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Culture,SportandWellbeingEvidenceProgramme

SystematicReview#3Protocol

VisualArts,MentalHealthandWellbeing

SR#3Team(inalphabeticalorder):DrKerryBall,ProfessorNormaDaykin,ProfessorPaulDolan,Ms.LilyGrigsby-Duffy,DrAlistairJohn,ProfessorGuyJulier,ProfessorTessKay,Mr.JackLane,DrLouiseMansfield,ProfessorCatherineMeads,DrChristineTapson,Mr.StefanoTestoni,ProfessorAlanTomlinson,ProfessorChristinaVictor

Background

Theaimofthissystematicreviewistoevaluatethesubjectivewellbeingoutcomesofvisualartsinterventionsforadults(“working-age”,15-64years),whohavebeendiagnosedwithamentalhealthcondition.

Mentalhealthconditionsrepresentalmost50%ofallillnessesinpeopleyoungerthan65years(Uttleyetal.,2015).Whilstmentalhealthproblemsaccountforahighdegreeofsickness,theNHSbudgettotreatpeoplewithmentalillnessisrelativelymodest,andthecosts(fromunemployment,sickleave,crime,etc.)andimpactofmentalillnessonanindividualandcommunitylevelaresignificant.TheOrganisationforEconomicCo-operationandDevelopment(OECD)estimatedthat-in2015–mentalhealthproblemscosttheUKeconomyapproximately£80billion(Nayloretal.,2016).Therefore,theNHShascomeunderincreasingpressuretoinitiatecost-effectivealternativestobettermanagetheneedsofpeoplesufferingfrommentalhealthconditions(Uttleyetal.,2015).ItisprogressivelyrecognisedthatvisualartsprojectscanreducetheburdenontheNHS(White,2004),byencouragingcommunityrelationshipsandprovidingskillsthatincreasepersonalexpressionandcontrol(Malleyetal.,2002).AsProfessorMichaelMarmotpointsout,thedegreetowhichpeopleareabletoparticipateintheircommunityandexercisecontrolovertheirownlives,providesa‘criticalcontributiontopsychosocialwell-beingandhealth’(Foot,2012:3).

Thenotionthatarts-basedinitiativescanbebeneficialforwellbeingandmentalhealthisincreasinglyacknowledged,withagrowingevidencebasereinforcinganecdotalclaims(Clift,2012).Visualartsinterventionshavebeenshowntoreduceanxietyandimprovemood(BellandRobins,2007),enhanceself-reportedhealth(Johanssonetal.,2001),promotepersonalgrowththroughskillacquisitionandimproveself-esteemandqualityoflife(Hackingetal.,

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2006),andpreventre-admissiontopsychiatrichospitals(White,2004).Inclinicalhealthcare,peoplearecommonlyregardedaspatients(Smith,2002),whereasinarts-basedinitiatives,peoplecanbecomeartistswithgenuinecontroloverwhattheyaredoingorcreating(ArgyleandBolton,2005).ArgyleandBolton(2005)foundthatpracticalinvolvementinvisualartsprovidedarangeofhealthandwellbeingbenefitsforvulnerableandmentallyillparticipants.Theyalsohighlighttherelativelylowcostofadministeringsomethingsimple,suchasadrawinggroup,whichcanhaveahighlyvaluableoutcomeforpeopleandcommunities(ArgyleandBolton,2005).

Previousevidencereviewsinthisfieldhavefocussedon;thewellbeingandmentalhealthbenefitsofartsattendanceandparticipation(Jindal-Snapeetal.,2014);theclinicaleffectivenessandcost-effectivenessofarttherapyforthosewithnon-psychoticmentalhealthconditions(Uttleyetal.,2015);thewellbeingoutcomesofparticipatoryartsforolderadults(Castora-Binkleyetal.,2010);thetherapeuticbenefitsofcreativeactivitiesonmentalwellbeing(Leckey,2011);andtheimpactofart,designandenvironmentinamentalhealthcaresetting(Daykinetal.,2008).Theevidenceintheaforementionedreviewsgenerallypointstopositivewellbeingoutcomesforparticipantsinvolvedinvisual/creativeartinterventionsandprojects.However,itiswidelyacknowledgedthatasubstantialdegreeofevidencesupportingtheseclaimslacksreliabilityandvalidity,andisindistinctintheclarityofkeyterms,suchasmentalhealthandwellbeing(Leckey,2011).Whilstvisualartsinterventionsareincreasinglyunderstoodasapublichealthresource,whichcansupporthealthandwellbeing,thereneedstobeahigherlevelofrobustandcriticalevidenceoftheireffectiveness,outcomesandrealcosts(PublicHealthEngland,2016).Systematicreviewsplayacrucialroleingatheringandextractingmeaningfulandinfluentialevidence,butareequallyvaluableinlocatinggapsinresearch,exposingmethodologicalinadequacies(andtriumphs)andidentifyingfuture,morerigorous,researchobjectives.

