Experiences and impacts of visual art-based interventions on perinatal well-being: an integrative review

Figures & data

Table 1. Inclusion and exclusion criteria.

	Inclusion	Exclusion	Search terms
Population	Pregnant women and/or parents of infants under the age of 2	Parents with children above the age of 2, other caregivers (e.g. grandparents)	maternal OR paternal OR parent OR mother or father AND perinatal OR antenatal OR pregnan OR post-partum OR postpartum OR postnatal
Exposure	Art therapy and visual art-based interventions	Other forms of arts therapy (e.g. dance, music), multi-modal interventions where art-based activities are not exclusively used	‘Art Therap*’ OR ‘Arts-based program*’ OR ‘Art* on prescription’ OR ‘Creative Art*’ OR ‘Arts for wellbeing’ OR ‘art workshop’ or ‘art session’ OR art
Outcome	Experiences, perspectives and impacts on mental health and well-being (e.g. self-esteem, self-efficacy, loneliness, depression, anxiety etc.)	Impacts other than parental mental health and well-being
Study design	Any empirical studies using qualitative, quantitative or mixed-methods design	Grey literature reports, editorials, commentaries, reviews, protocols, conference abstracts, books and book chapters, and dissertation/thesis
Language	English	Languages other than English
Publication dates	No date restrictions

Table 2. Quality assessment grading criteria.

Grade	Description
A	No, or few flaws. The study credibility, transferability, dependability, and confirmability are high
B	Some flaws, unlikely to affect the credibility, transferability, dependability and/or confirmability of the study
C	Some flaws that may affect the credibility, transferability, dependability and/or confirmability of the study
D	Significant flaws that are very likely to affect the credibility, transferability, dependability and/or confirmability of the study

Figure 1. Prospero flow chart.

Table 3. Descriptive summary of studies.

Author and Year	Country	Aim of study	N	Children’s ages	Participants	Details of Intervention	Type of visual art-based intervention and summary of key findings	Quality appraisal rating
Bruce and Hackett (2021)	UK	Introduction of art therapy in an NHS perinatal parent-infant mental health outpatient facility	9	0–10 mths	Mothers (2 antenatal and 7 postnatal)	One day a week over 6 months: Yoga-based mindful exercises, art and drawing tasks, reflection, affirmation of outcomes	Art therapy. Three quarters of mothers perceived art therapy as helping self-understanding of their problems, reducing social ioslation and half reported positive mood changes after initial consultation, at 5 and 6 weeks later. Three of 8 mothers saw improved relationships with their babies.	B-
Jalambadani et al. (2019)	Iran	Examine the effect of mindfulness-based art therapy (MBAT) in decreasing stress and improving lifestyle	84	Not applicable	Pregnant women, mothers of infants admitted to NICU	90 min once a wk. for 10 wks and 10 sessions-making of art products	Art therapy. Mindfulness based art therapy (MBAT). Preliminary support that MBAT can decrease stress levels, and improve lifestyle and relationships.	C-
Jouybari et al. (2018)	Iran	Examine the effect of narrative writing or art therapy on maternal stress	105	33–35 wks	Mothers of premature infants (born before 38 wks)	Performing narrative writing or art therapy for at least 3 times during 5 days	Art therapy narrative writing and art therapy had no effect on maternal stress. Significant difference in infant behaviour and appearance before the intervention but no significant difference after the intervention.	B
Moriarty et al. (2022)	UK	Acceptability and feasibility of a group-based art-therapy painting intervention	4	2 wks–1 yr.	Mothers with mild-moderate depression	12-week painting group	Art therapy.Building good relationships between mothers and interventionists as vital to allow successful delivery. Mothers reported that this gave them confidence, encouraged attendance, and highly valued opportunities to socialise with parents with shared experiences, with these relationships continued outside the sessions. Some women requested receiving further information about the group in advance.	B
Perry et al. (2008)	UK	Explore and evaluate the extent to which the brief intervention of creative arts was able to support women	9	Under 2 yrs.	Mothers with mild to moderate postnatal depression or anxiety	8 weekly one-and-a-half-hour sessions: Card making, creative writing and music	Creative arts. The intervention provided space and a supportive, relaxed, and creative environment for women experiencing postnatal depression/anxiety and raised women’s self-esteem and confidence. Women could struggle to share their experiences with others who had different realities, were disappointed about the lack of opportunities to continue social relationships and reported enhanced social isolation.	B
Ponteri (2001)	USA	Examine the effect of group art therapy on maternal self-image and self-esteem and quality of interactions between mother and child	4	6–24 mths	Mother-child pairs	8 consecutive weeks of 90-minute sessions with a 2-week break	Art therapy. All parents reported learning new coping strategies and felt more confident. Mixed results in relation to mother and child relationships. Feelings of positive self-esteem were generally not retained after the group sessions ended.	B
Swan-foster (1989)	USA	Impact of art therapy on imagery of experiences and sense of self	3	Not applicable	Pregnant women	Self-portraits	Art therapy. The use of self-portraits helped mother to connected with her unborn child.	D
Wahlbeck et al. (2018)	Sweden	Examine the experience of undergoing art therapy in women with severe fear of childbirth	19	Not applicable	Pregnant women with fear of childbirth	Five weekly 90–120 min sessions (choice of individual or group)	Art therapy. Art therapy was well accepted by the women. Through sharing their burden of fear by creating visible images, they gained hope and self-confidence in the face of their impending childbirth. Some women reported benefits on their partner relationships. Mixed responses in regard to sharing their expereinces with others at the group.	B
Wahlbeck et al. (2020)	Sweden	Examine art therapy as an adjunct to mid-wife-led counselling showed reduced fear of birth than women treated by midwife-led counselling alone	82	Not applicable	Pregnant women with fear of childbirth	As above	Art therapy. Fear of childbirth was significantly reduced in both groups (intervention and control) between the first and the second measurements. As all received midwifery counselling, the positive result might be interpreted as an effect of midwifery counselling	B+
White et al. (2010)	UK	To increase parental well-being and study the impact of running a creative arts intervention on the functioning of a neonatal unit	41	Not applicable	25 Mothers, 13 fathers and 3 siblings	Wide range of art materials, art books (for examples and inspiration), a digital SLR camera with zoom lens, and an all-in-one photo printer and scanner	Creative arts. Visual arts programme Parents initially had reservations, but all enjoyed the experience, claiming it relieved their stress and wanted it to continue. Some parents reported reductions in sense of isolation, it made their experience more real and increased self-confidence. Some found the detailed focus on their baby made them feel closer to their child, whereas for others it made no impact. Artists expressed difficulties in approaching parents.	C-

