The Effects of Art Therapy on Anxiety and Distress for Korean–Ukrainian Refugee: Quasi-Experimental Design Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Setting
2.3. Participants
Demographic Characteristics of Participants
2.4. Assessments
2.4.1. Generalized Anxiety Disorder-7 (GAD-7)
2.4.2. Subjective Unit of Distress Scale (SUDs)
2.4.3. Art Therapy Satisfaction
2.5. Procedure
2.6. Intervention
2.7. Statistical Analyses
2.8. Ethical Considerations
3. Results
3.1. Primary Outcome Evaluation: GAD-7, SUDs
3.2. Secondary Outcome Evaluation: GAD-7 Items
3.3. Secondary Outcome Evaluation: Satisfaction with Art Therapy
3.4. Secondary Outcome Evaluation: A Qualitative Analysis
4. Discussion
4.1. Strengths
4.2. Limitations
4.3. Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- UNHCR Ukraine Situation. Available online: https://reporting.unhcr.org/ukraine-situation (accessed on 16 December 2022).
- UNHCR Asia Paciifc. A What is a Refugee? UNHCR. Available online: https://www.unhcr.org/what-is-a-refugee.html (accessed on 20 January 2023).
- Ministry of Justice. Monthly Statistics on Immigration Policy. Available online: https://www.moj.go.kr/moj_eng/index.do (accessed on 16 December 2022).
- Korean Law Information Center. Available online: https://www.law.go.kr/ (accessed on 16 December 2022).
- Riad, A.; Drobov, A.; Krobot, M.; Antalová, N.; Alkasaby, M.A.; Peřina, A.; Koščík, M. Mental health burden of the Russian–Ukrainian war 2022 (RUW-22): Anxiety and depression levels among young adults in central Europe. IJERPH 2022, 19, 8418. [Google Scholar] [CrossRef] [PubMed]
- Chevtayeva, I. Available online: https://p.dw.com/p/4EMoZ (accessed on 16 December 2022).
- Bryant, R.A.; Schnurr, P.P.; Pedlar, D. Addressing the mental health needs of civilian combatants in Ukraine. Lancet Psychiatry 2022, 9, 346–347. [Google Scholar] [CrossRef] [PubMed]
- Morina, N.; Stam, K.; Pollet, T.V.; Priebe, S. Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies. J. Affect. Disord. 2018, 239, 328–338. [Google Scholar] [CrossRef] [PubMed]
- Peek, L. Children and disasters: Understanding vulnerability, developing capacities, and promoting resilience. Child Youth Environ. 2008, 18, 1–29. [Google Scholar]
- World Health Organization. Available online: https://reliefweb.int/report/ukraine/who-promotes-action-urgent-mental-health-needs-ukrainian-refugees (accessed on 16 December 2022).