Toourknowledge,thisisthefirstsystematicreviewtospecificallyfocusonthesubjectivewellbeingoutcomesassociatedwithvisualartsparticipationforworkingageadults(15-64years)whohavebeendiagnosedwithamentalhealthcondition.

Title

Asystematicreviewofthewellbeingoutcomesofvisualartsforadults(“working-age”,15-64years)withmentalhealthconditions,andoftheprocessesbywhichwellbeingoutcomesareachieved.

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ResearchQuestions1.Whatarethesubjectivewellbeingoutcomesofengagingwith(takingpartin,performing,viewing)visualartsforadults(“working-age’,15-64years)withdiagnosedmentalhealthconditions?

2.Whataretheprocessesbywhichthesubjectivewellbeingoutcomesareachieved?

Criteriaforconsideringreviewsforinclusion

Population/typesofparticipants

Adults(“working-age”,15-64years)withadiagnosedmentalhealthcondition,butexcludingdementia.Thepopulationwillincludeanygrouporindividualtakingpartin,performingorviewingvisualarts,butnotaspaidprofessionalartists.WewillincludestudiesfromcountrieseconomicallysimilartotheUK.

Typesofinterventions

Focusonparticipatoryvisualartinterventionsincludingmaking,viewingandperforming.Thiswillexcludearttherapyforclinicaloutcomesbutwillincludearts-basedwellbeinginterventionsofferedbyarangeofprofessionalsandvolunteers.Wewillalsoexcludeevidencerelatingtopaidprofessionalartistsandclinicalproceduressuchassurgery,medicaltestsanddiagnostics.

Comparison

Novisualartinterventionorusualroutine/care,i.e.aninactivecomparatororhistorical/time-basedcomparator,andincludingstudieswithanalternativeinterventionasthecomparator/comparisongroup(forinstance,sportordramaintervention).

Typesofoutcomemeasure

Includedstudiesmusthavemeasuredwellbeing.Studieswillneedtohavemeasuredsubjectivewellbeingusinganyrecognisedmethodormeasure.

Forthehealtheconomiccomponentkeyoutcomesaretheoutputsfromcost,cost-utility,cost-effectiveness,cost-benefitandcost-consequenceanalyses.

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Typesofstudies/studydesign

Empiricalresearch:quantitative,qualitativeormixedmethods,outcomesorprocessevaluations,andpublishedfrom2007-2017,willbeincluded.Greyliteratureandpracticesurveyspublishedfrom2014willbeincluded.Discussionarticles,commentariesoropinionpiecesnotpresentingempiricalortheoreticalresearchwillbeexcluded.

Searchmethodsforidentificationofreviews

Electronicsearches

Electronicdatabaseswillbesearchedusingacombinationofcontrolledvocabulary(MeSH)andfreetextterms.Searchtermswillbeincorporatedtotargetempiricalevidenceonvisualarts,mentalhealthandwellbeing.Wewillincorporatespecificfilterstoidentifyhealtheconomicevaluations.TheOVIDMEDLINEsearchstrategycanbefoundbelow.Alldatabasesearcheswillbebasedonthisstrategybutwillbeappropriatelyrevisedtosuiteachdatabase.Thefollowingdatabaseswillbesearchedfrom2007-2017:

• PsychInfo• OVIDMEDLINE• Eric• ArtsandHumanitiesCitationIndex(WebofScience)• SocialScienceCitationIndex(WebofScience)• ScienceCitationIndex(WebofScience)• Scopus• PILOTS• CINAHL• InternationalIndextoPerformingArts(IIPA)

