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

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Methods Tree drawing tests were administered to 59 patients with depression, 57 patients in remission, and 59 normal controls. Computer image recognition and data collection were used for quantitative analysis of the tree projections, and statistical analysis was conducted on the results from the three groups. Results ANOVA tests revealed significant statistical differences between the depression patients, remission patients, and normal controls in the following quantitative indices: canopy area, canopy height, canopy width, trunk area, trunk width, total area, and the ratio of canopy width to trunk width (P values: 0.000, 0.000, 0.000, 0.003, 0.000, 0.004, 0.000). No significant differences were found in trunk height, root width, root height, root area, total height, the ratio of canopy height to trunk height, and the ratio of canopy area to trunk area. Further LSD-t tests showed that compared to the depression group, the remission group exhibited significant differences in canopy area, canopy height, canopy width, trunk area, trunk width, the ratio of canopy height to trunk width, and total area (P values: 0.001, 0.000, 0.009, 0.002, 0.000, 0.046, 0.007, 0.000). No significant differences were found in the other six indices; also, no significant differences were found between the remission group and the normal control group across all 14 indices. Conclusion There are seven quantitative indices where significant statistical differences exist among the tree drawings from the depression group, the remission group, and the normal control group, and seven indices where no significant differences were found. The quantitative indices of tree drawing projections have potential value for the auxiliary diagnosis and condition assessment of depression. Biological sciences/Psychology Health sciences/Health care Tree drawing projection Depression Projection tests Quantitative research Auxiliary diagnosis Introduction Depressive symptoms are clinical manifestations of mood disorders, characterized by significantly and persistently low mood, slowed thinking, cognitive impairment, reduced volitional activity, and physical symptoms[1; 2]. Depression, a type of mood disorder, is marked by these clinical features and leads to impaired social functioning, decreased work efficiency, and even self-harm or suicide. It is recurrent and poses a substantial economic burden on individuals, families, and society[ 1 ]. Research indicates that depression has become a major contributor to the global burden of disease, with rising incidence rates in recent years. However, the typical treatment duration for depression exceeds six weeks, underscoring the importance of timely diagnosis and treatment to prevent the progression of depressive symptoms[3; 4]. Despite the increasing detail in diagnostic manuals such as the DSM and ICD, challenges remain in diagnosing depression, including the subjectivity of diagnostic criteria and the low diagnosis rate in primary care settings. Traditional diagnostic methods often rely on interviews and self-report questionnaires, which may lack sufficient objectivity and accuracy. Consequently, researchers are seeking new diagnostic tools to enhance diagnostic accuracy and objectivity. In this context, the search for more objective and effective diagnostic tools has become a research focus in the field of mental health. 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-specific stimuli, revealing their inner world and emotional state through the interpretation of tree drawings[ 5 – 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; 9–11]. 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 ]. Our team developed Tree Drawing Projection Test software in 2017, which, based on the data collection of tree drawing length, width, and height, employs computer image recognition technology to scan and collect data on the area of the tree crown, trunk, and roots in tree projections, thus enhancing the objectivity and accuracy of diagnosis through quantitative analysis of indicators. Previous research has identified differences in tree drawings between patients with depression and healthy individuals[ 14 ]. This comparative study examines changes in Tree Drawing Projection Test indicators before and after symptom relief in patients with depression, and the differences in indicators between post-relief patients and healthy individuals, further exploring the value of the Tree Drawing Projection Test in the auxiliary diagnosis and condition assessment of depression. Methods Subjects The study was conducted at Suzhou Guangji Hospital in Suzhou, China. Participants included a group of depression cases recruited from the hospital wards, a remission group, and a normal control group recruited from the community. The depression case group comprised 59 patients (20 males and 39 females). The remission group included 57 participants (22 males and 35 females), and the normal control group consisted of 59 individuals (25 males and 34 females). Patients in the depression case group met the DSM-5 criteria for depression[ 17 ], were aged between 18 and 60 years, and had no gender restrictions. They had HDRS-21 scores ≥ 21[ 18 ]. The remission group consisted of patients discharged after inpatient treatment, who met the DSM-5 criteria for depression[ 17 ]upon admission with HDRS-21 scores ≥ 21[ 18 ], and showed a reduction of more than 50% in HDRS-21 scores upon discharge, indicating a significant alleviation of depressive symptoms. They were also aged between 18 and 60 years, with no gender restrictions. The normal control group was from the same region as the patients and was recruited during the same period (2021–2022). Inclusion criteria for the control group were the absence of significant psychiatric symptoms (no positive factors on the SCL-90), no history of mental illness, and matching gender and age with the case group. All subjects were thoroughly informed about the purpose and procedures of the study before enrollment and provided written consent to participate. All methods were carried out in accordance with relevant guidelines and regulations, and the study received approval from the Medical Ethics Committee of Suzhou Guangji Hospital (Approval No.: 2021-012). The recruitment period was from February 2021 to June 2022. Tree Drawing Projection Test Each participant was provided with A4 printing paper and a black or blue-black pen. Participants were instructed to draw according to the following guidelines The drawing projection test is not a test of drawing skills, and the drawing does not need to be aesthetically pleasing. The drawing projection test is not a still life drawing, and it does not need to resemble real-life objects. If you cannot draw what you intend to, you may draw a circle and write a Chinese character inside it as a substitute. Before drawing the tree, close your eyes and meditate for half a minute. Draw the tree that appears in your meditation. If no tree appears, open your eyes and draw the tree you most want to draw. After completing your drawing, write your age and gender on the drawing paper. Instruments Epson High-Definition Scanner (DS-1630) This study utilized an Epson High-Definition Scanner (DS-1630) to digitize tree projection drawings. The scanned images were stored on a computer. Image Data Scanning and Collection Software: The research employed the Tree Drawing Projection Test software, which features an interactive design with measurements in centimeters. The software allows for the tracing of scanned images using a mouse, after which the computer automatically calculates various metrics and exports them. Statistical Methods Statistical analyses were conducted using SPSS software version 24.0. The primary tests used were ANOVA and LSD-t test. Quantitative data are presented in parentheses and were analyzed using t-tests; categorical data were analyzed using the Chi-square test. A p-value of < 0.05 was considered statistically significant. Results Basic demographic characteristics: This study included a group of 59 patients diagnosed with depression, aged between 12 and 60 years, comprising 20 males and 39 females. The depression remission group consisted of 57 individuals, including 22 males and 35 females. The normal control group included 59 subjects, aged