- Bogic, M.; Njoku, A.; Priebe, S. Long-term mental health of war-refugees: A systematic literature review. BMC Int. Health Hum. Rights 2015, 15, 29. [Google Scholar] [CrossRef]
- Attanayake, V.; McKay, R.; Joffres, M.; Singh, S.; Burkle Jr, F.; Mills, E. Prevalence of mental disorders among children exposed to war: A systematic review of 7,920 children. Med. Confl. Surviv. 2009, 25, 4–19. [Google Scholar] [CrossRef]
- Thapa, S.B.; Hauff, E. Psychological distress among displaced persons during an armed conflict in Nepal. Soc. Psychiatry Psychiatr. Epidemiol. 2005, 40, 672–679. [Google Scholar] [CrossRef]
- Tempany, M. What Research tells us about the Mental Health and Psychosocial Wellbeing of Sudanese Refugees: A Literature Review. Transcult. Psychiatry 2009, 46, 300–315. [Google Scholar] [CrossRef]
- Fazel, M.; Wheeler, J.; Danesh, J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. Lancet 2005, 365, 1309–1314. [Google Scholar] [CrossRef]
- Summerfield, D. War and mental health: A brief overview. BMJ 2000, 321, 232–235. [Google Scholar] [CrossRef]
- Shevchenko, R.; Kaafarani, A.; Aliieva, T.; Piletska, L.; Radul, I.; Klepar, M.; Popovych, I. Features of the psychoemotional state of internally displaced families from the war zone. Rev. Incl. 2020, 7, 157–169. [Google Scholar]
- Ugurlu, N.; Akca, L.; Acarturk, C. An art therapy intervention for symptoms of post-traumatic stress, depression and anxiety among Syrian refugee children. Vulnerable Child. Youth Stud. 2016, 11, 89–102. [Google Scholar] [CrossRef]
- Marshall, G.N.; Schell, T.L.; Elliott, M.N.; Berthold, S.M.; Chun, C.A. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA 2005, 294, 571–579. [Google Scholar] [CrossRef]
- Steel, Z.; Silove, D.; Phan, T.; Bauman, A. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study. Lancet 2002, 360, 1056–1062. [Google Scholar] [CrossRef]
- Hermansson, A.C.; Timpka, T.; Thyberg, M. The mental health of war-wounded refugees: An 8-year follow-up. J. Nerv. Ment. Dis. 2002, 190, 374–380. [Google Scholar] [CrossRef] [PubMed]
- Malchiodi, C. Art Therapy Sourcebook; McGraw Hill Professional: New York, NY, USA, 2007. [Google Scholar]
- Lee, H.J.; Kim, H.J.; Kim, S.Y.; Choi, H. A study on how art therapy affects the depression, anxiety, stress, and satisfaction experienced by immigrant “Koryo-saram” adolescents. Korean J. Art Ther. 2021, 28, 659–672. [Google Scholar] [CrossRef]
- Kim, S.Y.; Lee, Y.O.; Lee, S.Y.; Kim, M.S.; Choi, H. Art therapy for immigrant Korean youth: Indications of outcomes, acceptability and satisfaction. Int. J. Art Ther. 2022, 27, 121–129. [Google Scholar] [CrossRef]
- Malchiodi, C.A. (Ed.) Handbook of Art Therapy, 2nd ed.; McGraw-Hill: New York, NY, USA, 2011; pp. 57–60. [Google Scholar]
- Kalmanowitz, D.; Lloyd, B. Art Therapy and Political Violence: With Art, without Illusion; Routledge: London, UK, 2005. [Google Scholar]
- Thabet, A.A.M.; Karim, K.; Vostanis, P. Trauma exposure in pre-school children in a war zone. Br. J. Psychiatry 2006, 188, 154–158. [Google Scholar] [CrossRef]
- Thabet, A.A.M.; Matar, S.; Carpintero, A.; Bankart, J.; Vostanis, P. Mental health problems among labour children in the Gaza Strip. Child Care Health Dev. 2011, 37, 89–95. [Google Scholar] [CrossRef]
- Spiegel, D.; Malchiodi, C.; Backos, A.; Collie, K. Art therapy for combat related PTSD: Recommendations for research and practice. Art Ther. 2006, 23, 157–164. [Google Scholar] [CrossRef]