Forthereviewofhealtheconomicevaluationswewillseparatelysearchthefollowingdatabases:

• OVIDMEDLINE• Scopus• CINAHL• NHSEED(NHSEconomicEvaluationDatabase)• HTATechnologyAssessment)database

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Searchingothersources

Thereferencelistsofallrelevantsystematicreviewsfromthelast5yearswillbehand-searchedtoattempttoidentifyadditionalrelevantempiricalevidence.Asearchof‘greyliterature’willbeconductedviaanonlinecallforevidence.Greyliteraturewillbeincludedifitisafinalevaluationorreportincorporatingempiricaldata,hastheevaluationofavisualartsinterventionasthecentralobjective,waspublishedbetween2014-2017,andincludesdetailsofauthors(individuals,groupsororganisations).

Identificationofstudiesforinclusion

Searchresultswillbe independentlycheckedbytwooverviewauthorsandeligiblestudieswillbeincluded.Initiallythetitlesandabstractsofidentifiedstudieswillbereviewed.Ifitisclearfromthetitleandabstractthatthestudydoesnotmeettheinclusioncriteriaitwillbeexcluded.Where it isnotclearfromthetitleandabstractwhetherastudy isrelevantthefull article will be checked to confirm its eligibility. The selection criteria will beindependently applied to the full papers of identified reviews by two overview authors.Where two independent reviewers do not agree in their primary judgements they willdiscuss the conflict and attempt to reach a consensus. If they cannot agree then a thirdmember of the review teamwill consider the title and amajority decisionwill bemade.Studiesinanylanguagewillbeincluded.

Datacollectionandanalysis

Dataextractionandmanagement

Datawillbeextractedindependentlybytwooverviewauthorsusingastandardisedform.Anydiscrepancieswillberesolvedbyconsensus.Whereagreementcannotbereached,athirdoverviewauthorwillconsiderthepaperandamajoritydecisionwillbereached.

Forquantitativeevidenceofinterventioneffectiveness,thedataextractionformwillincludethefollowingdetails:

• Evaluationdesignandobjectives(theinterventionsstudiedandcontrolconditionsused,includingdetailwhereavailableontheinterventioncontent,doseandadherence,andethics)

• Sample(size,eligibilitycriteria,representativeness,reportingondrop-out,attritionanddetailsofparticipantsincludingdemographicsandprotectedcharacteristics)

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• Theoutcomemeasures(independence,validity,reliability,appropriatenesstowellbeingimpactquestions)

• Analysis(assessmentofthemethodologicalquality/riskofbias)• Resultsandconclusionsrelatingtorelevantobjectives• Thepresenceofpossibleconflictsofinterestforauthors/fundingbodies

Forqualitativeevidenceofinterventioneffectivenessthedataextractionformwillincludethefollowingdetails:

• Researchdesignandobjectives(interpretive,examiningsubjectiveexperiencesofparticipants,ethics)

• Datacollection(type/form,appropriateness,recording,theoreticaljustification)• Participants(numbersanddetailsincludingdemographic,recruitmentstrategy,

theoreticaljustification)• Analysis(rigor,assessmentofmethodologicalquality,identificationof

bias/involvementofresearcher,attributionofdatatorespondents,theoreticaljustification,relevancetowellbeingimpactquestion)

Forhealtheconomicstudieswewillextractthefollowingadditionalinformation:

• Includedstudydesigns,analyticmethods,perspective,timehorizon,discountrate• Typeofsensitivityanalysisundertaken• Typeandsourcesofdatauseforresourceuseandcosts,reportingfiguresforcosts;• Methodsofpreferenceelicitation(e.g.contingentvaluation,revealedpreferences,

trade-offmethods),reportingestimatesofpreferencevalues• MainresultsincludingspecifiedtypesofICERs(e.g.healthserviceorsocietal

perspective)• Mainhealtheconomicconclusionsofthereview

Wewillcontacttheauthorsofarticlesintheeventthattherequiredinformationcannotbeextractedfromthestudiesandisessentialforinterpretationoftheirresults.

