The COVID-19 pandemic has really affected adolescents, as most were forced to stay at home for health safety purposes. Stay at home guidelines affected adolescents in both positive and negative ways. Certain adolescents were affected in a negative way with online learning, restrictions on gathering, and living at home. Art therapy is a method to treat individuals with mental health issues using various artistic methods and it is designed to complement the traditional mental health treatment with the aim to manage behaviors, mood swings, and to reduce the stress and anxiety that is associated with mental health. Some artistic methods can include painting, drawing, and sculpturing. Therefore, the purpose of this study is to determine if the peer support art therapy helps adolescents with mental health conditions and explores if creative arts predict health outcomes. This study also explores current art therapy treatments that are available for adolescents. In addition, new alternative methods for art therapy treatments are considered. New alternative methods of art therapy can possibly gain more access to treat mental health. The intention is to help adolescents reduce mental health symptoms and manage his or her behavior. Furthermore, the research seeks to discover how art therapy treatment increases adolescent’s self-esteem.

Keywords: Art therapy, Adolescents, Peer support, Caregivers, Mental health, Mental issues

INTRODUCTION

Art therapy is another way to treat individuals with mental health issues using various artistic methods and it is designed to complement the traditional mental health treatment with the aim to manage behaviors, mood swings, and to reduce the stress and anxiety that is associated with mental health. Some artistic methods can include painting, drawing, and sculpturing. Art therapy is a treatment method that allows an individual to express his or her emotions in a nonverbal atmosphere. In addition, Art therapy provides unique treatments for the patients’ needs. Also, it is very instrumental in treating symptoms that connect to mental health and helpful to improve cognitive and sensorimotor functions, foster self-esteem, and self-awareness, cultivate emotional resilience, promote insight, enhance social skills, reduce, and resolve conflicts and distress, and advance societal and ecological change [1]. The use of art therapy is not new, the term was coined back in 1942, and soon, art therapy started to collaborate with psychiatrists for mental health treatment. Mental health is a disorder that certain individuals encounter. Individuals living with a mental health illness often have difficulty coping with life and that illness can affect family and friends as well. Thus, art therapy is one method of treatment to help cope with mental health. Although, there are many mental health illnesses, individuals require unique treatments that work best to achieve recovery. An individual’s behavior and rationale can be affected by mental health illness, including depression, anxiety, and/ or schizophrenia. Unfortunately, no mental health treatment works the same for every individual since illnesses are built upon various reasons. In addition, every individual is unique and copes with distress, emotions, and behaviors differently [2]. There has also been research on how art therapy can help improve adolescents’ academics, while coping with mental health. Research by American Psychological Association [3] focuses on the benefit of art therapy using adolescent boys of color. The study provided a large sample to see the academic improvements for adolescents. Within the research study [3] emphasis was on Latino and African American boys, who lived in poverty. Research by Ojeda [4] had already indicated that Latinos and African Americans have a higher rate for depression. As a result, adolescent boys who participated in art therapy received a better academic outcome. When schools promote art therapy treatment, adolescents seek peer support to help with mental health [3]. Treatment for mental health has either been medications or therapy sessions [5]. Medication is usually the common treatment for mental health; however, medication reactions affect certain individuals. There is a lack of a variety of solutions to help cope with mental health and more mental health treatment therapies were designed for an individual to have choices [6]. Based on psychiatric research, there have been more than 2682 research articles based on art therapy and mental health. The findings suggest that art therapy can help improve symptoms, such as anxiety and depression [7]. Therefore, art therapy could possibly be a treatment for mental health and a prevention for mental health symptoms. In California, the Los Angeles County continues to advance in technology within the environment. Adolescents seek interest on the newest technology. Most adolescents rely more on technology activities versus physical activities. Therefore, the field of art therapy started to link and adjust technology for adolescents within clinical therapy sessions. Virtual reality art therapy was a unique way to treat adolescents for mental health. Within research of two case studies [8] explored how virtual reality technology art therapy generates better outcomes for adolescents and further findings from the study, revealed an increase of adolescent cooperation for mental health treatment with the use of virtual reality technology art therapy versus a traditional art therapy clinic session. Although, both cases presented that peer support art therapy helps with mental health for adolescents, more testing on combining art therapy with virtual reality technology is required, due to a disconnection from the peer supporter, art therapist [8]. When COVID-19 started to spread worldwide, the uncertainty led individuals to gain anxiety, fear, and stress due to the uncertainly. In addition, the studies showed that COVID-19 caused more individuals to develop mental health issues from the government mandating rules and regulations of daily routine changes. For example, for certain adolescents, school was converted to online learning. With the COVID-19, technology advanced; however, continuous mental health support is needed for adolescents [9]. Mental health rates continue to increase for adolescents. During COVID-19, adolescents experienced a disturbance of emotional morale [10]. According to Gruber “Most important impact on adolescent lives will be a significant disruption to peer experiences that are critical for youth’s emotional, moral, behavioral, and identify development” (p. 413). There are multiple reasons why COVID-19 resulted in adolescents having mental health issues. The first reason for mental health issues during COVID-19 was the widespread and uncertainty of the virus. The second reason for mental health issues during COVID-19 was based on multi-dimensional stressors. Lastly, the third reason for mental health issues during COVID-19 was from the all the strict protection rules. As mental health issues increase, researchers are finding new ways to expand mental health services [10].

