The effects of crafts‐based interventions on mental health and well‐being: A systematic review

Abstract

Introduction

A recent upsurge of interest in the health benefits of crafts for mental health and well‐being has not been supported by systematic reviews of the effectiveness of crafts‐based interventions, prior to this review.

Methods

Five databases were searched: Scopus, CINAHL (EBSCO), APA PsycInfo (EBSCO), Eric (EBSCO), and ProQuest Dissertations and Theses. No date limitations were applied. The search was carried out in January 2024 and supplemented by citation searches in June 2024.

Results

The initial search yielded 14,115 papers; the citation search produced 226 additional references. Nineteen studies in total met the inclusion criteria.

Across the 19 studies, there is a wide variety of research designs and a range of crafts used as media for therapy. Interventions were delivered or supervised by either art therapists, nurses, or occupational therapists. Only nine studies report the theoretical basis for the intervention. Treatment duration varies from 10 min to 16 weeks.

Quality assessment revealed the quality of the studies varies considerably, with some studies of high‐quality and many suffering from methodological weaknesses. Common issues relating to risk of bias include failure to blind assessors; incomplete data and lack of clarity about how the intervention was administered.

All the studies report short‐term improvements in the outcomes measured, which include anxiety, stress, depression, interest in life, self‐efficacy, social skills, sociability, mood, well‐being, self‐esteem, life satisfaction, health‐related quality of life, and hopelessness.

Due to the wide variation in interventions, research designs, outcomes, outcome measures, and research quality, it is difficult to draw firm conclusions about the effectiveness of crafts‐based interventions.

Conclusion

There is some evidence that crafts‐based interventions may benefit mental health and well‐being, but more high‐quality research is needed, including on the mechanisms through which crafts‐based interventions operate.

Consumer and community involvement

No consumer or community involvement.

PLAIN LANGUAGE SUMMARY

Reports from the media suggest that doing crafts may improve mental health. Crafts are, for example, knitting, sewing, and pottery. Therapists have used crafts for years to treat mental illnesses. However, there is no strong proof that these treatments are effective for clients or worth the cost.

This paper reviews the effects of craft‐based treatments. The review found 19 studies that looked at whether people felt better after doing crafts. The participants included men and women with various physical, mental, and social problems. These issues included mental disorders, osteoarthritis, epilepsy, and dementia. Pottery, embroidery, knitting, papercraft, and woodwork were used. Some people did crafts for 10 min, while others had several sessions over weeks.

All 19 studies showed that mood and life satisfaction improved after the treatment. But, only one study checked if these improvements lasted in the weeks after.

It is encouraging to see that people feel better after doing crafts. But, these 19 studies together do not prove that the benefits last long‐term. More research is needed to get clearer answers.

Key points for occupational therapy.

• Crafts‐based interventions are applicable to diverse client groups within occupational therapy.

• There is evidence that crafts‐based interventions may benefit mental health and well‐being but more high‐quality research is needed.

• Further research is needed on the mechanisms through which crafts‐based interventions operate.

1. INTRODUCTION

The belief that craftwork has a positive influence on health and well‐being is said to date back to antiquity (e.g., Levin, ¹⁹³⁸; Macdonald, ¹⁹⁶⁰; Paterson, ¹⁹⁹⁷). The essence of doing crafts, as opposed to more regulated forms of manual work, is that it demands both physical and cognitive work by the maker (Crawford, 2009). Sennett (2008) stated that ‘Craftsmanship cuts a far wider swathe than skilled manual labor; [it involves] dimensions of skill, commitment, and judgement in a particular way … Every good craftsman conducts a dialogue between concrete practices and thinking’ (p. 9). Crafting involves a constant endeavour that allows someone to become better and better at what they can do with materials as they perfect a skill (Miller, 2011).

However, the use of crafts for therapeutic purposes has not been continuous. There have been times when crafts were purposefully used to promote health and well‐being, for example, with injured soldiers following the Second World War (Colson, 1945). There have also been times when crafts are less in evidence; in education (ENOTHE, ²⁰⁰⁴), in practice (Perrin, 2001), and in the professional literature. The late 19th century was an era when crafts were recognised as having a beneficial effect on human flourishing, with influential writers and public figures, such as John Ruskin and William Morris, arguing that social as well as personal benefits come from allowing workers to have control over the processes and outcomes of their labour, rather than carrying out routine tasks (Morris, ^1888/2008). Ruskin and Morris believed that people who engaged in handicrafts did not just make objects but also created themselves in the process (Sennett, 2008).

The profession of occupational therapy emerged at a time when the arts and crafts movement was flourishing in Europe and North America, and some of the profession's founders had direct links with its leaders (Bukhave & Creek, 2023). For example, one of the founder members of the first professional association of occupational therapists, the National Society for the Promotion of Occupational Therapy (NSPOT), George Barton, worked for a time with William Morris. An American anthropologist, Cheryl Mattingly, observed that: ‘the most clearly “humanist” streak in occupational therapy has its roots in this arts and crafts heritage, with its emphasis on creativity, on the need to create objects that are both useful and beautiful, artefacts of which one can be proud’ (Mattingly, 1994, pp. 68–69). This belief in the health benefits of crafts has been expressed many times in the occupational therapy literature, for example, by Reilly (1962): ‘Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health’ (p. 2).

By the late 20th century, when many occupational therapists were employed in health and social care services (Blom‐Cooper, 1989), crafts came to be seen as less important than other daily life activities, such as personal care, housework, and paid employment (Williams et al., 1987). Shorter stays in hospital, pressure to get people home safely and quickly and a reduced interest in crafting in the wider society can all be seen as contributing factors in occupational therapists moving away from using crafts as therapeutic media.

In the broader literature on health promotion and health care, a clear distinction is not always made between different creative media, which may be called crafts (Brenes, 2007), arts (APPG, ²⁰¹⁷), creative arts (Gorny‐Wegrzyn & Perry, 2022), art therapy (Doric‐Henry, 1997), or creative activities (Schmid, 2005). The terms arts and art therapy, for example, may include craft media and techniques, such as pottery. In order to explore the specific therapeutic potential of each type of activity, it is important to clearly define what we are talking about. For the purposes of this paper:

Craft is defined as an activity involving the creation of objects by skilful use of hands and brain resulting in a material end product;

Crafts‐based interventions involve crafts such as woodwork, pottery, embroidery, knitting and basketry employed as media for therapy (intervention) as sole or supplementary treatment.

