The relevance of depression in the clinical realm is well known, as it is one of the most common mental disorders in the United States. Clinical depression is the leading cause of disease for women worldwide. The sex difference in depression and anxiety has guided the research of not just recent studies but older studies as well, supporting the theory that gonadal hormones are associated with the mechanisms of emotional cognition. The scientific literature points towards a clear correlative relationship between gonadal hormones, especially estrogens, and emotion regulation. This thesis investigates the neural pathways that have been indicated to regulate mood and anxiety. Currently, the research points to the hypothalamic-pituitary-adrenal axis, which regulates the stress response through its ultimate secretion of cortisol through the adrenal cortex, and its modulated response when exposed to higher levels of estrogen. Another mechanism that has been investigated is the interaction of estrogen and the serotonergic system, which is noteworthy because the serotonergic system is known for its importance in mood regulation. However, it is important to note that the research seeking to determine the neurobiological underpinnings of estrogen and the serotonergic system is not expansive. Future research should focus on determining the direct relationship between cortisol hypersecretion and estrogens, the specific neurobiological effects of serotonergic receptor subtypes on the antidepressant actions of estrogens, and the simultaneous effects of the stress and serotonergic systems on depressive symptoms.

A recent analysis has predicted that close to a million Americans will have died from contracting COVID-19 (Sullivan, 2021, para. 1). Unsurprisingly, the most vulnerable people, like those who have been incarcerated, have been hit the hardest (Brennan Center for Justice, 2020, para. 1). The ongoing COVID-19 pandemic has created additional stress affecting inmates both physically and mentally. Therefore, the maintenance of good mental health among inmates should be a concern. However, the nature of the correctional environment limits the therapeutic options available to health care professionals. Among the challenges mental health professionals face in ensuring quality care are a poor rapport between the care provider and client, having a client living in an environment where distressing factors are omnipresent, and a lack of resources (Gussak, 2015, p. 2). All of these issues are exacerbated when the client requiring mental health care is in the correctional system. Depression and anxiety are some of the most common disorders affecting the prison population. However, in the correctional system, therapies that have been found effective among a general population have been shown to not benefit 30% to 60% of clients (Abbing, Baars, Van Haastrecht, & Ponstein, 2019, p. 1). Effectively treating depression is of great concern because, as Gussak (2007) found, depression can lead to self-harming behaviors and suicide when left untreated (p. 2). Additionally, addressing and treating anxiety is of particular importance today as COVID-19 has been a significant source of distress; explicitly, one incarcerated journalist reported witnessing entire units of inmates experiencing high levels of anxiety and panic attacks (Popperl et al., 2020, para. 5). Thus, a critical review of the available literature can reveal the particular effectiveness of art therapy in treating depression and anxiety in prison populations. The impacts of implementing more effective therapies in the correctional system are a reduction in recidivism and successful reintegration into society. Consequently, this literature review will suggest a potential application of art therapy for improving the mental health of those incarcerated in the correctional system with the intent of engendering positive social impact.