The effects of the arts and arts therapies on mental health outcomes of children and young people: a systematic review and meta-analysis

Background There is growing evidence on the positive effects of the arts and arts therapies for mental health (MH) outcomes. This review aims to fill a research gap by establishing the evidence on the effects of arts-based interventions on selected MH outcomes for children and young people (CYP). Methods Our systematic review and meta-analysis included randomised controlled trials with CYP aged 5–24 years receiving any type of arts-based intervention. Five databases (CINAHL, Embase.com, MEDLINE, PsycINFO, and Web of Science) were searched for studies published between 1/1/2005 and 18/5/2025. Two reviewers independently screened all records and assessed risk-of-bias using Cochrane Risk of Bias 2 (RoB2) and certainty using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were initially extracted using the AI-assisted review tool Elicit and independently verified by two reviewers. All data were pooled using random-effects meta-analysis, and effect estimates for MH outcomes are summarised as Standardised Mean Differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed using the I 2 statistic, with pre-specified subgroup and sensitivity analyses conducted to explore possible sources of inconsistency. This study is registered with PROSPERO (CRD420251015352). Findings One hundred trials across 29 countries involving CYP aged 5–24 years with a range of health conditions, alongside healthy populations, were included in this review. Based on studies with some concerns or high risk-of-bias, arts-based interventions were found to reduce individuals' depression (1.06 SMD lower [95% CI 0.45–1.67, n=1655, I 2 = 97%]), anxiety (0.75 SMD lower [95% CI 0.57–0.94, n=3898, I 2 = 87%]), and increase individuals' wellbeing (0.53 SMD higher [95% CI 0.26–0.80, n=538, I 2 = 49%]) and quality of life (0.54 SMD higher [95% CI 0.25–0.83, n=441, I 2 = 53%]) on average post-intervention. Certainty of results relating to wellbeing and quality of life was low due to imprecision and concerns about risk of bias, and very low for depression and anxiety due to additional inconsistency associated with high heterogeneity. Findings relating to anxiety were further supported by biomarker data (blood pressure and heart rate) with moderate certainty. Interpretation This systematic review provides a comprehensive synthesis of evidence from randomised controlled trials assessing the effects of a wide variety arts-based interventions on the mental health of CYP. Although the strength of any conclusions is limited by heterogeneity, imprecision and bias of the studies assessed, average effects were similar to those typically reported for established non-arts-based psychosocial interventions, including talking therapies. These findings advance our understanding of arts-based therapeutic strategies for CYP's MH. Further high-quality trials, with larger sample sizes and standardised outcome measures and timepoints, are needed to improve the certainty of evidence in this area. Funding UKRI.