Does Chinese calligraphy therapy reduce neuropsychiatric symptoms: a systematic review and meta-analysis

BACKGROUND There are currently no systematic reviews or meta-analyses of Chinese calligraphy therapy (CCT) to reduce neuropsychiatric symptoms. The aim of this systematic review and meta-analysis was to explore the efficacy of CCT for people with neuropsychiatric symptoms. METHODS We searched Chinese and English databases, including the Cochrane Central Register of Controlled Trials and Wanfang Data for relevant articles published between the earliest year available and December 2016. The search was limited to randomized controlled trials and controlled clinical studies and the associated keywords were "handwriting," "Chinese calligraphy," "Chinese calligraphy therapy," "Calligraphy exercise," and "Calligraphy training." The 21 articles that met these criteria were used in the analysis. The Joanna Briggs Institute critical appraisal checklist was used to assess methodological quality. RESULTS CCT significantly reduced psychosis (10 studies, 965 subjects, standardized mean difference [SMD] = - 0.17, 95% confidence intervals [CI] [- 0.30, - 0.40], Z = 2.60, p < 0.01), anxiety symptoms (9 studies, 579 subjects, SMD = - 0.78, 95% CI [- 0.95, - 0.61], Z = 8.98, p < 0.001), and depressive symptoms (7 studies, 456 subjects, SMD = - 0.69, 95% CI [- 0.88, - 0.50], Z = 7.11, p < 0.001). CCT also significantly improved cognitive function (2 studies, 55 subjects, MD = 2.17, 95% CI [- 0.03, 4.38], Z = 1.93, p = 0.05) and neurofeedback (3 studies, 148 subjects, SMD = - 1.09, 95% CI [- 1.44, - 0.73], Z = 6.01, p < 0.001). The therapy also significantly reduced the positive psychopathological expression of schizophrenia symptoms (4 studies, 287 subjects, SMD = - 0.35, 95% CI [- 0.59, - 0.12], Z = 2.96, p = 0.003) and reduced the negative symptoms of schizophrenia (4 studies, 276 subjects, SMD = - 1.39, 95% CI [- 1.65, - 1.12], Z = 10.23, p < 0.001). CONCLUSIONS CCT exerts a curative effect on neuropsychiatric symptoms, but the evidence remains insufficient. A large number of RCTs are needed to facilitate additional systematic reviews of evidence for CCT.