The past 20 years have seen an upsurge of interest in the potential health benefits of craft activities, within various professions, including sociologists (Sennett, 2008), philosophers (Crawford, 2009), designers (Charny, 2011), therapists (Perrin, 2001), and politicians (APPG, ²⁰¹⁷). Engaging in craftwork is said to enhance learning (APPG, ²⁰¹⁷), provide opportunities to experience a ‘sense of freedom and control in the world’ (Margetts, 2017, p. 39), promote self‐reliance (Crawford, 2009), and teach people how to govern themselves (Sennett, 2008). Crafts‐based interventions are said to raise self‐esteem, improve mood, counteract social isolation, and reduce anxiety and depression, among other benefits (e.g., Leckey, ²⁰¹¹; Peruzza & Kinsella, ²⁰¹⁰; Reynolds, ²⁰⁰³; Reynolds et al., ²⁰⁰⁸). If these effects can be evidenced, a strong argument can be made for governments to mandate and fund this type of intervention.

Mental health is an integral component of health and well‐being. The WHO (2022) conceptualises it as ‘a state of mental well‐being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community’. Mental health is often measured by levels of stress, anxiety, and depression, as these conditions are common indicators of mental well‐being across all age groups (WHO, ²⁰²²). Stress, anxiety, and depression are a major public health problem worldwide and are associated with increased mortality, higher health‐care costs (medication, hospitalisation, and GP visits), generally a poor prognosis and human suffering (e.g., Gu et al., ²⁰²²; Santini et al., ²⁰²²). Anxiety, depression, or stress may lead to impairment in important areas of functioning, such as family and social life, economic activity, and other occupational roles (Brenes, 2007).

Current health care sometimes incorporates therapies that use crafts, such as pottery, needlework, woodcarving, and gardening, to aid recovery (APPG, ²⁰¹⁷). With increasing recognition of holistic and person‐centred approaches within health care, and a quest for slow‐living, self‐care strategies, there is a resurgence of interest in crafts and their potential health benefits. The influence of crafts on health has long been researched but within small populations and mostly with anecdotal evidence. A scoping review, mapping the evidence of the role of the arts and crafts in improving mental health and well‐being, found positive psychological, physiological, social, and behavioural outcomes within prevention, health promotion, management, and treatment (Fancourt & Finn, 2019). No systematic reviews of the therapeutic benefits of crafts‐based interventions have been identified.

To date, information about the theoretical frameworks, techniques, practices, and dosage (i.e., frequency, duration, and intensity) guiding the use of crafts for mental health and well‐being has yet to be synthesised. Further research is required to systematically report on how such interventions have been implemented and to evaluate the quality of existing evidence. This systematic review aims to determine the effects of crafts‐based interventions on mental health and well‐being. This aim was met via the following two objectives:

• To evaluate evidence for the effectiveness of crafts‐based interventions on adults with mental health disorders or with anxiety, depression, or stress as secondary to a life‐threatening or chronic somatic disease.

• To compare the effects of different types of crafts as media for therapy, delivery mode, and dose against different client groups.

2. METHODS

This systematic review was conducted following A MeaSurement Tool to Assess systematic Reviews (AMSTAR2) (Shea et al., 2017) and reported following the Preferred Items for Systematic Reviews and Meta‐Analyses statement (Moher et al., 2009). The review used methods that were pre‐specified and documented in a protocol (Bukhave et al., 2024).

2.1. Criteria for including studies in this review

Eligibility criteria were established using the PICO framework (Thomas et al., 2024). Eligible studies include adults above the age of 18 years, who had a mental disorder relating to stress, anxiety, or depression as either primary diagnosis or secondary to another mental health condition or relating to a chronic, long‐term or life‐threatening somatic disorder and/or its treatment. Eligible studies include crafts used as media for therapy in groups or individually for any length of time, either as the only treatment or as an adjunctive treatment to supplement other treatments being used (e.g., medication, hospitalisation, and psychotherapy). Outcomes include mental health and well‐being, other unanticipated outcomes, quality of life (QoL), and change in health behaviour.

Studies were included if they met the following criteria:

1. Any study that collected empirical data and reported the effects of a crafts‐based intervention conducted with therapeutic intent with measurable outcomes related to mental health and well‐being.

2. Measures (such as anxiety, depression, stress‐related disorders, or QoL) were applied at baseline and at least once after the intervention. End‐point data are reported only if both end‐point and change data are available for the same outcomes. If scales were used, they were validated.

3. Participants were above the age of 18 years, with a mental disorder relating to stress, anxiety, or depression as either the primary diagnosis or secondary to another health condition or relating to life‐threatening or chronic somatic disorder or its treatment. Participants with any length or stage of illness.

4. Crafts were used as media for therapy, with groups or individuals, as the only treatment or as an adjunct to other treatments (e.g., medication, psychotherapy).

5. The intervention was delivered or supervised by a formally trained therapist, for example, occupational therapist or psychologist.

6. Any treatment setting within health care or the intervention was transferable to a health‐care setting.

Studies were excluded if they met the following criteria:

1. Arts‐based therapies (e.g., drama, music, dance, painting, and writing—i.e., open‐ended self‐expression).

2. Media or interventions with no material end product.

3. Theoretical studies, reviews (systematic, meta‐analyses), studies where crafts had not been part of an intervention, anecdotal narratives, conference proceedings, and book chapters.

2.2. Study design and search strategy

Systematic searches were conducted in the following electronic databases: Scopus, CINAHL (EBSCO), APA PsycInfo (EBSCO), Eric (EBSCO), and ProQuest Dissertations and Theses. The databases were searched from inception date, and we have therefore not applied any date limitations. The search strategy was tested several times in December 2023 and peer‐reviewed by an information specialist before the search was carried out in January 2024. The search strategies are available in Appendix S1. The block building strategy was supplemented by citation searches of all the included studies. The citation searches were carried out using Scopus in June 2024. An overview of the citation searches is available in Appendix S2.

2.3. Selection process

All titles and abstracts from the search were imported into the online systematic review software Covidence. Each study was assessed independently according to the eligibility criteria by two randomly allocated authors. Screening of titles and abstracts was done in two steps. Title screening was an initial filter to determine if publications were relevant to the review; obviously, irrelevant studies were eliminated early on. For the titles that seemed relevant, abstracts were screened. For studies that passed the abstract screening, we obtained and reviewed the full texts to determine their eligibility, based on our inclusion and exclusion criteria. Any conflicts between reviewers were resolved through consensus.

2.4. Data extraction

A data extraction form from the Cochrane Collaboration (Li et al., 2023) was adapted to fit the purpose of this review. A primary allocated review author extracted data and a second review author verified the data extraction, that is, the second reviewer checked if the extracted data were correct and no relevant data had been missed. If there were any discrepancies, they were resolved through consensus. Data extracted from the included articles comprised the following information: title, first author, year of publication, country of origin, aim of study, study design, participant characteristics, sample size, intervention description, types of crafts, delivery, dose, outcomes, measurements and time points, evaluation tools, and comparison intervention, if any.