STATEMENT OF THE PROBLEM

Although, there is widespread research to support peer support art, there is limited information and data on adolescents dealing with mental health [11]. In the United States, certain adolescents continue to have mental health issues. Adolescents’ mental health trends have been increasing in the United States. Between the years of 2009-2019, there has been a 40% increase of adolescents experiencing multiple emotions that lead to mental health issues [12]. When the COVID-19 pandemic spread in the year 2020, researchers focused more on adult mental health treatment as compared to adolescents [13]. More adolescents faced mental health issues during the unexpected COVID-19 pandemic, then previously thought. Mental health increased worldwide with the COVID-19 pandemic [9]. COVID 19 led to a significant change in the dynamics of interpersonal relationships and emotionality of adolescents, which resulted in relationship and mood changes [14]. Within previous research, certain adolescents have limited access to mental health treatment. Mental health treatment access is difficult for certain populations, such as the Latina/o’s and African Americans; with no mental health treatment for adolescents, this can potentially lead to poor academics and poor decisions. Precisely, the Latina/o population is at greater risk for mental health issues when being compared to other populations [15]. Latina/o’s and African Americans adolescents have high rates of depression in Los Angeles County. Latina/o and African American adolescents tend to have mental health issues based on multiple factors, such as family, poverty, and environment [4]. Mental health issues can affect an adolescent’s health, academics, and resilience [12]. Art therapy is just one treatment to explore that may benefit adolescents who are having mental health issues.

PURPOSE OF THE STUDY

The COVID-19 pandemic has really affected the adolescents, as most were left to stay at home for health safety purposes. Stay at home guidelines affected adolescents in both positive and negative ways. Certain adolescents were affected in a negative way with online learning, restrictions on gathering, and living at home [9]. While some adolescents were affected in a positive way with more self-time, family-time, and fewer social stressors. The constantly changing state of the world created a new norm for adolescents to have to learn to adjust rapidly for his or her safety, sometimes causing emotional changes [14]. Therefore, the purpose of this study is to determine if peer support art therapy helps adolescents with mental health conditions and explores if creative arts predict health outcomes. Whether art therapy is offered in technology or the traditional way, sessions seem to be flexible for adolescents. Although, sessions are flexible, the percentage of adolescents dealing with mental health issues continues to be high [12]. Research is needed to determine which type of artwork therapy works best for certain emotions an adolescent is expressing. According to Bosgraaf [16] research was done to discover if art therapy was beneficial for adolescents, no matter the type of peer support from the art therapist. The research included trials that were randomized, controlled, and pre-post designed. The peer supporters included art therapists that were directive, eclectic, and non-directive. As a result, the studies showed that adolescent’s benefit from art therapy, no matter who is the peer supporter. It is the responsibility of the peer supporter, and art therapist, to adjust to what is best in order for adolescents to feel free to express psychological problems [16].