between 12 and 60 years, with 25 males and 34 females. Table 1 presents the demographic data of the sample. The distribution of age and gender was similar across the groups, and no statistically significant differences were observed (P > 0.05). Table 1 Comparison of Demographic Differences Across Groups Variable Depression group Remission group Normal control group F p Age 41.10 ± 12.068 38.53 ± 10.202 36.95 ± 10.474 1.222 0.297 Sex 0.900 0.638 Male 20 22 25 Female 39 35 34 Comparison Among Depression, Depression Remission, and Normal Control Groups : Using the Tree Drawing Projection Test software for data acquisition and calculated by statistical software via ANOVA, significant differences were found among the three groups in the following quantitative metrics: canopy area, canopy height, canopy width, trunk area, trunk width, total area, and the ratio of canopy width to trunk width (P values: 0.000, 0.000, 0.000, 0.003, 0.000, 0.004, 0.000, respectively). No significant differences were observed in trunk height, root width, root height, root area, total height, the ratio of canopy height to trunk height, and the ratio of canopy area to trunk area (see Table 2 ). Table 2 Comparison of Tree Drawing Indicators Among Depression, Depression Remission, and Normal Control Groups Project Depression group Remission group Normal control group F p Canopy area 46.8658 ± 4.0090 83.3874 ± 6.2036 90.8369 ± 6.1954 10.546 0.000 Canopy height 6.4736 ± 3.3178 9.6912 ± 0.4724 10.3278 ± 0.4723 13.575 0.000 Canopy width 7.8992 ± 0.3902 9.979474 ± 0.4479 10.498814 ± 0.4412 6.119 0.003 Trunk area 8.7315 ± 0.8600 16.4674 ± 1.4870 19.3813 ± 1.5387 10.095 0.000 Trunk height 4.9681 ± 0.3048 4.7723 ± 0.3347 5.0735 ± 0.3443 0.125 0.882 Trunk width 1.7576 ± 0.1428 4.4864 ± 0.2601 5.0889 ± 0.2492 37.194 0.000 Root area 1.9748 ± 0.6560 3.8119 ± 1.2229 4.3774 ± 1.2459 0.804 0.449 Root height 0.4193 ± 0.087 1.2982 ± 0.3636 1.4559 ± 0.3768 1.963 0.144 Root width 1.0308 ± 0.2568 1.1209 ± 0.3250 1.2261 ± 0.3411 0.059 0.943 Ratio of canopy area to trunk area 40.4246 ± 1.4412 10.4678 ± 1.37778 9.0385 ± 1.3136 2.587 0.078 Ratio of canopy height to trunk height 2.2058 ± 0.2680 3.2895 ± 0.3035 3.2952 ± 0.2993 2.734 0.068 Ratio of canopy width to trunk width 11.4390 ± 2.0827 4.3897 ± 0.8526 3.6616 ± 0.8135 5.617 0.004 Total area 57.6179 ± 4.6693 103.5770 ± 7.4587 114.5269 ± 7.3809 12.241 0.000 Total height 11.8130 ± 0.5200 13.5265 ± 0.6327 14.3931 ± 0.6398 2.827 0.062 Comparison Between the Depression Group and the Normal Control Group : Following ANOVA, further analysis was conducted using the LSD-t test. It was found that compared to the normal control group, the trees drawn by patients in the depression group showed significant differences in canopy area, canopy height, canopy width, trunk area, trunk width, the ratio of canopy area to trunk area, the ratio of canopy height to trunk height, the ratio of canopy width to trunk width, total area, and total height (P values respectively: 0.000, 0.000, 0.001, 0.000, 0.000, 0.045, 0.043, 0.003, 0.000, 0.021). However, no significant differences were observed in trunk height, root area, root height, and root width compared to the healthy control group (see Table 3 ). Table 3 Comparison of Tree Drawing Indices Between the Depression Group and the Normal Control Group Project Depression group Normal control group p Canopy area 46.8658 ± 4.0090 90.8369 ± 6.1954 0.000 Canopy height 6.4736 ± 3.3178 10.3278 ± 0.4723 0.000 Canopy width 7.8992 ± 0.3902 10.498814 ± 0.4412 0.001 Trunk area 8.7315 ± 0.8600 19.3813 ± 1.5387 0.000 Trunk height 4.9681 ± 0.3048 5.0735 ± 0.3443 0.862 Trunk width 1.7576 ± 0.1428 5.0889 ± 0.2492 0.000 Root area 1.9748 ± 0.6560 4.3774 ± 1.2459 0.226 Root height 0.4193 ± 0.087 1.4559 ± 0.3768 0.067 Root width 1.0308 ± 0.2568 1.2261 ± 0.3411 0.732 Ratio of canopy area to trunk area 40.4246 ± 1.4412 9.0385 ± 1.3136 0.045 Ratio of canopy height to trunk height 2.2058 ± 0.2680 3.2952 ± 0.2993 0.043 Ratio of canopy width to trunk width 11.4390 ± 2.0827 3.6616 ± 0.8135 0.003 Total area 57.6179 ± 4.6693 114.5269 ± 7.3809 0.000 Total height 11.8130 ± 0.5200 14.3931 ± 0.6398 0.021 Comparison Between the Depression Group and the Depression Remission Group : Compared to the depression remission group, significant differences were observed in the trees drawn by the depression group in terms of canopy area, canopy height, canopy width, trunk area, trunk width, the ratio of canopy height to trunk height, the ratio of canopy width to trunk width, and total area (P values respectively: 0.001, 0.000, 0.009, 0.002, 0.000, 0.046, 0.007, 0.000). No significant differences were found in trunk height, root area, root height, root width, the ratio of canopy area to trunk area, or total height (see Table 4 ). Table 4 Comparison of Tree Drawing Indices Between the Depression Group and the Depression Remission Group Project Depression group Remission group p Canopy area 46.8658 ± 4.0090 83.3874 ± 6.2036 0.001 Canopy height 6.4736 ± 3.3178 9.6912 ± 0.4724 0.000 Canopy width 7.8992 ± 0.3902 9.979474 ± 0.4479 0.009 Trunk area 8.7315 ± 0.8600 16.4674 ± 1.4870 0.002 Trunk height 4.9681 ± 0.3048 4.7723 ± 0.3347 0.748 Trunk width 1.7576 ± 0.1428 4.4864 ± 0.2601 0.000 Root area 1.9748 ± 0.6560 3.8119 ± 1.2229 0.359 Root height 0.4193 ± 0.087 1.2982 ± 0.3636 0.124 Root width 1.0308 ± 0.2568 1.1209 ± 0.3250 0.876 Ratio of canopy area to trunk area 40.4246 ± 1.4412 10.4678 ± 1.37778 0.058 Ratio of canopy height to trunk height 2.2058 ± 0.2680 3.2895 ± 0.3035 0.046 Ratio of canopy width to trunk width 11.4390 ± 2.0827 4.3897 ± 0.8526 0.007 Total area 57.6179 ± 4.6693 103.5770 ± 7.4587 0.000 Total height 11.8130 ± 0.5200 13.5265 ± 0.6327 0.126 Comparison Between the Depression Remission Group and the Normal Control Group Compared to the normal control group, no significant differences were found in the trees drawn by the depression remission group regarding canopy area, canopy height, canopy width, trunk area, trunk height, trunk width, root area, root height, root width, the ratio of canopy area to trunk area, the ratio of canopy height to trunk height, the ratio of canopy width to trunk width, total area, and total height (see Table 5 ). Table 5 Comparison of Tree Drawing Indices Between the Depression Remission Group and the Normal Control Group Project Remission group Normal control group p Canopy area 83.3874 ± 6.2036 90.8369 ± 6.1954 0.471 Canopy height 9.6912 ± 0.4724 10.3278 ± 0.4723 0.421 Canopy width 9.979474 ± 0.4479 10.498814 ± 0.4412 0.513 Trunk area 16.4674 ± 1.4870 19.3813 ± 1.5387 0.241 Trunk height 4.7723 ± 0.3347 5.0735 ± 0.3443 0.862 Trunk width 4.4864 ± 0.2601 5.0889 ± 0.2492 0.148 Root area 3.8119 ± 1.2229 4.3774 ± 1.2459 0.777 Root height 1.2982 ± 0.3636 1.4559 ± 0.3768 0.782 Root width 1.1209 ± 0.3250 1.2261 ± 0.3411 0.855 Ratio of canopy area to trunk area 10.4678 ± 1.37778 9.0385 ± 1.3136 0.927 Ratio of canopy height to trunk height 3.2895 ± 0.3035 3.2952 ± 0.2993 0.991 Ratio of canopy width to trunk width 4.3897 ± 0.8526 3.6616 ± 0.8135 0.771 Total area 103.5770 ± 7.4587 114.5269 ± 7.3809 0.374 Total height 13.5265 ± 0.6327 14.3931 ± 0.6398 0.438 Discussion 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 deficiencies of scales. Existing studies have confirmed the correlation between tree drawing projection and depression. However, tree drawing projection tests have their limitations, such as non-standard scoring and interpretation, lack of consistency, and subjectivity in the selection of drawing features by researchers, making it difficult to compare results across different studies[19; 20]. Moreover, interpretations of certain drawing features vary; for instance, some researchers consider drawing a "chimney" as a negative expression of family or internal conflicts, while others view it as a negative expression in general[ 21 ]. In this study, our team utilized modern imaging scanning and computer image recognition technologies to conduct quantitative analysis of metrics such as canopy size and shape, trunk thickness, etc., thereby enhancing the objectivity and accuracy of diagnostics. Early results have preliminarily validated the value of tree drawing projections in assisting the diagnosis of depression[12; 14]. This comparative study of tree drawing indices among the depression, depression remission, and normal control groups revealed statistically significant