The impact of creative arts-based interventions for mental health in conflict-affected contexts: A systematic narrative review

In conflict-affected contexts, mental health interventions utilising creative arts methods are increasingly common. However, there is limited information on the effectiveness of these interventions. Building towards an evidence-base, this systematic narrative review applies a realist lens to explore where, for whom, and how arts-based interventions impact mental health in conflict-affected contexts. Academic studies were retrieved from 4 databases: 1) Web of Science, 2) OVID PsycInfo, 3) OVID Global Health, and 4) SCOPUS. 24 papers were included after screening and quality appraisal. Following extraction, studies were categorised according to impact. This was conceptualised as the author-stated results of the study in relation to the study aims and outcomes. Results showed that 20/24 (83.33%) studies had a positive impact on participant mental health. This suggests that arts-based interventions (ABIs), generally, can be effective in a wide range of contexts. However, the results of the review were limited by the range in context, population, methodology, and evaluation methods of each study. Given this variation, there were few conclusive results as to why certain interventions were effective or not, particularly due to a lack of attention to mechanisms of change within interventions. However, limited evidence suggests that Participatory Action Research (PAR) or otherwise high levels of participation from affected populations in intervention development, implementation, and evaluation may improve study outcomes. Evidence also weakly suggests that structured school-based interventions utilising resilience frameworks or structured dance-movement and music therapies may be more impactful. However, results are inconclusive and heavily influenced by gender, age, contexts of ongoing conflict or distress, and exposure to trauma. Accordingly, we recommend further research build from this review, focusing more narrowly on specific intervention typologies or theoretical approaches. Relatedly, we recommend realist, process, or formative evaluation designs be used within all future studies, regardless of methodology, to better understand mechanisms of change. • Arts-based interventions (ABIs) are broadly effective for the improvement of mental health in conflict-affected contexts, with particularly strong evidence for children and adolescent populations. However, impact is mediated by intervention and context-specific variables such as gender, ongoing violence, or age. • Limited evidence showed that interventions with high amounts of participation from affected populations during design, implementation, and/or evaluation may be more impactful. Investing in deeply participatory research and interventions may provide better results. However, more research is needed. • The results of this review are limited by a lack of evaluation designs that consider the mechanisms of change or mediators of impact within interventions. Further research is required in this area. • Most studies focus on children under age 16. Further research is needed with populations otherwise under-represented here, including older adults (60+), youth (16 – 26), and LGBTQ+ communities.