CONCEPTUAL FRAMEWORK

The conceptual framework of this study is built around the fact that it has been around since the 1940s and the pioneers in the field believe that the use of art therapy is a way of helping their clients tap into their inner thoughts, feelings and experiences through creative expression. The notion that overall human health encompasses many aspects, and that positive health outcomes involve integrated mental, physical, social/emotional and environmental approaches has generated a new look into the importance of art therapy in our society today [17]. Art therapy treatment results are encouraging for patients. After patients attend the proper art therapy for his or her symptoms, it leads to less stress and depression. Additionally, art therapy patients feel more valued and become more aware of their surroundings. Art therapy patients also develop positive coping skills [18]. With positive results of art therapy treatment, new methods are being created to allow more mental health access. For instance, that could include remote services and monitoring mental health symptoms that are being observed and/or treated [10]. Therefore, this study explores current art therapy treatments that are available for adolescents. In addition, new alternative methods for art therapy treatments are being considered. New alternative methods of art therapy can possibly gain more access to treat mental health. The intention is to help adolescents reduce mental health symptoms and manage his or her behavior. Furthermore, to discover how art therapy treatment increases adolescent’s self-esteem.

SIGNIFICANCE OF THE STUDY

This study is significant since art therapy benefits adolescent’s mental health to recognize and acknowledge feelings that have been keep within themselves. Art therapy treatments have been utilized more in health care settings. For example, inpatient adolescents in a health care setting have benefited from the use of art therapy treatment by feeling safe to express his or her feelings. However, art therapy is also being used in other settings, such as school, online, and virtual reality. No matter the setting, art therapy has an impact to treat and prevent mental health issues [11]. Also, there are multiple art therapy treatments to focus on adolescent’s mental health symptoms. The types of interactions employed between the art therapist and the patient can be clay modeling, painting, and drawing. Another example is when an adolescent has a symptom of schizophrenia, expressive art therapy is applied. The types of interactions used in these types of mental health issues between the art therapist and the patient can be painting, poetry, and sculpturing [18].

DATASET AND RESEARCH METHODS

The California Health Interview Survey [19] is a health survey organized every other year for California to evaluate information based on interviews. Separate interviews are conducted for adults (ages 18 and older), adolescents (ages 12-17) and children (birth through 11 years of age). For children, parents or guardians in the household, the one who is most knowledgeable about the child’s health is interviewed and adolescents are interviewed directly about their health and behaviors, while their insurance information is collected from the adult. The information collected for CHIS is centered on health services, behaviors, status, and condition and focuses on adult mental health for ages 18 and older. The dataset which explores mental health with about forty-two questions and several mental health questions were responded to in a “Yes” or “No” format. In addition, certain mental health questions were responded to in a 1- 10 Likert-scale scoring with 10 indicating extremely important [19].

STATISTICAL ANALYSIS

Mixed research was used for the analysis of this study. Firstly, a non-systematic meta-analysis of the literature review of the research found in the major databases under the terms “Art therapy treatments results” since the year 2019 was conducted in order to document the major findings of the research topic and how the findings can provide a new model for health therapy and policies [20]. Secondly, Statistical Package for Social Sciences (SPSS) was used to analyze and determine correlation between adolescent and adult depression using the 2019 CHIS data. Data was derived from multiple surveys; a combination of interviews and physical examinations were conducted. The measures used to analyze the data included descriptive statistics, such as frequencies, percentages, descriptive, and Chi-square. The statistical analysis conducted is described in Table 1 below.

DEPENDENT & INDEPENDENT VARIABLES

Within this study there are dependent and independent variables identified. The dependent variable is identified as mental health, while the independent variable for this study is adolescents and adults. Also, some questions were identified based on the purpose of the study.

The questions identified specifically for evaluation and analysis are:

1. During the past 12 months, have you suffered any physical or mental health problems yourself as a result of caring for care recipient in the past 12 years?
2. {What/At the time you provided care, what} disabilities or illnesses {does/did} {he/she/he or she} have that {requires/required} your help?
3. On a scale from 1 to 10, where 1 is not at all important, and 10 is extremely important, how important do you think individual or environmental factors - such as a person’s behaviors or access to healthy foods or recreation - are to a person’s health?

RESEARCH HYPOTHESES

The study’s hypothesis states that if adolescents/adults utilize various types of peer support art therapy for mental health, symptoms will decrease, and resilience will increase. In order to formally test if a relationship exists, a chi-square test was run to determine the association, if any, between the three questions identified above.

