The role of receptive arts and culture to improve anxiety, depression and psychological distress in young people: a realist review.

BACKGROUND

Arts and culture are increasingly recognised as potential supports for mental health, yet little distinction has been made between receptive engagement (e.g., visiting museums, watching performances, listening to music) and active participation (e.g., creating art or attending classes). There is limited understanding of how, for whom, and under what circumstances receptive engagement may influence anxiety, depression, and psychological distress in young people.

METHOD: We conducted a realist review of evidence up to February 2026 to examine how receptive arts and cultural engagement may affect mental health in young people aged 16-24 years. An initial programme theory, developed through the Online Active Community Engagement programme, stakeholder consultation, and peer research, informed the search and guided analysis. We searched five academic databases and relevant grey literature. Eligible documents were screened against predefined criteria. Context-mechanism-outcome configurations (CMOCs) were developed iteratively with peer researchers and the research team to refine the programme theory.

RESULTS

Eleven documents were included. Evidence supported CMOCs indicating that receptive engagement may support mental health through: (i) short-term affective relief via attentional shift and escapism; (ii) reflection and perspective-taking through exposure to diverse viewpoints; (iii) increased belonging through perceived human connection; (iv) identity safety through representation and inclusive content; and (v) support for emotion regulation when engagement is regular and accessible. Effects were most consistent for proximal outcomes during or shortly after engagement, with limited evidence for sustained reductions in anxiety, depression, or psychological distress beyond the engagement period.

CONCLUSIONS

Receptive arts engagement may provide an acceptable, low-stigma form of support that complements, rather than replaces, clinical care. Benefits may occur across the continuum of need and contribute to prevention, particularly when engagement is relevant, inclusive, and sustained. Evidence for longer-term symptom reduction remains limited and warrants further investigation.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023476421, PROSPERO 275 (CRD42023476421).