Does regular engagement with arts and creative activities improve adolescent mental health and wellbeing? A systematic review and assessment of causality.

Background: There is a growing body of evidence on the relationship between arts and creative activities and adolescent mental health and wellbeing. However, most research has focused on short, sharp creative arts interventions, and not on regular, day-to-day engagement with arts and creative activities. It is unclear the extent to which this complex relationship can be considered causal. This systematic review aimed to summarise the quantitative evidence on engagement with arts and creative activities and assess whether it supports causal conclusions. Methods: We systematically searched 10 databases. We included any quantitative studies (cross-sectional and longitudinal observational studies, natural and quasi-experimental designs, and controlled trials) assessing the link between regular engagement (multiple instances over a period of more than one week) with arts and creative activities, and adolescent (10-19y) mental health and wellbeing. We included studies published in English from 2014 to 2024. Methodological quality was assessed using JBI critical appraisal tools. Support for causal conclusions was assessed using the Bradford Hill Viewpoints. Results: Of 7769 records screened, 28 were selected for inclusion. Most studies suggested a positive association between arts engagement and adolescent mental health and wellbeing. We found some support for all Bradford Hill viewpoints, but less support for experimental evidence and a dose-response relationship. Discussion: This review provides moderate support for a causal relationship between arts engagement and adolescent mental health and wellbeing. More evidence from randomised experiments or generated by applying causal inference methods to observational data is needed to better account for selection, confounding, and reverse-causality.