FINDINGS AND ANALYSIS OF RESULTS

Even though art therapy does not have enough data. Art therapy is a treatment of recommendation that has been effective [21]. The questions derived from the dataset was utilized since there was no specific data for adolescents on the issue of mental health. Therefore, the findings for survey instruments were only focused on adults, not adolescents specifically. For the first question, if during the past 12 months, did the respondent suffer any physical or mental health problems as a result of providing care for themselves? A total of 22,160 individuals were surveyed and only 868 (3.9%) indicated yes and 5155 (23.3%) indicated no. However, about 16129 (72%) indicated that the question is not applicable to them. A result of the descriptive analysis shows no effect as respondents answered the question, and a descriptive statistical analysis was conducted to determine the relationship between all the three research questions (Table 2).

To determine how important an individual or environmental factor, such as a person’s behavior or access to healthy foods or recreation, is to a person’s health, a scale of 1-10 was used. Within the scale, the number 1 represented not at all important and the number 10 represented extremely important. The number 5 represented average on the scale. The results showed no significant valid percent for the numbers between 1-7. However, the numbers 8-10 had a significant valid percent. At a scale of 8, the valid percent was 15.7%. At a scale of 9, the valid present was 12.6%. At a scale of 10 the valid percent was 57.9%. With the number 10 being the most important, individual and environmental factors play a significant part of health. To determine {What/At the time you provided care, what} disabilities or illnesses {does/did} {he/she/he or she} have that {requires/required} help, “Yes” or “No” responses were used. Around 22,160 adults responded to the survey regarding disability or illness of the care recipient was due to mental illness, emotional illness, or depression. The findings were 5,031 (22.7%) adults responded no and 868 (3.9%) adults responded yes. However, 16, 253 (73.4%) adults did not respond to this question. As a result, this question does not validate the findings. To determine if during the past 12 months, if you suffered any physical or mental health problems yourself as a result of providing care to your {AJ90}, “Yes” or “No.” About 22,160 adults responded to the survey concerning suffered physical and mental health problems caring for care recipient. The findings were 5,155 adults (23.3%) responded no and 868 (3.9%) responded yes. However, 16,129 (72.8%) adults did not respond to this question. As a result, this question does not validate the findings. The data sets were analyzed to determine the significance in the associations between the variables identified. A Chi-Square test was employed using the data that was cross-tabulated. The analysis revealed the critical value (CV), degrees of freedom (df), and the p value. Significance of the associations were determined based on a p value of Table 3).

In determining the importance of individual and environmental factors to health, it was determined with Pearson Chi-Square value of 70591.721, df of 10 and p= .000, that it is statistically significant, showing that there is relationship with people with mental health issues and the importance of individual and the environmental factors to health. For the question related to people with a disability or illness of care recipient (mental, illness, emotional illness depression), the Pearson Chi-Square value of 17152.495, df of 2 and P= .000 is statistically significant. For those who suffered physical/metal health problems caring for care recipients in past 12-month, Pearson Chi-Square value of 29730.281, df of 3 and p= of .000 is statistically significant. The analysis does support the hypothesis that a relationship exists between mental health and art therapy. The Chi-Square analysis revealed the associations of the three questions, the importance of individual and environmental factors to health, disability or illness of care recipient pertaining to metal illness, emotional illness, depression, insurance and suffered physical and mental health problems caring for the care recipient in past 12 months are statistically significant. Therefore, the analysis does support the Hypothesis.

LIMITATION OF DATASET

Based on the findings, CHIS had nothing to do with art therapy. The 2019 CHIS adult survey questions were not included in the 2019 CHIS teen for adolescents. With limited information and data on adolescents dealing with mental health issues, CHIS need to include adolescents for a better understanding of the data. In addition, additional information is necessary to understand why there has been an increase of adolescents dealing with mental health issues. Within the CHIS data, another question in the dataset can conceivably be evaluated and analyzed. The question that should be looked at is, how often did you feel so depressed and nothing can cheer you up? The findings to this question could possibly lead to helping develop new alternatives for individuals dealing with mental health issues on daily or weekly basis, maybe by exploring peer support therapy.