If further information was needed to assess a study's eligibility, we contacted the corresponding author.

2.5. Quality assessment

Validated critical appraisal tools from the Joanna Briggs Institute (JBI) were used for quality assessment. For mixed methods study design, we used the Mixed Methods Appraisal Tool (MMAT) version 2018 (Hong et al. (n.d.)). One reviewer assessed the quality of the included studies and a second reviewer verified the appraisal. All included papers were critically appraised. If there was disagreement between two review authors, it was resolved by consensus. Studies were included with no regard to the strength of evidence; however, following AMSTAR, the quality assessment is accounted for in individual studies when discussing the review results.

2.6. Synthesis of the included studies

A narrative thematic synthesis method was used to develop an overview of the findings and to support the tabular presentations. Since the included studies represent significant heterogeneity, in key areas such as study designs, intervention types, outcome measurement tools, and study populations, data did not allow for a meta‐analysis. When there is substantial heterogeneity, synthesising data may result in misleading conclusions because the differences between studies outweigh the commonalities. Therefore, individual results need to be considered separately (McKenzie et al., 2024).

2.7. Positionality statements

The first and second authors have strong backgrounds in occupational therapy and health science. The relationship between crafts and health has been a focal point for our practice and scholarly work, and we have both striven to integrate an understanding of that relationship into the knowledge base of occupational therapy. The third author has a background in psychology and entrepreneurship science. She is dedicated to the health‐promoting effects of crafts and the psychology of crafts. The fourth author is a professor in information science with extensive experience in conducting systematic reviews within health science.

3. RESULTS

The total yield of studies from the databases was 14,115. Eighteen studies met the eligibility criteria and were included in the review. A supplementary citation search, performed in June 2024, produced 226 additional references. The citation search brought one new paper to light, which was published after our main search was performed (Yazici et al., 2024). This study was included and underwent the same procedure as the other included studies, resulting in a total of 19 studies being included. The screening of titles and abstracts resulted in 154 conflicts, indicating 98% agreement (Cohen's kappa ranges from 0.15 to 0.58 for the three reviewer combinations). The full‐text screening resulted in 12 conflicts, indicating 85% agreement (Cohen's kappa ranges from 0.44 to complete agreement). Figure 1 details the process of identifying eligible studies for this review.

FIGURE 1.

PRISMA flow diagram for inclusion and exclusion of peer‐reviewed studies. From: Page et al. (2021)—PRISMA 2020 flow diagram for new systematic reviews.

3.1. Dealing with missing data

For three papers, data about who delivered the intervention was unclear and the corresponding author was contacted by email. The requested information was provided by two authors, upon which one study was included (Elkis‐Abuhoff et al., 2008) and one study was excluded as it did not meet our inclusion criteria (Mollaoglu et al., 2023). We received no response from Chetty and Hoque (2012), and the study was excluded.

3.2. Study characteristics

Study characteristics are presented in Table 1 (further details can be found in Appendix S3). Of the 19 included studies, six are mixed methods designs, seven are non‐randomised pre‐and post‐test trials, three are randomised controlled trials (RCTs), one is a pilot RCT, one employed a qualitative design, and one is a registry study. Samples vary from three participants (Haynes, 2015) to 403 participants (Caddy et al., 2012), and the total number of participants in this review is 1224.

TABLE 1.

Study characteristics of included studies.

