Analysis of the screening and predicting characteristics of the house-tree-person drawing test for mental disorders: A systematic review and meta-analysis

Abstract

BackgroundThe house-tree-person (HTP) drawing test has received growing attention from researchers as a common projective test. However, the methods used to select and interpret drawing indicators still lack uniformity.ObjectiveThis study aims to integrate drawing indicators into the process of screening for or classifying mental disorders by conducting a systematic review and meta-analysis of the application of the HTP test.MethodsA search of the following electronic databases was performed in May 2022: PubMed, Web of Science, Embase, EBSCO, CNKI, VIP, and Wanfang. Screening and checking of the literature were performed independently by two researchers. The empirical studies published on the use of the HTP test in mental disorders and studies providing specific data on the occurrence frequency of drawing characteristics were analyzed. A total of 30 studies were included in the meta-analysis, including 665 independent effect sizes and 6,295 participants. The strength of the association between drawing characteristics of the HTP test and the prevalence of mental disorders was measured by the ratio (OR) with a 95% CI. Publication bias was assessed using a funnel plot, Rosenthal’s fail-safe number (Nfs), and the trim and fill method.ResultsThe results revealed 50 drawing characteristics that appeared at least three times in previous studies, of which 39 were able to significantly predict mental disorders. The HTP test can be divided into the following four dimensions: house, tree, person, and the whole. These dimensions reflect the structure, size, and other characteristics of the picture. The results showed that the greatest predictor of mental disorders was the whole (OR = 4.20, p < 0.001), followed by the house (OR = 3.95, p < 0.001), the tree (OR = 2.70, p < 0.001), and the person (OR = 2.16, p < 0.001). The valid predictors can be categorized into the following four types: item absence, bizarre or twisted, excessive details, and small or simplified. The subgroup analysis showed that the affective-specific indicators included no motion, leaning house, and decorated roof; thought-specific indicators included excessive separation among items, no window, loss of facial features, and inappropriate body proportions; and common indicators of mental disorders included no additional decoration, simplified drawing, very small house, two-dimensional house, and very small tree.ConclusionThese findings can promote the standardization of the HTP test and provide a theoretical reference for the screening and clinical diagnosis of mental disorders.

Research on the Application of Tree Drawing Projection Tests in the Auxiliary Diagnosis and Condition Assessment of Depression

“…Currently, the clinical diagnosis and severity assessment of depression primarily rely on clinician interviews combined with patient history and supplemented by scale assessments. Despite the diagnostic standards provided by manuals such as the DSM and ICD, these methods cannot completely avoid the drawback of subjectivity in assessments [5]. Projection tests, as one of the three major techniques in psychology, can compensate for the de ciencies of scales.…”

“…The Tree Drawing Projection Test, a psychological projective test, has proven useful in assessing depression and other emotional disorders. The test relies on the free expression of subjects to non-speci c stimuli, revealing their inner world and emotional state through the interpretation of tree drawings [5][6][7][8]. Compared to traditional psychological tests, the Tree Drawing Projection Test is simple to administer, imposes less psychological stress on subjects, and can mitigate intentional control by subjects to some extent[6; [9][10][11].…”

“…Researchers domestically and internationally have found the Tree Drawing Projection Test valuable in the auxiliary diagnosis of diseases such as schizophrenia, depression, somatization symptoms, anxiety disorders, and Alzheimer's disease [5; 6; 9; 12-16]. However, most studies on tree drawing projection remain at the subjective qualitative research level, lacking quantitative data collection and indicator analysis [5].…”

Tree Imagery in Drawing Tests for Screening Mental Disorders: A Systematic Review and Meta-analysis

“…It highlights the roles of individual unconsciousness, defense mechanisms, and projection (Gabbard, 2014). Based on this theory and classi cation criteria from previous studies (Guo et al, 2023), tree imagery characteristics that signi cantly predict mental disorders are categorized into ve types. Each type re ects distinct psychological aspects of individuals with mental disorders.…”