Background Depression and anxiety are common related mental health conditions associated with a profound impact on an individual’s health, wellbeing and social functioning, and impose a significant societal burden. There has been increasing interest in the potential benefit of the arts as a therapeutic medium in depression and anxiety. Previous reviews have focused on particular artistic modalities as well as secondary depression. This systematic review examined the potential benefit of all group-based performing arts interventions for primary anxiety and/or depression.

Methods In order to systematically evaluate the benefit of arts interventions in anxiety and depression, searches on MEDLINE, EMBASE and Web of Science were performed in February 2022. Google Scholar searches and citation chasing were conducted. Included studies used any quantitative design to assess the benefit of any active group-based arts intervention on depression and/or anxiety symptom severity, wellbeing, quality of life, functional communication or social participation in people with primary anxiety and/or depression. Following standardised duplicate screening and data extraction, data synthesis was conducted using thematic narrative synthesis. Risk of bias was evaluated using SURE checklists (Cardiff University).

Results Searches identified a total of 56,059 unique database records plus 18 additional records from supplementary searches. A total of 171 records were reviewed at the full-text stage and 12 publications (each a unique study) were included in the review. Dance was the most studied artistic modality (5 studies), followed by art therapy (3 studies), music therapy (2 studies), martial arts and theatre (1 study each). The evidence consistently favoured a benefit for artistic interventions for most outcomes, although there were no studies assessing functional communication. The evidence was strongest for the outcome depression and/or anxiety symptoms and weakest for quality of life. There were no studies directly comparing different arts interventions and 3 studies lacked a control arm. Risk of bias assessment showed that studies were generally of reasonable quality, but there were concerns including around consistency and representativeness of sampling frames and sufficient sample size.

Discussion Arts interventions may offer benefit in anxiety and depression. However, a substantial limitation of the evidence base is the lack of studies directly comparing different artistic modalities as opposed to comparing an artistic intervention against standard of care. Moreover, not all outcome domains were assessed for all artistic modalities. Therefore, further research is required to determine which artistic modalities are most beneficial for which specific outcomes.