Study ID	Intervention	Population	Aim	Results	Outcomes	Timing	Study design/size
Akhan/2017	Clay therapy	Neurology patients (stroke or epilepsy)	To determine the effects of clay therapy on hopelessness levels	Mean scores before clay therapy were significantly higher when compared to scores after clay therapy (P = 0.001).	Reduced feelings of hopelessness	40 sessions/30 min/10 weeks	One group pre‐post‐test (n = 50)
Caddy/2012	Diverse crafts	Patients with mental health disorders	To investigate the therapeutic relationship between creative activity and mental health	Sample improved across all measures from admission to discharge, with moderate to strong effect sizes.	Reduced depression, anxiety and stress, improved enjoyment, QoL, and social functioning	3–21 sessions/1.5 h/weeks a	Registry design
Cetinkaya/2019	Ceramic painting	Nursing home residents	To assess cognitive activity and life satisfaction	Statistically significant increase in the mean MMS score (P < 0.05), not statistically significant increase in average life satisfaction scale scores.	Improved cognitive ability, increased life satisfaction	16 sessions/30 min/8 weeks	RCT (n = 15)
Gaspar da Silva/2023	Embroidery	Immigrant women	To examine if and how art therapy practices might help to improve mental health well‐being	Reported benefits related to group cohesiveness, universality and the instillation of hope.	Improved psychological well‐being, reduced loneliness	8 sessions/2 h/weeks a	Narrative inquiry (n = 10)
Doric‐Henry/1997	Pottery	Nursing home residents	To discover whether the pottery intervention brought about a change in self‐esteem, depression or anxiety levels	Significant reduction in levels of depression (alpha level 0.5), significant improvement in self‐esteem (alpha level 0.5), significant reduction in state/trait anxiety (alpha level 0.5).	Decreased depression, increased self‐esteem, reduced anxiety	8 sessions/1 h/8 weeks	Quasi‐experimental design with comparison (n = 40)
Elkis‐Abuhoff/2008	Clay therapy	Parkinson's disease patients	To determine if engaging in the activity would decrease somatic and emotional symptoms	A greater decrease in somatic symptoms and emotional distress in intervention group.	Decreased emotional distress	1 session/unlimited time/1 week	Comparison study with control (n = 41)
Fulton/2016	Woodwork	Community rehabilitation service users (male)	To evaluate a therapeutic community‐based woodwork group for male community rehabilitation programme clients to see if it would decrease isolation and enhance health‐related quality of life	Increase in health‐related QOL Utility Scores, signifying a move towards full health; change in scores was not significant.	Increased health‐related QoL	8 sessions/2 h/8 weeks	Mixed methods with no control (n = 14)
Haynes/2015	Clay therapy	Sex trafficking victims (female)	To determine the effect of clay‐based art therapy on holistic recovery	Positive self‐thoughts, relatedness, lowered guarded boundaries, positive identity; t‐tests for TSC‐40 scores showed one symptom subscale had a statistically significant decrease.	Decreased trauma symptoms incl. anxiety, depression	6 sessions/duration a /6 weeks	Mixed methods (n = 3)
Johnson/2021	Ceramics	Senior housing residents	To explore the potential benefits of participating in ceramics classes	Interest in life, perceived mastery, statistically significant improvement; general belongingness: not significant improvement; perceived neighbourhood cohesion, personal growth, loneliness—No change; psychosocial benefits identified.	Improved interest in life, belongingness and psychosocial benefits: Emotional well‐being, social network and social support, interest in life/purpose, self‐efficacy and artistic identity	12 sessions/1.5 h/12 weeks	Mixed methods pilot study with control (n = 60)
Kim/2020	Food art	Persons with schizophrenia or depression	To verify the effects of food art therapy on the self‐esteem, self‐expression and social skills of people with mental illness	Significant increase in self‐esteem (t = 6.86, P < 0.001), improvement in self‐expression, (t = 8.12, P  < 0.001) and improved social skills in both groups.	Improved self‐esteem, self‐expression and social skills	8 sessions/80–90 min/16 weeks	Quasi‐experimental design with no comparison (n = 30)
Kimport/2015	Clay therapy	Psychiatric inpatients	To investigate whether creating a pinch pot would decrease state anxiety	Significant decrease (P = 0.001) in state anxiety from 46.84 to post‐test score 39.33.	Decreased anxiety	1 session/10 min/1 week	One group pre‐post‐test (n = 49)
Lee/2022	Food art	Persons with mild dementia or mild cognitive impairment	To identify the impact of the intervention on cognitive ability, daily living, depression, self‐esteem, self‐efficacy, self‐expression, and social functioning in older adults with MCI and mild dementia	Cognition scores significantly higher (P = 0.001). Self‐expression and self‐efficacy did not change. Depression scores were significantly higher (P = 0.002) and self‐esteem scores were significantly higher in the control group (P = 0.011).	Enhanced cognitive, emotional and social functioning	12 sessions/2 h/4 weeks	Mixed methods with control (n = 39)
Leonard/2022	Knitting	Women with hand OA	To examine the effect of the programme on morning stiffness, pain, functional status, hand and physical activity level, global impression of change, health‐related QoL, self‐efficacy, and grip strength	No significant change for any measures (P = <0.05).	No change in levels of depression and anxiety	16 sessions/20 min/8 weeks	Single‐blind two arm pilot RCT with parallel group (n = 37)
Morse/2015	Diverse crafts	Mental health and addiction recovery service users	To examine if confidence, sociability and well‐being would improve significantly between first and final sessions	Large effect sizes for confidence, sociability, and well‐being (P < 0.001), supported by qualitative results.	Improvement in confidence, sociability and well‐being	3–21 sessions/½‐1 day/3–21 weeks	Mixed methods with control (n = 144)
Mouradian/2013	Scrapbooking	Parents of neonatal infants	To examine whether an art‐based occupation group using scrapbooking in the neonatal intensive care unit (NICU) would reduce parent stress and anxiety	Reduced state anxiety from a mean pre‐activity level of 40.4 to a mean post‐activity level of 27.7. Decline in trait anxiety from 37.4 to 34.8, a mean of 2.6 points (statistically significant due to heterogeneity among the participants). Qualitative data support the findings.	Reduced anxiety, reduced social isolation.	1 session weekly/2 h/any length of weeks	Mixed methods single group pre‐ and post‐test design (n = 40)
Nan/2017	Clay therapy (CAT)	Depression outpatients	To aid in reducing symptoms of MDD, to improve general health, body–mind‐spirit well‐being, and expression of feelings	Changes in both depressive signs and general health in the CAT group revealed a large effect. BMS well‐being also showed significant improvement after treatment.	Reduced depression, improved general mental health and holistic well‐being.	6 sessions/2.5 h/6 weeks	RCT (n = 106)
Perez‐Saez/2020	Pottery	Dementia day care users and residents	To assess the effects of a pottery workshop, discover if it improves self‐esteem and measure if mood state improves	Mood improved from a mean of 3.74 (SD = 0.74) pre‐test to 4.46 (SD = 0.50) post‐test. Self‐esteem scores raised from mean of 31.36 (SD = 3.685) to 34.88 (SD = 3.428). No significant effect on pleasure, negative affect and sadness.	Increased self‐esteem and mood, enhanced well‐being	10 sessions/45 min/10 weeks	Repeated measures design with no control (n = 30)
Yazici/2024	Clay therapy	Chronic stroke patients	To examine the effect of clay therapy on hopelessness and depression levels	Depression post‐test scores (P < 0.05), hopelessness post‐test scores (P < 0.05).	Reduced depression and feelings of hopelessness	16 sessions/1 h/8 weeks	RCT (n = 60)
Özkafaci/2020	Marbling	Domestic violence survivors with PTSD (female)	To examine the effect of art psychotherapy using marbling art on depression, anxiety and hopelessness in female survivors of domestic violence with post‐traumatic stress disorder (PTSD)	Statistically significant difference between pre‐ and post‐test for depression (z = −2.041 P < 0.05), hopelessness (z = −2.220 P < 0.05) and anxiety (z = −2.214 P < 0.05) scores.	Reduced depression, anxiety, feelings of hopelessness.	14 sessions/2 h/14 weeks	Quasi‐experimental design with no comparison (n = 8)

^a information not provided.

Three studies were reported to be part of an educational effort, such as a master's degree (Doric‐Henry, 1997; Gaspar da Silva, ²⁰²³; Haynes, ²⁰¹⁵), and 16 studies were original articles, feature articles, and research reports. Results are presented below, using the PICO format.

3.3. Participants

The majority of client groups related to mental disorders (n = 6) (see Table 1). However, there was a great diversity in study populations, ranging from survivors of sex trafficking (Haynes, 2015) to parents of neonatal infants (Mouradian et al., 2013) and women with hand osteoarthritis (Leonard et al., 2021). Across studies, participants were aged between 18 and 95 years. Mixed‐gender populations with a majority of females were the most common; five studies were conducted with one gender only (Fulton et al., 2016; Gaspar da Silva, ²⁰²³; Haynes, ²⁰¹⁵; Leonard et al., ²⁰²¹; Özkafacı & Eren, ²⁰²⁰). One study reported no data on gender (Yazici et al., 2024). Diverse intervention settings were reported, from a safe house to an art gallery.