- Isfahani, S.N. Art therapy with a young refugee woman–survivor of war. Int. J. Art Ther. 2008, 13, 79–87. [Google Scholar] [CrossRef]
- Fitzpatrick, F. A search for home: The role of art therapy in understanding the experiences of Bosnian refugees in Western Australia. Art Ther. 2002, 19, 151–158. [Google Scholar] [CrossRef]
- Baker, B.A. Art speaks in healing survivors of war: The use of art therapy in treating trauma survivors. J. Aggress. Maltreat. Trauma 2006, 12, 183–198. [Google Scholar] [CrossRef]
- Feen-Calligan, H.; Grasser, L.R.; Debryn, J.; Nasser, S.; Jackson, C.; Seguin, D.; Javanbakht, A. Art therapy with Syrian refugee youth in the United States: An intervention study. Arts Psychother 2020, 69, 101665. [Google Scholar] [CrossRef]
- Schouten, K.A.; van Hooren, S.; Knipscheer, J.W.; Kleber, R.J.; Hutschemaekers, G.J. Trauma-focused art therapy in the treatment of posttraumatic stress disorder: A pilot study. J. Trauma Dissoc. 2019, 20, 114–130. [Google Scholar] [CrossRef]
- Haynes, A.B.; Haukoos, J.S.; Dimick, J.B. TREND reporting guide-lines for nonrandomized/quasi-experimental study designs. JAMA Surg. 2021, 156, 879–880. [Google Scholar] [CrossRef]
- Spitzer, R.L.; Kroenke, K.; Williams, J.B.; Löwe, B. A brief measure for assessing generalized anxiety disorder. Arch. Intern. Med. 2006, 166, 1092–1097. [Google Scholar] [CrossRef]
- Löwe, B.; Spitzer, R.L.; Williams, J.B.; Mussell, M.; Schellberg, D.; Kroenke, K. Depression, anxiety and somatization in primary care: Syndrome overlap and functional impairment. Gen. Hosp. Psychiatry 2008, 30, 191–199. [Google Scholar] [CrossRef]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B.; Monahan, P.O.; Löwe, B. Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Ann. Intern. Med. 2007, 146, 317–325. [Google Scholar] [CrossRef]
- Löwe, B.; Decker, O.; Müller, S.; Brähler, E.; Schellberg, D.; Herzog, W.; Herzberg, P.Y. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med. Care 2008, 46, 266–274. [Google Scholar] [CrossRef]
- Patient Health Questionnaire Screeners. Available online: https://www.phqscreeners.com (accessed on 16 April 2022).
- Benjamin, C.L.; O’Neil, K.A.; Crawley, S.A.; Beidas, R.S.; Coles, M.; Kendall, P.C. Patterns and predictors of subjective units of distress in anxious youth. Behav. Cogn. Psychother. 2010, 38, 497–504. [Google Scholar] [CrossRef]
- Choi, H.; Jung, D.-J.; Jeon, Y.-H.; Kim, M.J. The effects of combining art psychotherapy with pharmacotherapy in treating major depressive disorder: Randomized control study. Arts Psychother 2020, 70, 101689. [Google Scholar] [CrossRef]
- Sholt, M.; Gavron, T. Therapeutic qualities of clay-work in art therapy and psychotherapy: A review. Art Ther. 2006, 23, 66–72. [Google Scholar] [CrossRef]
- Dieterich-Hartwell, R.; Koch, S. Creative arts therapies as temporary home for refugees: Insights from literature and Practice. Behav. Sci. 2017, 7, 69. [Google Scholar] [CrossRef][Green Version]
Variables | Sub-Variables | Number | Percentage (%) |
---|---|---|---|
Age (years) | Teenager (13–18 years) | 22 | 40.7 |
Adult (19–68 years) | 32 | 59.3 | |
Gender | Male | 15 | 27.8 |
Female | 39 | 72.2 | |
Country of origin | Ukraine | 54 | 100 |
Length of stay since arrival (months) | <1 | 4 | 7.4 |
1–5 | 38 | 70.4 | |
6–11 | 2 | 3.7 | |
>24 | 8 | 14.8 | |
No response | 2 | 3.7 | |
Korean language level | Advance | 0 | 0 |
Intermediate | 5 | 9.2 | |
