical health settings is limited, and there are long waiting times for access to child mental health services. Arts-based therapies involve using creative media to develop a therapeutic relationship, and offer a potential alternative to talking-based therapies. The aim of this systematic review is to establish the effectiveness of arts-based therapies for improving the mental health of children with physical health LTCs. The review protocol was published on PROSPERO. Four electronic databases were searched (Medline, Embase, Cinahl, and PsycINFO), plus hand searches of two key journals and relevant reviews, and forward/back citations searches of selected articles were conducted. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess bias in selected articles. Second reviewers completed 10% of article screening and 20% of bias assessments. The findings were synthesized narratively. Sixteen studies met inclusion criteria and demonstrated some improvements on indicators of mental health and well-being including quality of life, coping behaviors, anxiety, self-concept, and mood. However, replication across interventions and outcomes was absent. Overall, the quality of evidence of effectiveness in the studies reviewed was moderate/weak. This was due to bias in study design; other limitations included a lack of detail on intervention components, e.g., use of a manual, and single recruitment sites. The heterogeneity of existing research evaluating arts-based therapies for children with physical health LTCs limits conclusions about effectiveness. Suggestions are made to inform the design of future research studies to help build a robust evidence base.
患有长期身体健康问题（LTCs）的儿童相对于健康同龄人而言，出现心理健康问题的风险更高。然而，儿科身体健康机构中整合的心理支持服务有限，且获得儿童心理健康服务的等待时间很长。基于艺术的疗法涉及利用创意媒介建立治疗关系，并为基于谈话的疗法提供了一种潜在的替代方案。本系统评价的目的是确定基于艺术的疗法对改善患有长期身体健康问题儿童心理健康状况的有效性。该评价方案已在国际前瞻性系统评价注册库（PROSPERO）上发表。检索了四个电子数据库（医学索引数据库、荷兰医学文摘数据库、护理学与健康领域数据库和心理学文摘数据库），另外还对手检了两份关键期刊及相关综述，并对所选文章进行了前后向引文检索。使用有效公共卫生实践项目（EPHPP）质量评估工具来评估所选文章中的偏倚。第二位评审员完成了10%的文章筛选和20%的偏倚评估。研究结果采用叙述性综合分析。十六项研究符合纳入标准，并在心理健康和幸福感指标（包括生活质量、应对行为、焦虑、自我概念和情绪）方面显示出一些改善。然而，干预措施和结果之间缺乏重复性。总体而言，所综述研究中有效性证据的质量为中等/较弱。这是由于研究设计中的偏倚；其他局限性包括干预组成部分（如使用手册）缺乏细节，以及单一招募地点。现有针对患有长期身体健康问题儿童的基于艺术疗法的研究异质性限制了关于有效性的结论。本文提出了一些建议，为未来研究的设计提供参考，以帮助建立一个可靠的证据基础。