Assessmentofmethodologicalqualityofincludedstudies

WewillusethequalitychecklistsandstandardapproachesforassessingqualityofincludedstudiesforquantitativeandqualitativestudiesdetailedintheWhatWorksCentreforWellbeingmethodsguide;andforeconomicevaluationsuseTheDrummondChecklist(1996)toassessthemethodologicalqualityofthestudies.

Includedstudiesarelikelytohaveassessedthemethodologicalquality/riskofbiasinavarietyofways.Wewillusethejudgementsmadebytheauthorsofstudiesregardingthe

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qualityofevidence/riskofbiasandreportitwithinthecontextofourassessmentofthequalityofastudyitself.

Datasynthesis

Wewilltabulatesummariesofthecharacteristicsoftheincludedstudies.

Theprecisefindingspresentedwillprimarilybedeterminedbythecontentoftheincludedstudies.Wewillpresenteffectsizesusingappropriatemetricsincludingestimatesofprecision.Datawillbegroupedaccordingtovisualartinterventiontypeandwellbeingoutcomes.Wewillreportonprocessesbywhichinterventionsworkanddonotwork,forwhomandinwhatcontextsinenhancingwellbeing.Importantlimitationswithintheevidencebasewillbepresentedanddiscussed.Wewillconsiderthepossibleinfluenceofpublication/smallstudybiasesonstudyfindings.WhereincludedstudieshavenotratedthequalityofthebodyofevidencewewillapplytheGRADEapproachforkeyfindings.

Forhealtheconomicevidencewewillsummarisethestudydesigns,analyticmethods,perspective,timehorizon,discountrate,typeofsensitivityanalysisundertaken,typeandsourcesofdatauseforresourceuseandcosts,reportingfiguresforcosts,methodsandresultsofpreferenceelicitation,mainresultsincludingspecifiedtypesofICERs(e.g.healthserviceorsocietalperspectivewithandwithouthealthcaresavings)andmainhealtheconomicconclusionsofthereview.

DemonstrationSearchStrategy(OVIDMEDLINE)

1. MeSHdescriptor:[wellbeing]2. well-being3. wellbeing4. “visualart*”.mp5. drawing.mp6. painting.mp7. sculpture.mp8. craft*.mp9. handicraft.mp10. ceramics.mp11. pottery.mp12. printmaking.mp13. knitting.mp14. woodwork.mp15. textiles.mp16. tapestry.mp17. dressmaking.mp18. “clothesmaking”.mp

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19. upholstery.mp20. crochet*.mp21. illustration.mp22. photography.mp23. video.mp24. filmmaking.mp25. “movingimage”.mp26. animation.mp27. “computergames”.mp28. “digitalart”.mp29. “internetart”.mp30. “performanceart”.mp31. “communityart”.mp32. “bodypainting”.mp33. “bodyart”.mp34. “facepainting”.mp35. graffiti.mp36. “streetart”.mp37. “publicart”.mp38. “urbandesign”.mp39. “landscapearchitecture”.mp40. “participatoryart”.mp41. gardening.mp42. “landart”.mp43. “interiordesign”.mp44. “interiordecoration”.mp45. “graphicdesign”.mp46. (1or2or3)and(4or5or6or7or8or9or10or11or12or13or14or15or16or

17or18,or19or20or21or22or23or24or25or26or27or28or29or30or31or32or33or34or35or36or37or38or39or40or41or42or43or44or45)

47. “mentalhealth”.mp48. “mentalillness”.mp49. anxiety.mp50. phobias.mp51. “mooddisorders”.mp52. depression.mp53. bipolar.mp54. “postnataldepression”.mp55. “seasonalaffectivedisorder”.mp56. mania.mp57. hypomania.mp58. “obsessivecompulsivedisorder”.mp

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59. “psychoticdisorders”.mp60. schizophrenia.mp61. hallucinations.mp62. delusions.mp63. paranoia.mp64. “splitpersonality”.mp65. “personalitydisorder”.mp66. “dissociativeidentitydisorder”.mp67. stress.mp68. psychosis.mp69. “panicdisorder”.mp70. “panicattacks”.mp71. addiction.mp72. “substanceabuse”.mp73. “eatingdisorder”.mp74. anorexia.mp75. bulimia.mp76. “bingeeating”.mp77. “bodydysmorphicdisorder”.mp78. “posttraumaticstressdisorder”.mp79. “ticdisorders”.mp80. “qualityoflife”.mp81. self-esteem.mp82. loneliness.mp83. “lifeadjsatisfaction”.mp84. happiness.mp85. worthwhileness.mp86. anxiety.mp87. (46)and(47or48or49or50or51or52or53or54or55or56or57or58or59or

60or61or62or63or64or65or66or67or68or69or70or71or72or73or74or75or76or77or78or79)and(80or81or82or83or84or85or86)

88. limittohumans,peerreviewedarticles,agerange15-64.

