Abstract
Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama, and music modalities, are utilized internationally to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama, and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g., increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g., enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g., creative expression, aesthetic pleasure), cognitive (e.g., stimulation of memory), and social (e.g., increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research includes stronger focus on testing of processes and mechanisms.
Highlights
The number and proportion of older adults in the population has increased in virtually every country in the world over past decades, because of increased life expectancy and decreased fertility (United Nations Department of Economic Social Affairs Population Division, 2015)
Based on the processes identified in the literature, we propose that the mechanisms of a change for depressive symptoms through art interventions are: TABLE 2 | Results of analysis of dance movement intervention studies
Quality scores using PEDRO were evenly spread between 2 and 9 out of 11. Eleven of these studies were led by another professional; two by a leader of unknown training; and none by a dance movement therapist. This was despite several studies stating that the intervention was dance movement therapy, while providing no indication that a certified DM therapist was involved
Summary
The number and proportion of older adults in the population has increased in virtually every country in the world over past decades, because of increased life expectancy and decreased fertility (United Nations Department of Economic Social Affairs Population Division, 2015). Health issues impacting older adults are likely to make a significant contribution to the global health burden in coming decades (United Nations Department of Economic Social Affairs Population Division, 2017). Depression affects approximately 7% of the world’s older adults (World Health Organization, 2017a), with the highest rates in countries including Australia (10–15%) (National Ageing Research Institute, 2009) and USA (up to 27% with major depression and 31% with depressive symptoms) (Mental Health America, 2018). While prevalence is the same for both genders, functional disability causes by depression is greater for men (Forlani et al, 2014)
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