3.4. Intervention

A range of crafts was used as media for therapy (see Table 1). Activities using clay or related to clay work constituted the majority of crafts‐based interventions (n = 11). Eight studies used pottery as the only craft medium; two studies used clay modelling as part of the crafts‐based intervention (Caddy et al., 2012; Johnson et al., ²⁰²¹), and one study used a ceramics‐related activity (Çetinkaya et al., 2019). Two studies used textile crafts, embroidery (Gaspar da Silva, 2023), and knitting (Leonard et al., 2021) and two studies used papercrafts (Mouradian et al., 2013; Özkafacı & Eren, ²⁰²⁰). Three studies used a mix of two or more of the types of crafts mentioned above (Caddy et al., 2012; Johnson et al., ²⁰²¹; Morse et al., ²⁰¹⁵). The discipline of art therapy is strongly represented in delivering the intervention (n = 9). Other health‐care professionals delivered or supervised the intervention in seven studies: nurses (n = 4) and occupational therapists (n = 3).

Nine of the included studies reported that the intervention was based on theoretical frameworks; mainly psychotherapy, art therapy, and psychodynamic theory (e.g., Csikszentmihalyi, ¹⁹⁹⁰; Malchiodi, ¹⁹⁹⁹; Yalom, ¹⁹⁸³). The studies that drew on art therapy (e.g., Akhan et al., ²⁰¹⁷; Gaspar da Silva, ²⁰²³; Kimport & Hartzell, ²⁰¹⁵; Yazici et al., ²⁰²⁴) offered hypotheses about the relationship between crafts and health, for example, as stated by Elkis‐Abuhoff et al. (2008):

Malchiodi posited that healing involves a process of becoming whole both physically and psychologically, and that art may function to help synthesise and integrate a patient's pain and loss. As a result, the creative process may produce positive physical changes in the body. (p. 123)

Five papers provided no information about the theoretical basis of the intervention (Caddy et al., 2012; Çetinkaya et al., ²⁰¹⁹; Fulton et al., ²⁰¹⁶; Haynes, ²⁰¹⁵; Leonard et al., ²⁰²¹). Johnson et al. (2021) reported having followed the EngAGE Inc. concept for the delivery, but this was not referenced. Five studies collected empirical evidence (Doric‐Henry, 1997; Kimport & Hartzell, ²⁰¹⁵; Lee et al., ²⁰²²; Morse et al., ²⁰¹⁵; Pérez‐Sáez et al., ²⁰²⁰). Only one study identified the active components of the intervention: Johnson et al. (2021) provided a table of proposed mechanisms such as ‘trying new things’, ‘sharing ideas’ and ‘mastering new skills’ (p. 265).

Treatment duration varied considerably, from a single 10‐min session (Kimport & Hartzell, 2015) to 2‐h sessions over 14 weeks (Özkafacı & Eren, 2020). Positive short‐term effects were reported across all studies.

None of the studies stated explicitly what criteria determined delivery and dose (e.g., funding). In the studies that included complete data on timing, 2‐h sessions were most common and were applied with diverse client groups, such as male community rehabilitation service users, persons with dementia, parents of neonatal, and female survivors of domestic violence (Fulton et al., 2016; Lee et al., ²⁰²²; Mouradian et al., ²⁰¹³; Özkafacı & Eren, ²⁰²⁰). The most common length of treatment was 8 weeks and was applied with mature client groups, including nursing home residents, community rehabilitation service users, women with hand osteoarthritis, and chronic stroke patients (Çetinkaya et al., 2019; Doric‐Henry, ¹⁹⁹⁷; Fulton et al., ²⁰¹⁶; Leonard et al., ²⁰²¹; Yazici et al., ²⁰²⁴).

3.5. Comparison

Of the included papers, nine employed control groups. The most common comparison was usual care (n = 6). Usual care was described as, for example, social skills training/sports, recreational classes, physiotherapy, and rehabilitation. One study used delayed‐start control groups (Johnson et al., 2021) and one compared scores between two different diagnostic groups within the intervention group (Morse et al., 2015). One study used a comparison group with a non‐clinical sample (Elkis‐Abuhoff et al., 2008). Two studies reported no information about the comparison group except that they were non‐participants (Çetinkaya et al., 2019; Doric‐Henry, ¹⁹⁹⁷).

3.6. Outcomes of individual studies

We included any study that collected empirical data on the effect of the intervention. Results indicated that crafts‐based interventions have a positive short‐term effect on depression, anxiety, stress, and mental well‐being. Across the included studies, the effect was measured immediately or shortly after the intervention, with limited measurement of long‐term effects. An exception is Leonard et al. (2021), who measured the effect at a 12‐week follow‐up and found no change in depression and anxiety.

The outcome measures used across studies differ considerably. Apart from a variety of validated scales, they also comprise questionnaires designed for the specific study and qualitative evaluation tools (see Appendix S4). Results and possible associated outcomes are not always clearly separated. The outcomes reported were measurable and mostly symptom‐oriented. We excluded studies with an occupation‐based focus if they did not meet our inclusion criteria.

Power was calculated in four studies (Çetinkaya et al., 2019; Lee et al., ²⁰²²; Mouradian et al., ²⁰¹³; Yazici et al., ²⁰²⁴). Some of the included studies were of high quality (Akhan et al., 2017; Çetinkaya et al., ²⁰¹⁹; Doric‐Henry, ¹⁹⁹⁷; Johnson et al., ²⁰²¹; Lee et al., ²⁰²²) and support the use of crafts‐based interventions for mental health and well‐being. Other studies concluded that craft activities may benefit mental well‐being and promote social functioning (e.g., Caddy et al., ²⁰¹²) but presented no clear evidence to support the claim.

Outcomes are presented below in two groupings, based on the findings: depression/anxiety/stress/mental well‐being, and health‐related quality of life (QoL)/life satisfaction.

3.6.1. Depression, anxiety, stress, and mental well‐being

Six studies using control groups reported positive changes in depression, anxiety, stress, and well‐being. One study found no effect.

The study by Elkis‐Abuhoff et al. (2008) examined the effect of clay manipulation on individual Parkinson's disease patients (n = 41) at a research institute. Delivery was structured with the choice of one from four coloured clay balls, instruction to squeeze 10 times in each hand, followed by pulling the ball apart and shaping a form of free choice other than a ball. Outcomes were measured post‐intervention and compared against a non‐clinical sample (n = 19). The study reported decreased emotional distress in both groups, with greater change in the intervention group.

The study by Doric‐Henry (1997) examined the effect of pottery as an individual intervention for residents (n = 40) in an evangelical nursing home. Delivery was designed to take participants through the entire ceramics process, with each completing one piece of work. Scores for depression, self‐esteem, and anxiety, measured post‐intervention, were reported to be statistically significant. Outcomes were compared against non‐participants on site.