DISCUSSION AND CONCLUSION

Before and during the COVID-19 pandemic, receiving mental health services remains challenging due to the current limited access for treatments being offered. However, with the use of various peer support art therapy treatments for adolescents/adult’s mental health, symptoms will decrease, and resilience will increase. Peer support art therapy is useful for adolescents to participate in a mindfulness environment versus typical conversational therapy treatment. A mindfulness environment can be an adolescent’s favorite place; therefore, as technology continues to advance art therapy treatment should be incorporated. Adolescents continue to be interested in seeking help for mental health treatment in a method that best fits his or her preference. Therefore, virtual reality art therapy is one unique method to gain cooperation for treating adolescents for mental health. The benefit of art therapy has a positive impact for adolescents’ academics, mental health, and resilience. Peer support art therapy can be useful for adolescents to participate in a mindfulness environment versus typical conversational therapy sessions. In the U.S., adolescents have fluctuating rates of depression and thoughtless behaviors that can possibly lead to suicide, therefore, a mindfulness environment, such as art therapy, is a healthy development to incorporate to prevent suicide for adolescents. In addition, a mindfulness environment that offers art therapy can help adolescents focus on the present moment [21]. Most adolescents between the ages of 10-25 are yet to develop their brain completely to normalize powerful emotions and some have a difficultly expressing their emotions. A recent case study was conducted to explore how art therapy with adolescents is helpful to reconnect mindfulness by focusing on an adolescent, who is Mexican American male with family and school issues. The findings of the case study demonstrated that art therapy allowed for the Mexican American male adolescent to be more at ease after expressing various emotions with different art techniques [21]. Mental health services are difficult to access as an adolescent. In the year 2017, about 60.1% adolescents did not receive mental health treatment for depression in the U.S. due to access [6]. Certain mental health services require access through technology; therefore, parents seek the treatment help for an adolescent [22]. Sometimes technology access can be difficult for parents. Thus, receiving no mental health treatment is the easiest choice for an adolescent. Adolescents that come from a low-income household rely on school settings for mental health services [22]. The benefit of art therapy has a positive impact for adolescents that are being affected with mental health and resilience [12,15]. Conducted a study on the impact of art therapy for Latina/o adolescents in southern United States. The Latina/o adolescents was the sample population due to the high risk of mental health. After a seven-week session of art therapy, the results had a positive impact on Latina/o’s resilience, personal recovery, and depression symptoms. Adolescents taking art therapy sessions, experienced increased resilience and personal recovery. In addition, adolescents experienced reduced depression symptoms. With a positive impact for adolescents, more clinical mental help peer supporters should promote art therapy [15]. Peer support art therapy has influenced mental health for adolescents. The current mental health treatments that were explored within this research study have not been beneficial for all adolescents. Developing new alternative methods can possibly help gain more access to art therapy treatment. In addition, art therapy allows adolescents to cope with mental health in a unique and creative way. The methodology reviewed through secondary data, revealed that there continues to be limited information and data on adolescents dealing with mental health issues. In addition, inaccurate results due to a majority survey questionnaire were left answered. More research and studies are still needed to focus on adolescents, like adults’ information and data. Art therapy is significant since it is another type of treatment that benefits adolescent’s mental health ability to recognize feelings. Peer support art therapy is already being used within multiple settings, such as hospitals, school, online, and virtual reality. With the current types of interactions between art therapists and the adolescents, the use of painting, drawing, and sculpturing can be a baseline to develop new alternatives and more art therapy alternatives for an adolescent, receiving mental health treatment will increase. There is enough support to prove that art therapy has an impact to treat and prevent mental health issues.

RECOMMENDATIONS

Adolescents attract interest towards technology. One technology device an adolescent uses daily is a cellphone. Certain adolescents have a smart cellphone that allow free applications to be downloaded. Therefore, a possible recommendation is to incorporate peer support art therapy into an application. With a development of a peer support application, allows adolescents to receive greater access for mental health treatment. Currently, there are multiple artistic methods for art therapy, such as painting, sculpturing and drawing. Within current applications, separate artistic applications already exist to paint, sculpture, and draw. If some preexisting artistic applications collaborate with peer support art therapy, a new application can be established. The new application would be available daily for adolescents and other individuals to utilize and receive peer support art therapy for mental health. With daily access, mental health symptoms will decrease, and resilience will increase. In addition, therapists would be able to access the art therapy profile confidentially to understand emotions and feelings being changed while using the application. Overall, this recommendation could be possible to help adolescents/adults utilize various peer support art therapy for mental health.

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