Basic | 48 | 88.9 | |
No response | 1 | 1.9 |
Variables | Pre | Post | t | p |
---|---|---|---|---|
M a (SD b) | M a (SD b) | |||
GAD-7 c | 4.61 (4.55) | 3.29 (4.61) | 3.092 ** | 0.003 |
SUDs d | 33.70 (22.92) | 29.25 (23.83) | 3.335 ** | 0.002 |
Items of GAD-7 | Pre | Post | t | p |
---|---|---|---|---|
M a (SD b) | M a (SD b) | |||
1. Nervousness | 0.85(0.88) | 0.69(0.87) | 1.589 | 0.118 |
2. Inability to stop worrying | 0.72(0.90) | 0.35(0.62) | 3.369 *** | 0.001 |
3. Excessive worry | 0.85(0.86) | 0.48(0.69) | 3.471 *** | 0.001 |
4. Restlessness | 0.69(0.72) | 0.50(0.77) | 2.207 * | 0.032 |
5. Difficulty in relaxing | 0.43(0.77) | 0.33(0.70) | 1.093 | 0.279 |
6. Easy irritation | 0.70(0.86) | 0.48(0.81) | 2.704 ** | 0.009 |
7. Fear of something awful happening | 0.69(0.99) | 0.46(0.84) | 2.195 * | 0.033 |
Questionnaire | Range | Frequency (n) | Percentage (%) |
---|---|---|---|
Q1. Did you find art therapy interesting? | Yes | 16 | 29.6 |
Quite yes | 32 | 59.2 | |
Neutral | 4 | 7.4 | |
Not quite | 2 | 3.7 | |
Not at all | 0 | 0 | |
Q2. Did art therapy make you feel safe? | Yes | 18 | 34.0 |
Quite yes | 28 | 52.8 | |
Neutral | 4 | 7.5 | |
Not quite | 2 | 3.8 | |
Not at all | 1 | 1.9 | |
Q3. Was there enough time for art therapy? | Yes | 15 | 27.8 |
Quite yes | 32 | 59.2 | |
Neutral | 4 | 7.4 | |
Not quite | 2 | 3.7 | |
Not at all | 1 | 1.8 | |
Q4. Do you want to do art therapy again in the future? | Yes | 5 | 9.2 |
Quite yes | 37 | 68.5 | |
Neutral | 7 | 13.0 | |
Not quite | 3 | 5.6 | |
Not at all | 2 | 3.7 | |
Q5. What aspects of art therapy did you enjoy the most? | Setting and Environment | 9 | 17.0 |
Creating art | 7 | 13.2 | |
Discussion about artwork | 8 | 15.1 | |
All three of above | 29 | 54.7 |
Experience of Art Therapy by Participants | Category | Theme |
---|---|---|
I appreciated and felt better while receiving the art therapy. | Expression of positive emotions | Anxiety relief through positive emotion reinforcement |
I enjoyed all the activities within the art therapy process. | ||
It was fun to play with clay and draw pictures on fabric. | ||
I realized we were together through this program, so I am not alone. | Experience a sense of security | |
Thank you for being able to escape from constant worry and fear. | ||
I felt safe and good because of the comfortable and positive atmosphere and place. | ||
I could take care of my feelings and understand myself better. | ||
I felt safe and comfortable in this art therapy session. | ||
I liked everything because it felt like I was being understood how I felt. | Self-emotional awareness | |
I could feel what the Ukrainians felt. | ||
May peace be brought to Ukraine. | Hopeful future |
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Kim, S.-Y.; Lee, J.S.; Choi, H. The Effects of Art Therapy on Anxiety and Distress for Korean–Ukrainian Refugee: Quasi-Experimental Design Study. Healthcare 2023, 11, 466. https://doi.org/10.3390/healthcare11040466
Kim S-Y, Lee JS, Choi H. The Effects of Art Therapy on Anxiety and Distress for Korean–Ukrainian Refugee: Quasi-Experimental Design Study. Healthcare. 2023; 11(4):466. https://doi.org/10.3390/healthcare11040466
Chicago/Turabian StyleKim, Soo-Yeon, Jenny Seongryung Lee, and Han Choi. 2023. "The Effects of Art Therapy on Anxiety and Distress for Korean–Ukrainian Refugee: Quasi-Experimental Design Study" Healthcare 11, no. 4: 466. https://doi.org/10.3390/healthcare11040466