The study by Lee et al. (2022) investigated the impact of a multimodal food art (MM‐FAT) group intervention with a mixed group of people with mild cognitive impairment and mild dementia (n = 39). Delivery was structured with a 15‐min warm‐up (e.g., stretching), 20 min sharing personal stories relating to the session's theme, 65 min creating artworks and 20 min sharing and reflecting on the process. Themes were structured around lifetime sequences. A positive effect was reported for emotional and social functioning. Outcomes were measured post‐intervention and at 1‐month follow‐up and compared against an equivalent control group.

The study by Nan and Ho (2017) examined the effect of clay therapy on mental health and well‐being as a group intervention for depressed outpatients (n = 106) at three community health centres. The delivery was structured with a brief discussion of the treatment process at the beginning and sharing the products at the end of each session. Scores for depression and general mental health post‐intervention and at 3‐week follow‐up indicated the therapy was effective. The outcome was measured against an equivalent group.

The study by Yazici et al. (2024) examined the effect of clay therapy on hopelessness and depression as group intervention with chronic stroke patients (n = 60) at a hospital rehabilitation unit. The delivery of each session was structured into the phases of introduction, activity, and conclusion, including free choice of project. Outcomes were measured post‐intervention and compared with an equivalent control group. The study reported decreased depression and reduced feelings of hopelessness to be statistically significant.

The study by Leonard et al. (2021) investigated the effect of knitting on women with hand osteoarthritis (n = 37). The settings were a seniors' club for group sessions and home‐based individual sessions. No information was provided on how the delivery was structured. Outcomes were measured post‐intervention and at 12‐week follow‐up and were compared with an equivalent control group. No significant change was found for levels of depression and anxiety.

Eleven studies conducted without comparative controls reported positive changes in depression, anxiety, stress, and well‐being:

The study by Akhan et al. (2017) examined the effect of individual clay therapy on patients (n = 50) with stroke (90%) or epilepsy (10%). The delivery was described as one session introducing clay followed by autonomous work with ornaments in a hospital setting. Outcomes were measured at discharge and at 3‐week follow‐up. The scores for feelings of hopelessness were reported as reduced and statistically significant.

The study by Caddy et al. (2012) examined retrospectively the effect of diverse crafts (beading, sewing, clay work, papercrafts, etc.) for psychiatric inpatients (n = 403) at a private psychiatric hospital. Information about the delivery was not provided. The study was based on deidentified patient data stemming from discharge. It reported reduced depression, anxiety, and stress, as well as improved life satisfaction and social functioning.

The study by Gaspar da Silva (2023) examined the effect of storytelling embroidery as a group intervention for Portuguese‐speaking immigrant women (n = 10), in a virtual setting due to COVID‐19 restrictions. The delivery was described as 1 week of learning stitches, followed by 6 weeks of freely creating images depicting personal stories, finishing with a 2‐week virtual art exhibition. Outcomes were measured post‐intervention with qualitative tools. The study findings indicated improved psychological well‐being and reduced loneliness.

The study by Haynes (2015) examined the effect of clay therapy on trauma symptoms in survivors of sex trafficking (n = 3) in a safe house. Information about the delivery was reported as directives aimed at holistic recovery, but no further information was provided about the structure. Outcomes were measured 1 week after the final intervention. The findings indicated decreased trauma symptoms, including reduced depression and anxiety.

The study by Johnson et al. (2021) explored potential benefits to well‐being of participating in visual arts (ceramics or collage) and literary arts (creative writing or storytelling) classes for older adults at four affordable senior housing sites (n = 60). The delivery was structured according to the EngAGE concept: intention setting, goal setting, acknowledging the work done, and a culminating exhibition event. The outcomes were measured post‐intervention against a delayed‐start control group. Qualitative findings indicated psychosocial benefits, such as emotional well‐being, social networking, interest in life, and self‐efficacy for all classes. Similar results emerged from quantitative data on interest in life, perceived mastery, and belongingness for the ceramics classes, with no change in loneliness.

The study by Kim et al. (2020) investigated the effects of food art therapy on self‐esteem, self‐expression, and social skills as a group intervention with people with schizophrenia (n = 90%) and depression (n = 10%) (n = 30) at three mental health facilities. The delivery was structured with a greeting, a brief discussion about the weather and an introduction to the day's topic, which shifted between sessions. Outcomes were measured after the last session. The findings indicated a positive impact on participants' self‐esteem, self‐expression, and social skills.

The study by Kimport and Hartzell (2015) investigated the effect on anxiety of clay manipulation as an intervention with psychiatric inpatients (n = 49) at a private psychiatric hospital. The delivery was structured with a choice between two balls of different air‐dry clay (baseball size), a brief demonstration of technique by the therapist, 10 min forming a pinch pot and no evaluation of the product. Outcomes were measured immediately after the intervention, and decreased anxiety was reported.

The study by Morse et al. (2015) examined the effect on well‐being of diverse crafts (e.g., bookbinding, photography, stained glass, and textiles) as a group intervention for mental health (n = 85) and addiction (n = 59) service users (n = 144) at a museum, art gallery, and archive service. The delivery was structured with facilitated conversation in early sessions, introduction to different art activities, free choice of activity, either individually or as a group, and a culminating exhibition for friends and family. Outcomes were measured at the last session and were compared between the two different diagnostic groups of participants. The study indicated improved well‐being and sociability across both groups.

The study by Mouradian et al. (2013) examined the effect on stress of scrapbooking as a group intervention for parents of newborn infants (n = 40) at a neonatal intensive care unit. The delivery was structured by showing samples of scrapbook pages, assisting with supplies and equipment, and providing non‐directive suggestions and support to parents. Outcomes were measured post‐intervention, and findings indicated reduced anxiety and stress.

The study by Pérez‐Sáez et al. (2020) examined the effect of a pottery group intervention on self‐esteem and mood in people with Alzheimer's disease and other forms of dementia (n = 30) at a dementia‐specialised facility. The delivery was organised with staff providing help and instructions during sessions; however, no information was provided about how sessions were structured. Outcomes were measured following the last session and findings indicated increased self‐esteem, regardless of participants' stage of dementia, enhanced mood, and increased well‐being.

The study by Özkafacı and Eren (2020) examined the effect of marbling as a group intervention with female survivors of domestic violence with PTSD (n = 8) at a private counselling centre. The delivery was structured with a 15‐min introduction, 15 min of breathing warm‐ups, 30 to 40 min of marbling, and 30 to 40 min sharing and discussion. Sessions were accompanied by music. Outcomes were measured post‐intervention. Findings indicated decreased depression and anxiety and reduced feelings of hopelessness.

3.6.2. Health‐related QoL and life satisfaction

One study using a control group reported positive changes in life satisfaction.