differences in canopy area, canopy height, canopy width, trunk area, trunk width, total area, and the ratio of canopy width to trunk width (P < 0.05), while no significant differences were found in trunk height, root width, root height, root area, total height, the ratio of canopy height to trunk height, and the ratio of canopy area to trunk area (see Table 2 ). These findings affirm the value of tree drawing projection tests in the auxiliary diagnosis of depression. Further, the study conducted LSD-t tests to explore the application value of tree drawing indices in the progression of depression symptoms. Previous studies have indicated that the canopy in tree drawings primarily reflects a person's thinking, cognitive abilities, and social interactions[16; 22]. Comparisons between the depression group, the depression remission group, and the normal control group (see Tables 3 and 4 ) revealed that the drawn canopy width, height, and area were smaller (P < 0.05). This corresponds to issues in these areas and aligns with symptoms reported by patients with depression, such as slowed thinking, helplessness, lack of interest, diminished capability, poor concentration, cognitive decline, and reluctance to go out and socialize. These findings are consistent with previous research results. The overall tree mainly represents the current psychological and mental state of the drawer; smaller total tree areas in the depression group compared to the remission and control groups suggest poor psychological states, low energy, or feelings of inferiority and lack of self-confidence[23; 24]. In tree drawing projection tests, the trunk primarily reflects the emotional state of the drawer[ 25 ]. A smaller trunk area in the depression group compared to the depression remission group and the normal control group (P < 0.05) indicates emotional issues (see Tables 2 and 3 ), characterized by unhappiness, low mood, and negativity. Scholars such as Ji Yuanhong believe that in tree drawing tests, the width of the tree can reflect the emotional stability of the drawer[26; 27]. A wider trunk indicates more stable emotions. LSD-t test results showed that the trunk width was narrower in the depression group compared to the remission and control groups, indicating characteristics of emotional fragility and instability. In tree drawing projection tests, the canopy, trunk, and roots represent the superego, ego, and id of the drawer, respectively[ 26 ]. In this study, the ANOVA and LSD-t results for the three groups showed no statistical differences in root area, width, and height. The roots represent an individual's instincts and subconscious. Some scholars also believe that roots reflect the collective subconscious of the drawer's community[ 25 ], that is, the customs or habits formed by the long-term living conditions of their region and community. The lack of significant differences in the three root indicators in this study might be attributed to the influence of Confucian and other cultural norms prevalent in Chinese society, which advocate restraint and moderation towards instinctual behaviors. As a result, most of the drawings in this tree projection test lack detailed root sections. The study results showed that the ratio of canopy to trunk area is larger in the depression group compared to the normal control group (P < 0.05), which may be due to emotional symptoms being more pronounced than cognitive symptoms in individuals with depression, resulting in a relatively smaller trunk area compared to the normal control group and thus a larger ratio of canopy to trunk area[ 28 ]. The ANOVA results for total height showed no significant differences across the three groups, and the LSD-t test results for the depression and depression remission groups also indicated no significant differences in trunk height and total height. This is consistent with previous research, suggesting that compared to area and width, height is not a sensitive indicator of changes in depressive symptoms[ 24 ]. The results of this study indicate that there are no statistically significant differences between the depression remission group and the normal control group across various indices, including canopy area, canopy height, canopy width, trunk area, trunk height, trunk width, root area, root height, root width, the ratio of canopy area to trunk area, the ratio of canopy height to trunk height, the ratio of canopy width to trunk width, total area, and total height. This suggests that as the symptoms of depression improve—such as slowed thinking, reduced volition and behavior, and low mood—the values for tree canopy area, height, width, trunk area, width, total area, and total height tend to increase. Although the statistical analysis shows no significant differences between the depression remission group and the normal control group (see Table 5 ), the average values for canopy area, height, width, trunk area, width, total area, and total height in the depression remission group are still less than those in the normal control group, indicating that cognitive, social interaction, and other functions have not fully returned to normal levels immediately after depression remission[ 28 ]. Conclusion The findings of this study not only provide a new perspective for the diagnosis of depression but also pave the way for the potential use of tree drawing projection tests as an auxiliary diagnostic tool in clinical psychology. With further validation through research, tree drawing projection tests could become an important tool for assessing the severity of depression and the effectiveness of its treatment. Declarations Data availability The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Authors’ contributions Each author made an indispensable contribution to this research paper. The specific contributions of each author are as follows: Guorui Liu collected data; Ziyang Li analyzed data; Yanfei Zhang wrote the paper; Yige Liu , Hui Jin , Peiqi Shi , Jing Wen, and Yihao Wang searched for literature; Liu Wei and Bai Yonghai guided this research and reviewed the manuscript. Liu Guorui, Zhang Yanfei, and Li Ziyang were the first co-authors. Competing interests The authors declare no competing interests. Funding This work no funding support. Additional information Correspondence and requests for materials should be addressed to W.L or YH.B. References Thapar, A., Eyre, O., Patel, V. & Brent, D. Depression in Young People. LANCET. 400, 617–631 (2022). Guo, Q., Yu, G., Wang, J., Qin, Y. & Zhang, L. 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Chen, G. & Yan, W. Utility of the Rorschach inkblot test in clinical psychological diagnosis. 中China Journal of Health Psychology. 30, 475–480 (2022). Zhou, H. Research on the Relathionship between Rumination Thinking of Junior Middle School Students and H-T-P Drawing Characteristics : Bohai University, 2021. Zhang, T. & Zhang, H. Unlocking the Secrets of personality H-T-P drawing psychological test China Literary Federation Publishing Company 2007 Kaneda, A. et al. Characteristics of the Tree-Drawing Test in Chronic Schizophrenia. PSYCHIAT CLIN NEUROS. 64, 141–148 (2010). Zhang, et al. Difference Analysis of Quantitative Indexes of Tree-drawing Test Painting in Schizophrenia and Depression. Chinese General Practice. 23, 63–67 (2020). ROWLEY, M. Drawing a Tree Create Space Independent publishing platform, San Bernardino CA 2015 Ji, R. Tree Personality Projection Test. Chongqing Chongqing publishing group,Chongqing 2011 Murayama, N. et al. Characteristics of Depression in Community-Dwelling Elderly People as Indicated by the Tree-Drawing Test. PSYCHOGERIATRICS. 16, 225–232 (2016). Kanter, J. W., Busch, A. M., Weeks, C. E. & Landes, S. J. The Nature of Clinical Depression: Symptoms, Syndromes, and Behavior Analysis. Behav Anal. 31, 1–21 (2008). