The effects of art therapy using the Zentangle method for older adults with depressive symptoms

ISRCTN ISRCTN66410347
DOI https://doi.org/10.1186/ISRCTN66410347
Submission date
05/04/2021
Registration date
14/04/2021
Last edited
27/06/2023
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Mental and Behavioural Disorders
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Approximately 10% of older adults in Hong Kong have depression. Antidepressant medications and psychotherapy have always been recommended for treating older adults with depression. Medication may have side effects. Hence, the high level of involvement of well-trained experts or professionals is necessary to provide timely and intensive psychotherapy intervention. The original Zentangle method is an art form that promotes calmness and increases awareness by drawing structured patterns. It may also enhance one’s self-compassion. A growing interest has been observed in applying Zentangle in mental health or elderly services in Hong Kong. However, no empirical study has been conducted on the effects of this method.

Who can participate?
Community-dwelling older adults (aged 60 years or above) with depression.

What does the study involve?
A six-session protocol of intervention was developed on the basis of the original Zentangle method. Participants were randomly assigned to the intervention group and the waitlist control group. The effects were examined by comparing the participants who received a six-week Zentangle intervention with those in the waitlist control group.

What are the possible benefits and risks of participating?
None

Where is the study run from?
NAAC Shumshuipo District Elderly Community Centre (Hong Kong, China)

When is the study starting and how long is it expected to run for?
August 2019 to September 2020

Who is funding the study?
Investigator initiated and funded

Who is the main contact?
Dr Henri Chun-yiu Chan, henrichan@vtc.edu.hk

Contact information

Dr Henri Chun-yiu Chan
Public

Hong Kong Institute of Vocational Education (Sha Tin)
21 Yuen Wo Road, Sha Tin, New Territories
Hong Kong
-
Hong Kong

ORCiD logoORCID ID 0000-0001-6275-2636
Phone +852 92880458
Email henrichan@vtc.edu.hk

Study information

Study designRandomized waitlist controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Community
Study typeTreatment
Participant information sheet ISRCTN66410347_PIS.pdf
Scientific titleThe effects of the original Zentangle method for older adults with depressive symptoms: a randomised waitlist controlled trial
Study objectives1. Older adults randomised to the Zentangle programme have more improvements in the symptoms of depression than those in the waitlist control group
2. Older adults randomised to the Zentangle programme have more improvements in the level of self-compassion than those in the waitlist control group
Ethics approval(s)Approved 20/08/2019, Human Subjects Ethics Sub-committee, The Hong Kong Polytechnic University (Hung Hom, Hong Kong, China; +852 2766 6378; cherrie.mok@polyu.edu.hk), ref: HSEARS20190806001
Health condition(s) or problem(s) studiedCommunity-dwelling older adults with depressive symptoms
InterventionParticipants were randomly assigned to the intervention group and the waitlist control group. The effects were examined by comparing the participants who received a six-week Zentangle intervention with those in the waitlist control group. Baseline (T0), post-intervention (T1, six weeks after T0) and six-week follow-up (T2, twelve weeks after T0) measures were completed in this study. Forty-six community-dwelling older adults with scores of five or above in the Patient Health Questionnaire-9 (PHQ-9) were recruited. Outcomes including depressive symptoms, self-compassion, self-soothing tendency, self-defeating tendency, positive affect, negative affect, participation in pleasant activities and perceived health were assessed. Same treatment is provided to the waitlist-control group after the data-collection period.
Intervention typeBehavioural
Primary outcome measureMeasured at baseline, 6 and 12 weeks:
1. Depression is measured using PHQ-9
2. Self-compassion is measured using Self-Compassion Scale- Short Form (SCS-SF)
Secondary outcome measuresThere are no secondary outcome measures
Overall study start date20/08/2019
Completion date30/09/2020

Eligibility

Participant type(s)Patient
Age groupSenior
SexBoth
Target number of participants42
Total final enrolment46
Key inclusion criteria1. The older adult is living in the community
2. The older adult is aged 60 or above
3. The older adult scored over 5 or above in the Patient Health Questionnaire-9 (PHQ-9)
4. The older adult should have no formal diagnosis of other mental health illness other than depression based on their self-report in the pre-test interview
5. The older adult should be able to understand Cantonese
6. The older adult should have no visual impairment
7. The older adult should be able to hold a pen and have no severe medical conditions with physical mobility based on their self-report in the pre-test interview
8. The older adult should be able to attend 80% of the programme sessions
Key exclusion criteria1. The older adult has formal diagnosis of other mental health illness other than depression based on their self-report in the pre-test interview
2. The older adult is not able to understand Cantonese
3. The older adult has no visual impairment
4. The older adult is not able to hold a pen and has severe medical conditions with physical mobility based on their self-report in the pre-test interview
5. The older adult is not able to attend 80% of the programme sessions
Date of first enrolment01/09/2019
Date of final enrolment30/06/2020

Locations

Countries of recruitment

  • Hong Kong

Study participating centre

NAAC Shumshuipo District Elderly Community Centre
1/F, Ancillary Facilities Block
Shek Kip Mei Estate
100 Woh Chai Street
Sham Shui Po
Kowloon
Hong Kong
-
Hong Kong

Sponsor information

Hong Kong Polytechnic University
University/education

Hung Hom
Hong Kong
-
Hong Kong

Phone +852 22567408
Email fhss.email@polyu.edu.hk
Website https://www.polyu.edu.hk
ROR logo "ROR" https://ror.org/0030zas98

Funders

Funder type

Other

investigator initiated and funded

No information available

Results and Publications

Intention to publish date01/05/2021
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planPlanned publication in a high-impact peer-reviewed journal.
IPD sharing planDr. Henri Chan, henrichan@vtc.edu.hk, Individual participant data that underlie the results reported in this article, after deidentification the datasets used and/or analysed during the study are available upon reasonable request. Data requestors will need to sign a data access agreement.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Participant information sheet 04/05/2021 No Yes
Thesis results 01/01/2021 04/10/2022 No No
Results article 05/05/2023 27/06/2023 Yes No

Additional files

ISRCTN66410347_PIS.pdf
uploaded 04/05/2021

Editorial Notes

27/06/2023: Publication reference added.
04/10/2022: Added link to thesis.
04/05/2021: The participant information sheet was uploaded as an additional file.
14/04/2021: Internal review.
12/04/2021: Trial's existence confirmed by The Hong Kong Polytechnic University.