Bruce, D., & Hackett, S. S. (2021). Developing art therapy practice within perinatal parent-infant mental health. International Journal of Art Therapy, 26(3), 111–122. https://doi.org/10.1080/17454832.2020.1801784

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Jalambadani, Z., Borji, A., & Bakaeian, M. (2019). Examining the effect of mindfulness-based art therapy (MBAT) on stress and lifestyle of Iranian pregnant women. Journal of Obstetrics and Gynaecology, 40(6), 779–783. https://doi.org/10.1080/01443615.2019.1652889

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Jouybari, L., Abbariki, E., Jebeli, M., Mehravar, F., Asadi, L., Akbari, N., Sanagoo, A., & Moradi, Z. (2018). Comparison of the effect of narrative writing and art therapy on maternal stress in neonatal intensive care settings. The Journal of Maternal-Fetal & Neonatal Medicine, 33(4), 664–670. https://doi.org/10.1080/14767058.2018.1499719

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Moriarty, Y., O'Neill, C., Robling, M., Arroyo, C., & Owen, O. (2022). Feasibility of recruiting mother-infant dyads with mild-moderate depression to an art therapy painting group. https://doi.org/10.21203/rs.3.rs-1489112/v1

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Perry, C., Thurston, M., & Osborn, T. (2008). Time for me: The arts as therapy in postnatal depression. Complementary Therapies in Clinical Practice, 14(1), 38–45. https://doi.org/10.1016/j.ctcp.2007.06.001

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Ponteri, A. K. (2001). The effect of group art therapy on depressed mothers and their children. Art Therapy, 18(3), 148–157. https://doi.org/10.1080/07421656.2001.10129729

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Swan-foster, N. (1989). Images of pregnant women: Art therapy as a tool for transformation. The Arts in Psychotherapy, 16(4), 283–292. https://doi.org/10.1016/0197-4556(89)90051-8

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Wahlbeck, H., Kvist, L. J., & Landgren, K. (2018). Gaining hope and self-confidence – an interview study of women’s experience of treatment by art therapy for severe fear of childbirth. Women and Birth, 31(4), 299–306. https://doi.org/10.1016/j.wombi.2017.10.008

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Wahlbeck, H., Kvist, L. J., & Landgren, K. (2020). Art therapy and counseling for fear of childbirth: A randomized controlled trial. Art Therapy, 37(3), 123–130. https://doi.org/10.1080/07421656.2020.1721399

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White, M. P., Anderdson, S., Stansfield, K. E., & Gulliver, B. (2010). Parental participation in a visual arts programme on a neonatal unit. Infant, 6(5), 165–169.

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