Abstract
BACKGROUND: Depression is the most common mental health disorder among the older populations, leading to a higher reduction in quality of life and an increased financial burden on the health care system. One promising non-pharmacological approach for improving mental health in older adults is the use of art-based interventions. METHODS: This systematic review and meta-analysis followed PRISMA guidelines. Eligible randomized controlled trials (RCTs) examined any form of art intervention (including music, dance, and visual arts) targeting depression in adults aged > 55 years. Databases searched included PubMed, Scopus, Web of Science, PsycINFO, and the Cochrane Library through July 2025. Two reviewers independently extracted data, assessed risk of bias using the Cochrane RoB 2 tool, and determined study eligibility. Standardized mean differences (SMDs) were calculated using random-effects meta-analysis, followed by subgroup analyses, meta-regression, and publication bias assessment (Egger's test and funnel plot). RESULTS: Out of the 41 RCTs reviewed, 37 report results from 23 of these studies and were eligible for meta-analysis, including a total of 3791 participants. In the pooled analysis, it was revealed that art-based interventions had a greater impact in lowering levels of depression as compared to their respective controls (SMD = - 0.93, 95% CI: - 1.19 to - 0.68, p < 0.001) and had a high degree of heterogeneity (I(2) = 91.7%). Subgroup analyses suggested receptive interventions had a stronger effect (SMD = - 1.97, 95% CI: - 1.43 to - 2.50, p < 0.001) than active interventions (SMD = - 0.67, 95% CI: - 0.42 to - 0.91, p < 0.001) and interventions provided in the hospital or care home settings. Also, meta-regressions showed no significant association of effect size with the independent variables of age of subjects, number of sessions, or duration of intervention. Most of the studies had moderate to high risk of bias. Egger's test indicated no significant publication bias (p = 0.133). CONCLUSIONS: Art-based interventions effectively reduce depression in older adults and can serve as valuable complements to mental health strategies for aging populations. However, due to heterogeneous study designs and variable quality, additional high-quality trials are needed to confirm these benefits and optimize intervention delivery.