Çetinkaya et al. (2019) examined the effect on cognitive ability and life satisfaction of ceramic painting as a group intervention with older residents in a nursing home (n = 30). The sessions were structured with 5 to 10 min chatting, free choice of materials, 30 to 35 min of activity, and 10 min feedback. Groups were of five and gender separated. Outcomes were measured post‐intervention against a control group receiving no art therapy (n = 15). The authors reported an increased average in life satisfaction, although no statistically significant change was found.

One study conducted without comparative controls reported a positive change in health‐related QoL.

Fulton et al. (2016) examined the effect on social isolation and health‐related QoL of woodwork as a group intervention with male community rehabilitation service users (n = 14). Participants worked in groups of four to enable getting to know each other. Individually tailored projects were completed within the time frame of the programme. The structure for each session was facilitator‐led informal discussion at the beginning and end, safety orientation, activity, and clean‐up. Outcomes were measured post‐intervention, and findings indicated an increase in health‐related QoL.

3.7. Quality assessment

The quality assessment revealed that the quality of included studies varied considerably. There are examples of high‐quality studies (Akhan et al., 2017; Çetinkaya et al., ²⁰¹⁹; Doric‐Henry, ¹⁹⁹⁷; Johnson et al., ²⁰²¹; Lee et al., ²⁰²²), although many suffer from methodological weaknesses. The quality of studies was not tied to the study design. Common issues relating to moderate to high risk of bias included: failure to blind outcome assessors, incomplete outcome data, and lack of clarity about how the intervention was administered. Details of the quality assessment can be found in Appendix S5. In summary, the varying quality of the studies suggests that recommendations based on the findings should be made with caution.

4. DISCUSSION

This systematic review provides an overview of current evidence for the effectiveness of crafts‐based interventions for adults with mental health disorders or with stress, anxiety, or depression relating to chronic or life‐threatening somatic disease.

We begin this discussion by summarising the evidence for the effects of crafts‐based interventions and assessing the strength of that evidence. We then discuss the extent to which the research has explored the mechanisms through which crafts‐based interventions bring about change and what we can learn from this about the most appropriate craft medium, delivery mode, and dose for different client groups.

4.1. Evidence for the effects of crafts‐based interventions

The first objective of this systematic review was to evaluate evidence for the effectiveness of crafts‐based interventions in adults with mental health disorders or with anxiety, depression, or stress as secondary to a life‐threatening or chronic disease. An All‐Party Parliamentary Group (APPG) report on arts, health, and well‐being, published in the United Kingdom in 2017, looked at a range of different forms of evidence for the relationship between arts and health, including randomised controlled trials, qualitative methods, and economic analysis (APPG, ²⁰¹⁷). However, the report suggested that ‘a departure from biomedical, positivist philosophy’ (op cit, p. 39) was advisable and advocated a realist approach to capture the many factors shaping the impact of arts participation on health and well‐being. Since this review excluded studies that took such a realistic approach, it may have missed some of the forms of evidence advocated by the APPG.

The 19 studies included in this review explored the effects of a range of crafts‐based interventions on the health and well‐being of a variety of client groups. None of the studies was designed to test theories about the relationship between crafts and health or to build theories about the mechanisms by which engagement in crafts can affect health and well‐being. It has been postulated that one of the barriers to understanding how creativity might enhance well‐being and quality of life is that studies of creativity tend to focus on highly creative people rather than on the everyday creativity of ordinary people (Reynolds, 2005). ‘As a consequence, we … cannot be completely sure about the role of creativity in preserving or promoting health and well‐being’ (op cit, p.108).

According to the scoping review by Fancourt and Finn (2019), arts activities (including crafts) ‘can be considered as complex or multimodal interventions in that they combine multiple different components that are all known to be health promoting’. These components include, but are not limited to characteristics of the therapist; setting; craft medium(s) used; characteristics of participants; the way delivery is structured; instructions given to participants; participants' level of autonomy; group dynamics; relationship between therapist and patient; and environment (Bukhave & Creek, 2023; Mosey, ¹⁹⁸⁶; Ryan & Deci, ²⁰¹⁷). This means that crafts‐based interventions can be defined as complex interventions with several interacting components (Skivington et al., 2021). All the components need to be identified in order to evaluate which ones are the active ingredients of any change. None of the included studies described the intervention as complex or named its separate components. It is, therefore, not possible to identify the active components of the intervention or the mechanisms of action in any of the studies. However, in their study limitations section, Lee et al. (2022) reflected that ‘future studies should investigate each modality's degree of impact to apply for the best dose in relation to the baseline characteristics and desired outcome measures of target’ (p. 370). Defining crafts‐based interventions as complex interventions might also help to overcome the challenges related to differences in terminology, the diversity of crafts used, and the range of clinical variables.

The report on The Arts for Health and Well‐being (APPG, ²⁰¹⁷) concluded that ‘there are gaps in the evidence base in areas such as prevention, management of long‐term conditions and delaying dementia onset’ (p.156) and that more evidence is needed of sustained benefits over time in larger population groups. The findings of this review confirm what was previously concluded by Leckey (2011) and recently by Liu et al. (2024) that further research is needed to confirm the effectiveness of crafts‐based interventions. Leckey (2011) conducted a systematic review that indicated a possible reduction in anxiety and depression after exposure to creative activities (arts and crafts) in patients within mental health care. Liu et al. (2024) conducted a scoping review investigating the use of creative activities (arts and crafts) for psychological well‐being. They found support for the potential positive role of creative activities in stroke rehabilitation but recommended further, in‐depth research.

Some of the included studies attempted to confirm or build on evidence from prior studies (Doric‐Henry, 1997; Kim et al., ²⁰²⁰; Kimport & Hartzell, ²⁰¹⁵; Morse et al., ²⁰¹⁵; Pérez‐Sáez et al., ²⁰²⁰). For example, Lee et al. (2022) stated that they structured their preliminary programme based on a literature review of food art therapy and discussions with mental health professionals at community rehabilitation facilities. The intervention setup in most studies was designed to fit the local purpose and context, as is appropriate for a complex intervention. However, this idiosyncratic structure reduces the generalisability of the findings.

Across the included studies, the effects were measured immediately or shortly after the intervention, with limited measurement of long‐term effects. An exception is Leonard et al. (2021), who measured the effects at a 12‐week follow‐up and found no change in depression and anxiety.

In conclusion, the studies included in this review neither tested existing theories about the relationships between crafts‐based interventions, health, and well‐being nor generated new theories. None offer a theoretical justification for the use of crafts‐based interventions with different client groups, and none define the intervention as complex. This review confirmed the findings of other reviews (Leckey, 2011; Liu et al., ²⁰²⁴) and inquiries (APPG, ²⁰¹⁷; Keyes et al., ²⁰²⁴) that there are gaps in the evidence base for the effects of crafts‐based interventions.