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4574362","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":321252781,"identity":"f00ab1ac-d11e-4bdb-8e42-d2c0840fbc2d","order_by":0,"name":"Guorui Liu","email":"","orcid":"","institution":"Department of Medical Psychology, The 905th Hospital of the PLA Navy,","correspondingAuthor":false,"prefix":"","firstName":"Guorui","middleName":"","lastName":"Liu","suffix":""},{"id":321252782,"identity":"3c00fc32-4ecb-48bd-bfef-96fb06121646","order_by":1,"name":"Yanfei Zhang","email":"","orcid":"","institution":"Department of Medical Psychology, Shanghai Changzheng Hospita","correspondingAuthor":false,"prefix":"","firstName":"Yanfei","middleName":"","lastName":"Zhang","suffix":""},{"id":321252783,"identity":"42141359-21ac-4ab8-9623-999e48059b50","order_by":2,"name":"Ziyang Li","email":"","orcid":"","institution":"Zhenjiang College","correspondingAuthor":false,"prefix":"","firstName":"Ziyang","middleName":"","lastName":"Li","suffix":""},{"id":321252784,"identity":"c5c18431-b696-43aa-9843-4d8817a50b17","order_by":3,"name":"Yige Liu","email":"","orcid":"","institution":"Nanchang Vocational University","correspondingAuthor":false,"prefix":"","firstName":"Yige","middleName":"","lastName":"Liu","suffix":""},{"id":321252785,"identity":"694b9e1d-87cf-4744-9295-da63f65b2694","order_by":4,"name":"Hui Jin","email":"","orcid":"","institution":"Nanchang Vocational University","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Jin","suffix":""},{"id":321252786,"identity":"02fb8f7c-c330-42e0-8009-3135c2df9070","order_by":5,"name":"Peiqi Shi","email":"","orcid":"","institution":"Department of Medical Psychology, The 905th Hospital of the PLA Navy,","correspondingAuthor":false,"prefix":"","firstName":"Peiqi","middleName":"","lastName":"Shi","suffix":""},{"id":321252787,"identity":"68af8db1-40ce-4b4d-b8f9-806aa78c4242","order_by":6,"name":"Jing Wen","email":"","orcid":"","institution":"Department of Medical Psychology, The 905th Hospital of the PLA Navy,","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Wen","suffix":""},{"id":321252788,"identity":"d094258e-9ab9-4128-9b46-36c04bac6592","order_by":7,"name":"Yihao Wang","email":"","orcid":"","institution":"Department of Medical Psychology, Shanghai Changzheng Hospita","correspondingAuthor":false,"prefix":"","firstName":"Yihao","middleName":"","lastName":"Wang","suffix":""},{"id":321252789,"identity":"21f0b12a-888a-4a9d-9c22-f513450ca7af","order_by":8,"name":"Yonghai Bai","email":"","orcid":"","institution":"Department of Medical Psychology, Shanghai Changzheng Hospita","correspondingAuthor":false,"prefix":"","firstName":"Yonghai","middleName":"","lastName":"Bai","suffix":""},{"id":321252790,"identity":"8f584b1e-b370-41d8-b2a3-9462836aeb30","order_by":9,"name":"Wei Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYBACNvmD7R8+/LDh4Wc4fIA4LXwSzMcYZ/akyUg2HksgToucBFsaMw/bYRuD5jMGRDpMusfsMQ8PM48B25mPN94w2MnpNhDSInPG3HCOBRuPOc/ZzZZzGJKNzQ4Q0sKQYyDxhoeHx3LG2W3SPAwHErcRpYWHTYLH4P6bZ0RqkUhLk+RhM+AxOHCGjUgtPIcPG87sSeCRbDhmbDnHgAi/yLc3Nj748OO/PTAqH954U2EnR1ALCgD6iBTlEC2k6hgFo2AUjIIRAQDjJUEJPH3+YgAAAABJRU5ErkJggg==","orcid":"","institution":"Nanchang Vocational University","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-06-13 07:41:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4574362/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4574362/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64814057,"identity":"ec892d1b-1539-4d2d-b729-26a1f47436ae","added_by":"auto","created_at":"2024-09-19 06:21:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":630255,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4574362/v1/4d35c356-37a5-4181-8a2d-2f211e633513.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Research on the Application of Tree Drawing Projection Tests in the Auxiliary Diagnosis and Condition Assessment of Depression","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDepressive symptoms are clinical manifestations of mood disorders, characterized by significantly and persistently low mood, slowed thinking, cognitive impairment, reduced volitional activity, and physical symptoms[1; 2]. Depression, a type of mood disorder, is marked by these clinical features and leads to impaired social functioning, decreased work efficiency, and even self-harm or suicide. It is recurrent and poses a substantial economic burden on individuals, families, and society[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Research indicates that depression has become a major contributor to the global burden of disease, with rising incidence rates in recent years. However, the typical treatment duration for depression exceeds six weeks, underscoring the importance of timely diagnosis and treatment to prevent the progression of depressive symptoms[3; 4]. Despite the increasing detail in diagnostic manuals such as the DSM and ICD, challenges remain in diagnosing depression, including the subjectivity of diagnostic criteria and the low diagnosis rate in primary care settings. Traditional diagnostic methods often rely on interviews and self-report questionnaires, which may lack sufficient objectivity and accuracy. Consequently, researchers are seeking new diagnostic tools to enhance diagnostic accuracy and objectivity.\u003c/p\u003e\u003cp\u003eIn this context, the search for more objective and effective diagnostic tools has become a research focus in the field of mental health. 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-specific stimuli, revealing their inner world and emotional state through the interpretation of tree drawings[\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. 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\u0026ndash;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\u0026ndash;16]. However, most studies on tree drawing projection remain at the subjective qualitative research level, lacking quantitative data collection and indicator analysis[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur team developed Tree Drawing Projection Test software in 2017, which, based on the data collection of tree drawing length, width, and height, employs computer image recognition technology to scan and collect data on the area of the tree crown, trunk, and roots in tree projections, thus enhancing the objectivity and accuracy of diagnosis through quantitative analysis of indicators. Previous research has identified differences in tree drawings between patients with depression and healthy individuals[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This comparative study examines changes in Tree Drawing Projection Test indicators before and after symptom relief in patients with depression, and the differences in indicators between post-relief patients and healthy individuals, further exploring the value of the Tree Drawing Projection Test in the auxiliary diagnosis and condition assessment of depression.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eThe study was conducted at Suzhou Guangji Hospital in Suzhou, China. Participants included a group of depression cases recruited from the hospital wards, a remission group, and a normal control group recruited from the community. The depression case group comprised 59 patients (20 males and 39 females). The remission group included 57 participants (22 males and 35 females), and the normal control group consisted of 59 individuals (25 males and 34 females). Patients in the depression case group met the DSM-5 criteria for depression[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], were aged between 18 and 60 years, and had no gender restrictions. They had HDRS-21 scores\u0026thinsp;\u0026ge;\u0026thinsp;21[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The remission group consisted of patients discharged after inpatient treatment, who met the DSM-5 criteria for depression[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]upon admission with HDRS-21 scores\u0026thinsp;\u0026ge;\u0026thinsp;21[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and showed a reduction of more than 50% in HDRS-21 scores upon discharge, indicating a significant alleviation of depressive symptoms. They were also aged between 18 and 60 years, with no gender restrictions. The normal control group was from the same region as the patients and was recruited during the same period (2021\u0026ndash;2022). Inclusion criteria for the control group were the absence of significant psychiatric symptoms (no positive factors on the SCL-90), no history of mental illness, and matching gender and age with the case group.\u003c/p\u003e \u003cp\u003e All subjects were thoroughly informed about the purpose and procedures of the study before enrollment and provided written consent to participate. All methods were carried out in accordance with relevant guidelines and regulations, and the study received approval from the Medical Ethics Committee of Suzhou Guangji Hospital (Approval No.: 2021-012). The recruitment period was from February 2021 to June 2022.