Relief and Prevention of Post-Traumatic Headache Using Intranasal Delivery of Lidocaine for Youth (RAPPIDLY): A Feasibility Study.

Depression is one of the leading mental disorders contributing to disability-adjusted life years (DALYs) lost worldwide (). According to the World Health Organization, the global number of individuals with depression exceeded 320 million in 2024, accounting for 4.0% of the world’s population, with the proportion reaching 5.7% among adults (). Depressive symptoms are the core manifestation of depressive disorders () and are also highly prevalent in subclinical populations and among patients with chronic physical illnesses (, ). In adulthood, depressive symptoms not only severely impair emotional regulation, social functioning, and occupational capacity, but also show high comorbidity with cardiovascular disease, diabetes, and suicidal behavior, thereby imposing a substantial public health burden (, ). In addition, the comorbidity rate of depressive and anxiety symptoms is as high as 45.7%–70.0% (), and the two mutually exacerbate each other, leading to poorer treatment outcomes and a higher risk of relapse (). At present, pharmacological treatments for alleviating depressive symptoms mainly include selective serotonin reuptake inhibitors (SSRIs) and related agents (). However, pharmacotherapy is associated with several limitations, including delayed onset of action (typically 4–6 weeks), significant side effects (e.g., weight gain, sexual dysfunction), and poor adherence to long-term medication (, ). When depressive and anxiety symptoms coexist, both the response rate and clinical remission rate to standard antidepressant treatment are significantly reduced (). Existing evidence indicates that combined pharmacotherapy and psychotherapy is significantly more effective than pharmacotherapy alone (). Against this background, psychological interventions such as behavioural activation, cognitive behavioural therapy, interpersonal psychotherapy, and music therapy (, ) have been widely recognized as effective adjunctive or alternative options for the treatment of depression. In recent years, visual art therapy (VAT), as an emerging non-pharmacological psychological intervention, has shown promising potential for application in improving depressive symptoms due to its unique modes of expression and therapeutic mechanisms (). VAT is a form of psychological intervention that uses visual art media such as drawing, coloring, collage, and sculpture as core tools. Under the professional guidance of a therapist, art-making is deliberately employed to mobilize imagery, color, form, and material qualities as a nonverbal channel for emotional expression and regulation, thereby facilitating emotional expression, self-exploration, and meaning-making (). Randomized controlled trials have shown that VAT can significantly improve depressive symptoms in older women with depression (). Specifically, Zentangle-based interventions significantly alleviated depressive symptoms in community-dwelling older adults with depression, with the therapeutic effects persisting up to six weeks after the intervention (); moreover, mandala group art therapy significantly reduced depressive scores among bereaved college students (). In addition, VAT has also been found to alleviate anxiety symptoms in adults with major depressive disorder ().