Synthetic House-Tree-Person Drawing Test: A New Method for Screening Anxiety in Cancer Patients

Characteristics of House-Tree-Person Drawing Test in Junior High School Students with Depressive Symptoms

OBJECTIVE

This study aims to explore the drawing characteristics of the house-tree-person drawing test (HTP) in junior high school students with depressive symptoms.

METHODS

A total of 167 junior high school students were recruited and completed HTP and questionnaires. 12 drawing characteristics of HTP were extracted and compared to explore the potential drawing characteristics of depressive symptoms.

RESULTS

Among 12 drawing characteristics, eight drawing characteristics appeared more frequently in the depressed group (CES-D ≥ 20) than in the non-depressed group (CES-D < 20), while one drawing characteristic appeared with a lower frequency. Further, controlling for the risk perception of COVID-19, seven drawing characteristics, not suggestive of movement, lacking details, blackening the paper, drawing in an only dark color, drawing a detailed crown, hands behind the back, and omitting expression, emerged as predictors of depressive symptoms (CES-D ≥ 20) in junior high school students.

CONCLUSION

Seven drawing characteristics of HTP are significantly associated with depressive symptoms in junior high school students. HTP is insightful for early screening for junior high school students with depressive symptoms.

The House-Tree-Person test is not valid for the prediction of mental health: An empirical study using deep neural networks

As one of the projective drawing techniques, the House-Tree-Person test (HTP) has been widely used in psychological counseling. However, its validity in diagnosing mental health problems remains controversial. Here, we adopted two approaches to examine the validity of HTP in diagnosing mental health problems objectively. First, we summarized the diagnostic features reported in previous HTP studies and found no reliable association between the existing HTP indicators and mental health problems studied. Next, after obtaining HTP drawings and depression scores from 4196 Chinese children and adolescents (1890 females), we used the Deep Neural Networks (DNNs) to explore implicit features from entire HTP drawings that might have been missed in previous studies. We found that although the DNNs successfully learned to extract critical features of houses, trees, and persons in HTP drawings for object classification, it failed to classify the drawings of depressive individuals from those of non-depressive individuals. Taken together, our study casts doubts on the validity of the HTP in diagnosing mental health problems, and provides a practical paradigm of examining the validity of projective tests with deep learning.

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

BACKGROUND

The 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.

OBJECTIVE

This 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.

METHODS

A 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 (N _fs), and the trim and fill method.

RESULTS

The 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.

CONCLUSION

These findings can promote the standardization of the HTP test and provide a theoretical reference for the screening and clinical diagnosis of mental disorders.

"I Have No Hope": The Experience of Mothers in Polygamous Families as Manifested in Drawings and Narratives

Polygamy is associated with lower marital satisfaction and is known to involve sexual, physical, and emotional abuse on the part of the husband. Less is known about the experience of mothers in polygamous families. This study was designed to shed light on the experiences of women in polygamous families in a sample of 80 Israeli Arab mothers living in polygamous families who use social services, domestic violence agencies, and health centers. Mothers were asked to draw their experiences in their families and to provide narratives for the drawings. A phenomenological approach was used to analyze the drawings, and yielded five different pictorial phenomena: (1) pseudo-sweetness, (2) houses, (3) the absentee father and the estranged mother, (4) incorporation of graphic symbols and lettering that represented distress, and (5) growth and development. Most of the drawings were restricted and shallow, indicating a complex emotional state of despair and distress. The central feelings that emerged from the drawings were negative emotions of anger, sadness, loneliness, and powerlessness. While some women longed for romantic relationships with their husbands, others expressed the desire for revenge and justice. Dissociation and parentification, as central coping strategies, emerged from the drawings and the narratives. The findings are discussed theoretically and clinically.

Association of Synthetic House-Tree-Person Drawing Test and Depression in Cancer Patients

Background

Evidence regarding the relationship between synthetic house-tree-person (S-HTP) drawing test and depression in cancer patients is limited. The aim of this study was to explore the applicability and validity of S-HTP drawing test in cancer patients suffering from depression.

Methods

As a population based cross-sectional study, 167 patients with cancer were enrolled in a hospital in China from December 2015 to December 2017. Self-edited general information questionnaire, self-rating depression scale (SDS), and the S-HTP drawing test were completed by all participants.

Results

The average age of 167 selected participants was 52.92 ± 10.43 years old, and about 58.7% (98/167) of them were male. On SDS, depression rate was found in 34.1% (27/167) cancer patients. The logistic regression equation was established by using the depression drawing characteristics as the independent variables and the evaluation results from SDS as the dependent variable and 9 drawing characteristics employed in the regression equation (χ2 = 68.657, P < 0.001. Nagelkerke R²= 0.466). Correlation analysis revealed a positive correlation between S-HTP drawing test and SDS for depression state of cancer patients (p < 0.01).

Conclusions

There are interrater reliability and test-retest reliability between S-HTP drawing test and SDS. The S-HTP drawing test could help in screening depression in cancer patients.