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References

Argyle,E.Bolton,G.(2005)Artinthecommunityforpotentiallyvulnerablementalhealthgroups.HealthEducation,105(5),pp.340–354.

Bell,C.Robins,S.(2007)EffectofArtProductiononNegativeMood:ARandomized,ControlledTrial.ArtTherapy:JournaloftheAmericanArtTherapyAssociation,24(2)pp.71-75.

Castora-Binkley,M.Noelker,L.Prohaska,T.Satariano,W.(2010)ImpactofArtsParticipationonHealthOutcomesforOlderAdults.JournalofAging,Humanities,andtheArts,4(4),pp.352–367.

Clift,S.(2012)Creativeartsasapublichealthresource:movingfrompractice-basedresearchtoevidence-basedpractice.PerspectivesinPublicHealth,132(3),pp.120-127.

Daykin,N.Byrne,E.Soteriou,T.O’Connor,S.(2008)Review:TheImpactofArt,DesignandEnvironmentinMentalHealthcare:asystematicreviewoftheliterature.TheJournaloftheRoyalSocietyforthePromotionofHealth,128(2),pp.85–94.

Foot,J.(2012)Whatmakesushealthy?Theassetapproachinpractice:evidence,action,evaluation.[Online]Availableat:www.assetbasedconsulting.co.uk/Publications.aspx(accessedMarch,2017).

Hacking,S.Secker,J.Kent,L.Shenton,J.Spandler,H.(2006)Mentalhealthandartsparticipation:thestateoftheartinEngland.TheJournalofTheRoyalSocietyofthePromotionofHealth,126(3),121–127.

Jindal-Snape,D.Morris,J.Kroll,T.Scott,R.etal.(2014)Theimpactofartattendanceandparticipationonhealthandwellbeing:Systematicliteraturereview.GlasgowCentreforPopulationHealth:Glasgow.

Johansson,S.Konlaan,B.Bygren,L.(2001)Sustaininghabitsofattendingculturaleventsandmaintenanceofhealth:Alongitudinalstudy.HealthPromotionInternational,16(3),pp.229–234.

Leckey,J.(2011)Thetherapeuticeffectivenessofcreativeactivitiesonmentalwell-being:asystematicreviewoftheliterature.JournalofPsychiatricandMentalHealthNursing,18(6),pp.501-509.

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Malley,S.Datillo,J.Gast,D.(2002)Effectsofvisualartsinstructiononthementalhealthofadultswithmentalretardationandmentalillness.MentalRetardation,40(4),pp.278-96.

Naylor,C.Das,P.Ross,S.Honeyman,M.Thompson,J.Gilburt,H.(2016)BringingtogetherphysicalandmentalhealthAnewfrontierforintegratedcare.[Online]Availableat:https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Bringing-together-Kings-Fund-March-2016_1.pdf(accessedMarch2017).

PublicHealthEngland(2016)Artsforhealthandwellbeing:Anevaluationframework.[Online]Availableat:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/496230/PHE_Arts_and_Health_Evaluation_FINAL.pdf(accessedMarch2017).

Uttley,L.Scope,A.Stevenson,M.Rawdin,A.Taylor,E.Sutton,A.etal.(2015)Systematicreviewandeconomicmodellingoftheclinicaleffectivenessandcost-effectivenessofarttherapyamongpeoplewithnon-psychoticmentalhealthdisorders.HealthTechnologyAssess,19(18).

White,M.(2004)‘Artsinmentalhealthforsocialinclusion:towardsaframeworkforprogrammeevaluation’,inCowling,J.(Ed.),ForArt’sSake:SocietyandtheArtsinthe21stCentury,InstituteofPublicPolicyResearch:London.

4thApril2017