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTree Drawing Projection Test\u003c/strong\u003e \u003cp\u003eEach participant was provided with A4 printing paper and a black or blue-black pen. Participants were instructed to draw according to the following guidelines\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe drawing projection test is not a test of drawing skills, and the drawing does not need to be aesthetically pleasing.\u003c/p\u003e \u003cp\u003eThe drawing projection test is not a still life drawing, and it does not need to resemble real-life objects.\u003c/p\u003e \u003cp\u003eIf you cannot draw what you intend to, you may draw a circle and write a Chinese character inside it as a substitute.\u003c/p\u003e \u003cp\u003eBefore drawing the tree, close your eyes and meditate for half a minute. Draw the tree that appears in your meditation. If no tree appears, open your eyes and draw the tree you most want to draw.\u003c/p\u003e \u003cp\u003eAfter completing your drawing, write your age and gender on the drawing paper.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInstruments\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEpson High-Definition Scanner (DS-1630)\u003c/strong\u003e \u003cp\u003eThis study utilized an Epson High-Definition Scanner (DS-1630) to digitize tree projection drawings. The scanned images were stored on a computer.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eImage Data Scanning and Collection Software: The research employed the Tree Drawing Projection Test software, which features an interactive design with measurements in centimeters. The software allows for the tracing of scanned images using a mouse, after which the computer automatically calculates various metrics and exports them.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Methods\u003c/h2\u003e \u003cp\u003eStatistical analyses were conducted using SPSS software version 24.0. The primary tests used were ANOVA and LSD-t test. Quantitative data are presented in parentheses and were analyzed using t-tests; categorical data were analyzed using the Chi-square test. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eBasic demographic characteristics:\u003c/h2\u003e \u003cp\u003eThis study included a group of 59 patients diagnosed with depression, aged between 12 and 60 years, comprising 20 males and 39 females. The depression remission group consisted of 57 individuals, including 22 males and 35 females. The normal control group included 59 subjects, aged between 12 and 60 years, with 25 males and 34 females. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic data of the sample. The distribution of age and gender was similar across the groups, and no statistically significant differences were observed (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Demographic Differences Across Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRemission group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal control group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.10\u0026thinsp;\u0026plusmn;\u0026thinsp;12.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.95\u0026thinsp;\u0026plusmn;\u0026thinsp;10.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison Among Depression, Depression Remission, and Normal Control Groups\u003c/b\u003e: Using the Tree Drawing Projection Test software for data acquisition and calculated by statistical software via ANOVA, significant differences were found among the three groups in the following quantitative metrics: canopy area, canopy height, canopy width, trunk area, trunk width, total area, and the ratio of canopy width to trunk width (P values: 0.000, 0.000, 0.000, 0.003, 0.000, 0.004, 0.000, respectively). No significant differences were observed in trunk height, root width, root height, root area, total height, the ratio of canopy height to trunk height, and the ratio of canopy area to trunk area (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Tree Drawing Indicators Among Depression, Depression Remission, and Normal Control Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRemission group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal control group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e46.8658\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e83.3874\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e90.8369\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.4736\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.6912\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.3278\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.8992\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.979474\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.498814\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.7315\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.4674\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.3813\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.9681\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.7723\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.0735\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.7576\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.4864\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.0889\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.9748\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.8119\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.3774\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.4193\u0026thinsp;\u0026plusmn;\u0026thinsp;0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.2982\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.4559\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.0308\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.1209\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.2261\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.943\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy area to trunk area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e40.4246\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.4678\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.0385\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy height to trunk height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.2058\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2895\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.2952\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy width to trunk width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.4390\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.3897\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.6616\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e57.6179\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e103.5770\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e114.5269\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.8130\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.5265\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.3931\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison Between the Depression Group and the Normal Control Group\u003c/b\u003e: Following ANOVA, further analysis was conducted using the LSD-t test. It was found that compared to the normal control group, the trees drawn by patients in the depression group showed significant differences in canopy area, canopy height, canopy width, trunk area, trunk width, the ratio of canopy area to trunk area, the ratio of canopy height to trunk height, the ratio of canopy width to trunk width, total area, and total height (P values respectively: 0.000, 0.000, 0.001, 0.000, 0.000, 0.045, 0.043, 0.003, 0.000, 0.021). However, no significant differences were observed in trunk height, root area, root height, and root width compared to the healthy control group (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Tree Drawing Indices Between the Depression Group and the Normal Control Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal control