Changes in depressive symptoms following the 3H psychosocial intervention among patients with noncommunicable diseases: A quasi-experimental study in Thailand

ABSTRACT Background: Depression commonly co-occurs with chronic non-communicable diseases (NCDs) and is associated with poorer treatment adherence, reduced quality of life, and increased healthcare burden. Although pharmacological and psychotherapeutic treatments are available, complementary psychosocial strategies may offer additional support for emotional regulation and psychological well-being. This study aimed to examine changes in depressive symptoms following participation in the 3H (Heal, Health, Heart) art-based psychosocial program among patients with chronic NCDs in Thailand. Materials and Methods: A quasi-experimental one-group pretest–posttest design was conducted with 40 participants. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) before and after a 12-week structured intervention consisting of mindfulness-oriented drawing, expressive art activities, and guided reflection. Quantitative data were analyzed using paired-samples t-tests, and qualitative observations described patterns of expressive engagement. Results: Depressive symptom scores were significantly lower following participation in the program [t(39) = 19.99, P < 0.001]. Qualitative findings indicated consistent engagement in creative expression and reflective dialogue. Conclusion: These results provide preliminary evidence of within-sample symptom change; however, given the quasi-experimental design without a control group, the findings should be interpreted cautiously. Further controlled studies are needed to determine causal relationships and evaluate long-term sustainability.