Aim: Diagnosing and treating major depressive disorder (MDD) remains a pressing global
health challenge. Generative-AI tools, by lowering technical barriers and offering
rapid visual feedback, may open new avenues for art-based assessment and intervention.
Methods: In this exploratory qualitative pilot, we conducted reflexive thematic analysis
of semi-structured interviews with N = 10 young adults at elevated risk for depression
who generated self-representative images in Midjourney during a 45-minute session.
Participants were selected from a larger cohort described elsewhere; no quantitative
analyses were conducted in the present paper. Results: Qualitative findings suggested
therapeutic-like mechanisms that mirror—and in some cases amplify—those reported for
traditional art therapy, including the experience of flow and spontaneity, a heightened
sense of creative agency, and the safe externalization of difficult or extreme emotions.
Some participants described abrupt “sentiment switches,” where joyful imagery was
immediately followed by scenes of sudden, intrusive self-criticism. Importantly, the
generative process also surfaced idiosyncratic “resource images” (e.g., nature motifs,
hobbies, values, loved ones) that participants experienced as calming or empowering,
hinting at personalised anchors for future interventions. Conclusions: In line with
prior quantitative work showing that more negative prompt sentiment statistically
relates to higher BDI scores, the present qualitative narratives offer an interpretive
account of how such negativity may emerge during AI-assisted self-representation.
However, the current study does not integrate datasets or perform mixed-methods triangulation
and uses those prior findings solely for contextualization. We conclude that, with
appropriate ethical safeguards, generative-AI image making may serve as a flexible,
low-cost adjunct to existing diagnostic and art-therapeutic practices, offering clients
and clinicians a shared visual language for exploring the multi-layered experience
of depression.