group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e46.8658\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e90.8369\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.4736\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.3278\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.8992\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.498814\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.7315\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.3813\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.9681\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.0735\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.7576\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.0889\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.9748\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.3774\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.4193\u0026thinsp;\u0026plusmn;\u0026thinsp;0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.4559\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.0308\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.2261\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy area to trunk area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e40.4246\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.0385\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy height to trunk height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.2058\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2952\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy width to trunk width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.4390\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.6616\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e57.6179\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e114.5269\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.8130\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.3931\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison Between the Depression Group and the Depression Remission Group\u003c/b\u003e: Compared to the depression remission group, significant differences were observed in the trees drawn by the depression group in terms of canopy area, canopy height, canopy width, trunk area, trunk width, the ratio of canopy height to trunk height, the ratio of canopy width to trunk width, and total area (P values respectively: 0.001, 0.000, 0.009, 0.002, 0.000, 0.046, 0.007, 0.000). No significant differences were found in trunk height, root area, root height, root width, the ratio of canopy area to trunk area, or total height (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Tree Drawing Indices Between the Depression Group and the Depression Remission Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRemission group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e46.8658\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e83.3874\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.4736\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.6912\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.8992\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.979474\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.7315\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.4674\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.9681\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.7723\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.7576\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.4864\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.9748\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.8119\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.359\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.4193\u0026thinsp;\u0026plusmn;\u0026thinsp;0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.2982\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.0308\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.1209\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy area to trunk area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e40.4246\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.4678\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy height to trunk height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.2058\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2895\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy width to trunk width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.4390\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.3897\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e57.6179\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e103.5770\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.8130\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.5265\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eComparison Between the Depression Remission Group and the Normal Control Group\u003c/strong\u003e \u003cp\u003eCompared to the normal control group, no significant differences were found in the trees drawn by the depression remission group regarding canopy area, canopy height, canopy width, trunk area, trunk height, trunk width, root area, root height, root width, the ratio of canopy area to trunk area, the ratio of canopy height to trunk height, the ratio of canopy width to trunk width, total area, and total height (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Tree Drawing Indices Between the Depression Remission Group and the Normal Control Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProject\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRemission group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal control group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e83.3874\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e90.8369\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.6912\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.3278\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanopy width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.979474\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.498814\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.4674\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.3813\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.7723\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.0735\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.4864\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.0889\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.8119\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.3774\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.2982\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.4559\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoot width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.1209\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.2261\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy area to trunk area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.4678\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.0385\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.927\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy height to trunk height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.2895\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2952\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRatio of canopy width to trunk width\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.3897\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.6616\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e103.5770\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e114.5269\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.5265\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.3931\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrently, 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[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Projection tests, as one of the three major techniques in psychology, can compensate for the deficiencies of scales. Existing studies have confirmed the correlation between tree drawing projection and depression. However, tree drawing projection tests have their limitations, such as non-standard scoring and interpretation, lack of consistency, and subjectivity in the selection of drawing features by researchers, making it difficult to compare results across different studies[19; 20]. Moreover, interpretations of certain drawing features vary; for instance, some researchers consider drawing a \"chimney\" as a negative expression of family or internal conflicts, while others view it as a negative expression in general[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, our team utilized modern imaging scanning and computer image recognition technologies to conduct quantitative analysis of metrics such as canopy size and shape, trunk thickness, etc., thereby enhancing the objectivity and accuracy of diagnostics. Early results have preliminarily validated the value of tree drawing projections in assisting the diagnosis of depression[12; 14]. This comparative study of tree drawing indices among the depression, depression remission, and normal control groups revealed statistically significant differences in canopy area, canopy height, canopy width, trunk area, trunk width, total area, and the ratio of canopy width to trunk width (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while no significant differences were found in trunk height, root width, root height, root area, total height, the ratio of canopy height to trunk height, and the ratio of canopy area to trunk area (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These findings affirm the value of tree drawing projection tests in the auxiliary diagnosis of depression. Further, the study conducted LSD-t tests to explore the application value of tree drawing indices in the progression of depression symptoms.