4.2. The mechanisms of change

The second objective of this systematic review was to compare the effects of different types of crafts as media for therapy, delivery mode, and dose against different client groups. We deal first with the types of craft and client groups involved in the 19 included studies.

Across the 19 studies, five main types of crafts were used in interventions: pottery, food art, woodwork, textile crafts, papercrafts, and a mix of crafts. Pottery was the most commonly used medium and was applied to a diverse range of client groups, including patients with stroke or epilepsy (Akhan et al., 2017; Yazici et al., ²⁰²⁴); nursing home residents (Çetinkaya et al., 2019; Doric‐Henry, ¹⁹⁹⁷); Parkinson's disease patients (Elkis‐Abuhoff et al., 2008); survivors of sex trafficking (Haynes, 2015); senior housing residents (Johnson et al., 2021); patients with mental health disorders (Caddy et al., 2012; Kimport & Hartzell, ²⁰¹⁵; Nan & Ho, ²⁰¹⁷), and persons with Alzheimer's disease or other forms of dementia (Pérez‐Sáez et al., 2020) (see Table 1). Pottery was found to be effective in decreasing depression, anxiety, and emotional distress; in reducing feelings of hopelessness; and in increasing self‐esteem and interest in life (Akhan et al., 2017; Doric‐Henry, ¹⁹⁹⁷; Elkis‐Abuhoff et al., ²⁰⁰⁸; Yazici et al., ²⁰²⁴) in diverse client groups such as patients with stroke or epilepsy (Akhan et al., 2017; Yazici et al., ²⁰²⁴); nursing home residents (Çetinkaya et al., 2019; Doric‐Henry, ¹⁹⁹⁷); Parkinson's disease patients (Elkis‐Abuhoff et al., 2008); survivors of sex trafficking (Haynes, 2015); senior housing residents (Johnson et al., 2021); patients with mental health disorders (Caddy et al., 2012; Kimport & Hartzell, ²⁰¹⁵; Nan & Ho, ²⁰¹⁷); and persons with Alzheimer's disease or other forms of dementia (Pérez‐Sáez et al., 2020). Based on these findings, we can conclude that pottery as a crafts‐based intervention is flexible and applicable to diverse client groups.

Some types of crafts were applied with specific genders, for example, textile crafts with women (Gaspar da Silva, 2023; Leonard et al., ²⁰²¹) and woodwork with men (Fulton et al., 2016). However, the choice of crafts was not justified against the desired outcome in any of the studies, so it is not possible to draw conclusions about which types of crafts are most suitable for particular client groups. In addition, the studies used a wide range of scales and measured different outcomes, which complicates any comparisons (see Appendix S4).The next part of our discussion considers evidence about delivery and dose of crafts‐based interventions for different client groups. In most studies, the intervention was presented as an entity rather than as a complex intervention, which means that there is limited information about such variables as delivery and dose. Some studies reported the content or structure of the intervention (e.g., Kim et al., ²⁰²⁰; Lee et al., ²⁰²²; Özkafacı & Eren, ²⁰²⁰), one study reported grading the activity to fit the individual in a group intervention (Fulton et al., 2016), and six studies made explicit the level of autonomy of participants, operationalised as, for example, free choice of technique, materials, or product, (Akhan et al., 2017; Çetinkaya et al., ²⁰¹⁹; Gaspar da Silva, ²⁰²³; Haynes, ²⁰¹⁵; Kimport & Hartzell, ²⁰¹⁵; Morse et al., ²⁰¹⁵). A study by Keyes et al. (2024), based on a population survey, supports well‐being benefits of engaging in general crafting regardless of dose and delivery in self‐initiated craft activities. They report the health benefits to match or exceed the influence of socio‐demographic factors and thus conclude crafting to be a useful tool at a public health level.

In conclusion, it was not found possible to synthesise or compare the findings of different studies, due to the wide range of differences between them. This issue was compounded by none of the studies defining the crafts‐based intervention as complex nor attempting to identify all the active components of the intervention. While change was measured in all the included studies, there was no attempt to explain the mechanisms by which change was initiated or sustained. It is, therefore, difficult to make any strong recommendations from this review about delivery and dose for specific client groups, considering the gaps in information and the situated nature of each intervention.

4.3. Limitations

This review has attempted to identify and quantify the effects of crafts‐based interventions on mental health and well‐being. Every effort was made to trace and critically evaluate all existing studies, including reaching out to the authors of some included and excluded papers in order to measure the quality of these studies as objectively as possible and in accordance with our protocol.

However, although our literature search included the most important databases and sources of empirical studies of crafts‐based interventions, we cannot rule out the possibility that some relevant publications were missed. To reduce the chances of this happening, we performed citation searches; however, future updates of this review could consider searching more databases, including those from low‐ and middle‐income countries.

The findings were based on numerically few studies that covered many different types of interventions, delivery, population, and duration, making it difficult to compare outcomes. The majority of studies had less than 50 participants, which means that care should be taken in generalising the findings.

4.4. Implications for practice and future research

The findings from this review suggest that there is some potential for crafts‐based interventions to be used in the treatment of depression, anxiety, and stress and to improve subjective well‐being. Practitioners should be aware, however, that there is limited research‐based evidence to support the therapy's effectiveness.

It is recommended that further, high‐quality research should be undertaken to investigate the mechanisms through which crafts‐based interventions may benefit mental health and well‐being and to confirm which populations may benefit.

AUTHOR CONTRIBUTIONS

All authors contributed to the development of the study concept and design. Screening of papers, analysis, and data extraction were carried out by EBB, JC, and AK. The first draft of the manuscript was prepared by EBB and JC, with contributions from TFF. All authors contributed to the refinement of the manuscript.

CONFLICT OF INTEREST STATEMENT

The authors have no conflict of interest to declare.

Supporting information

Appendix S1. Search history – all databases

Appendix S2. Citation search performed in Scopus June (7th + 20th) 2024

Appendix S3. Supplementary overview of study characteristics

Appendix S4. Overview of measures and scales in included studies

Appendix S5. JBI CRITICAL APPRAISAL CHECKLIST FOR QUASI‐EXPERIMENTAL STUDIES

Bukhave, E. B. , Creek, J. , Linstad, A. K. , & Frandsen, T. F. (2025). The effects of crafts‐based interventions on mental health and well‐being: A systematic review. Australian Occupational Therapy Journal, 72(1), e70001. 10.1111/1440-1630.70001

DATA AVAILABILITY STATEMENT

The data supporting this study's findings are available in the appendices.