\u003c/p\u003e \u003cp\u003ePrevious studies have indicated that the canopy in tree drawings primarily reflects a person's thinking, cognitive abilities, and social interactions[16; 22]. Comparisons between the depression group, the depression remission group, and the normal control group (see Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) revealed that the drawn canopy width, height, and area were smaller (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This corresponds to issues in these areas and aligns with symptoms reported by patients with depression, such as slowed thinking, helplessness, lack of interest, diminished capability, poor concentration, cognitive decline, and reluctance to go out and socialize. These findings are consistent with previous research results. The overall tree mainly represents the current psychological and mental state of the drawer; smaller total tree areas in the depression group compared to the remission and control groups suggest poor psychological states, low energy, or feelings of inferiority and lack of self-confidence[23; 24].\u003c/p\u003e \u003cp\u003eIn tree drawing projection tests, the trunk primarily reflects the emotional state of the drawer[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. A smaller trunk area in the depression group compared to the depression remission group and the normal control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) indicates emotional issues (see Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), characterized by unhappiness, low mood, and negativity. Scholars such as Ji Yuanhong believe that in tree drawing tests, the width of the tree can reflect the emotional stability of the drawer[26; 27]. A wider trunk indicates more stable emotions. LSD-t test results showed that the trunk width was narrower in the depression group compared to the remission and control groups, indicating characteristics of emotional fragility and instability.\u003c/p\u003e \u003cp\u003eIn tree drawing projection tests, the canopy, trunk, and roots represent the superego, ego, and id of the drawer, respectively[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In this study, the ANOVA and LSD-t results for the three groups showed no statistical differences in root area, width, and height. The roots represent an individual's instincts and subconscious. Some scholars also believe that roots reflect the collective subconscious of the drawer's community[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], that is, the customs or habits formed by the long-term living conditions of their region and community. The lack of significant differences in the three root indicators in this study might be attributed to the influence of Confucian and other cultural norms prevalent in Chinese society, which advocate restraint and moderation towards instinctual behaviors. As a result, most of the drawings in this tree projection test lack detailed root sections.\u003c/p\u003e \u003cp\u003eThe study results showed that the ratio of canopy to trunk area is larger in the depression group compared to the normal control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), which may be due to emotional symptoms being more pronounced than cognitive symptoms in individuals with depression, resulting in a relatively smaller trunk area compared to the normal control group and thus a larger ratio of canopy to trunk area[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The ANOVA results for total height showed no significant differences across the three groups, and the LSD-t test results for the depression and depression remission groups also indicated no significant differences in trunk height and total height. This is consistent with previous research, suggesting that compared to area and width, height is not a sensitive indicator of changes in depressive symptoms[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of this study indicate that there are no statistically significant differences between the depression remission group and the normal control group across various indices, including canopy area, canopy height, canopy width, trunk area, trunk height, trunk width, root area, root height, root width, the ratio of canopy area to trunk area, the ratio of canopy height to trunk height, the ratio of canopy width to trunk width, total area, and total height. This suggests that as the symptoms of depression improve\u0026mdash;such as slowed thinking, reduced volition and behavior, and low mood\u0026mdash;the values for tree canopy area, height, width, trunk area, width, total area, and total height tend to increase. Although the statistical analysis shows no significant differences between the depression remission group and the normal control group (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), the average values for canopy area, height, width, trunk area, width, total area, and total height in the depression remission group are still less than those in the normal control group, indicating that cognitive, social interaction, and other functions have not fully returned to normal levels immediately after depression remission[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConclusion The findings of this study not only provide a new perspective for the diagnosis of depression but also pave the way for the potential use of tree drawing projection tests as an auxiliary diagnostic tool in clinical psychology. With further validation through research, tree drawing projection tests could become an important tool for assessing the severity of depression and the effectiveness of its treatment.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach author made an indispensable contribution to this research paper. The specific contributions of each author are as follows: Guorui Liu collected data; Ziyang Li analyzed data; Yanfei Zhang \u0026nbsp;wrote the paper; Yige Liu , Hui Jin , Peiqi Shi , Jing Wen, and Yihao Wang searched for literature; Liu Wei and Bai Yonghai guided this research and reviewed the manuscript. Liu Guorui, Zhang Yanfei, and Li Ziyang were the first co-authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis work no funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCorrespondence and requests for materials should be addressed to W.L or YH.B.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThapar, A., Eyre, O., Patel, V. \u0026amp; Brent, D. Depression in Young People. LANCET. 400, 617\u0026ndash;631 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo, Q., Yu, G., Wang, J., Qin, Y. \u0026amp; Zhang, L. Characteristics of House-Tree-Person Drawing Test in Junior High School Students with Depressive Symptoms. CLIN CHILD PSYCHOL P. 28, 1623\u0026ndash;1634 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarwaha, S. et al. Novel and Emerging Treatments for Major Depression. The Lancet (British edition). 401, 141\u0026ndash;153 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, H. et al. Microglia in Depression: An Overview of Microglia in the Pathogenesis and Treatment of Depression. J NEUROINFLAMM. 19, (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo, H. et al. Analysis of the Screening and Predicting Characteristics of the House-Tree-Person Drawing Test for Mental Disorders: A Systematic Review and Meta-Analysis. FRONT PSYCHIATRY. 13, (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStanzani Maserati, M. et al. The Tree Drawing Test in Evolution: An Explorative Longitudinal Study in Alzheimer\u0026rsquo;S Disease. American Journal of Alzheimer's Disease \u0026amp; Other Dementias\u0026reg;. 37, 1419744093 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobens, S. et al. The Digital Tree Drawing Test for Screening of Early Dementia: An Explorative Study Comparing Healthy Controls, Patients with Mild Cognitive Impairment, and Patients with Early Dementia of the Alzheimer Type. Journal of Alzheimer's disease: JAD. 1\u0026ndash;14 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHandler, L. \u0026amp; Thomas, A. D. \u003cem\u003eDrawings in Assessment and Psychotherapy\u003c/em\u003eTaylor \u0026amp; Francis Group 2013\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShinya, N. et al. Comparison of Changes in Oxygenated Hemoglobin During the Tree-Drawing Task Between Patients with Schizophrenia and Healthy Controls. Neuropsychiatric Disease \u0026amp; Treatment. 14, 1071\u0026ndash;1082 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShukla, P., Ram, D. \u0026amp; Sengar, K. S. Performance of Schizophrenic and Manic Patients On Human Figure Drawing: A Comparative Study. SIS journal of projective psychology \u0026amp; mental health. 19, 66 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim, H. K. \u0026amp; Slaughter, V. Brief Report: Human Figure Drawings by Children with Asperger's Syndrome. J AUTISM DEV DISORD. 38, 988\u0026ndash;994 (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu, S. et al. Screening Depressive Disorders with Tree-Drawing Test. FRONT PSYCHOL. 11, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu, G. et al. Quantitative study on the characteristics of the tree-drawing test in schizophrenia patients. Chin J Behav Med \u0026amp; Brain Sci. 27, 5 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, Y. Liu, G. Li, Z. Zhang, Z. \u0026amp; Liu, W. Quantitative Study of the Characteristics of the Tree-Drawing Test in Depressive Patients. Chinese General Practice. 3 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen, K. Song, B \u0026amp; Shen, H. Using Projective Drawing Test to Evaluate the Anxiety Symptom. Journal of Psychological. 34, 1512\u0026ndash;1515 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaserati et al. The Tree-Drawing Test (Koch's Baum Test): A Useful Aid to Diagnose Cognitive Impairment. BEHAV NEUROL. (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization, A. P. \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorders (5Th Ed.)\u003c/em\u003eDiagnostic and statistical manual of mental disorders (5th ed.) 2013\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, M. \u003cem\u003ePsychiatric Rating Scale Manual\u003c/em\u003e Hunan Science \u0026amp; Technology Press, Changsha 1998\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCai, W. Tang, Y. Wu, S. \u0026amp; Chen, Z. Image of trees in the projection test system. Advance in Psychological. 20, 782\u0026ndash;790 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen, G. \u0026amp; Yan, W. Utility of the Rorschach inkblot test in clinical psychological diagnosis. 中China Journal of Health Psychology. 30, 475\u0026ndash;480 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou, H. \u003cem\u003eResearch on the Relathionship between Rumination Thinking of Junior Middle School Students and H-T-P Drawing Characteristics\u003c/em\u003e: Bohai University, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, T. \u0026amp; Zhang, H. \u003cem\u003eUnlocking the Secrets of personality H-T-P drawing psychological test\u003c/em\u003e China Literary Federation Publishing Company 2007\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaneda, A. et al. Characteristics of the Tree-Drawing Test in Chronic Schizophrenia. PSYCHIAT CLIN NEUROS. 64, 141\u0026ndash;148 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, et al. Difference Analysis of Quantitative Indexes of Tree-drawing Test Painting in Schizophrenia and Depression. Chinese General Practice. 23, 63\u0026ndash;67 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eROWLEY, M. \u003cem\u003eDrawing a Tree\u003c/em\u003e Create Space Independent publishing platform, San Bernardino CA 2015\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJi, R. Tree Personality Projection Test. Chongqing Chongqing publishing group,Chongqing 2011\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurayama, N. et al. Characteristics of Depression in Community-Dwelling Elderly People as Indicated by the Tree-Drawing Test. PSYCHOGERIATRICS. 16, 225\u0026ndash;232 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanter, J. W., Busch, A. M., Weeks, C. E. \u0026amp; Landes, S. J. The Nature of Clinical Depression: Symptoms, Syndromes, and Behavior Analysis. Behav Anal. 31, 1\u0026ndash;21 (2008).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tree drawing projection, Depression, Projection tests, Quantitative research, Auxiliary diagnosis","lastPublishedDoi":"10.21203/rs.3.rs-4574362/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4574362/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to extract and quantitatively analyze the tree drawing projection indices from groups of patients with depression, patients in remission, and a normal control group, to explore characteristic indicators of tree drawing projections in individuals with depression and provide a basis for auxiliary diagnosis and condition assessment of depression.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTree drawing tests were administered to 59 patients with depression, 57 patients in remission, and 59 normal controls. Computer image recognition and data collection were used for quantitative analysis of the tree projections, and statistical analysis was conducted on the results from the three groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eANOVA tests revealed significant statistical differences between the depression patients, remission patients, and normal controls in the following quantitative indices: canopy area, canopy height, canopy width, trunk area, trunk width, total area, and the ratio of canopy width to trunk width (P values: 0.000, 0.000, 0.000, 0.003, 0.000, 0.004, 0.000). No significant differences were found in trunk height, root width, root height, root area, total height, the ratio of canopy height to trunk height, and the ratio of canopy area to trunk area. Further LSD-t tests showed that compared to the depression group, the remission group exhibited significant differences in canopy area, canopy height, canopy width, trunk area, trunk width, the ratio of canopy height to trunk width, and total area (P values: 0.001, 0.000, 0.009, 0.002, 0.000, 0.046, 0.007, 0.000). No significant differences were found in the other six indices; also, no significant differences were found between the remission group and the normal control group across all 14 indices.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThere are seven quantitative indices where significant statistical differences exist among the tree drawings from the depression group, the remission group, and the normal control group, and seven indices where no significant differences were found. The quantitative indices of tree drawing projections have potential value for the auxiliary diagnosis and condition assessment of depression.\u003c/p\u003e","manuscriptTitle":"Research on the Application of Tree Drawing Projection Tests in the Auxiliary Diagnosis and Condition Assessment of Depression","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-03 11:28:15","doi":"10.21203/rs.3.rs-4574362/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40fbf359-49a0-4a8b-843a-5d31a400ed0d","owner":[],"postedDate":"July 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33962954,"name":"Biological sciences/Psychology"},{"id":33962955,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2024-10-29T07:08:53+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-03 11:28:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4574362","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4574362","identity":"rs-4574362","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}