Review: The effectiveness of musical therapy in improving depression and anxiety symptoms among children and adolescents – a systematic review

Abstract

Background: Depression and anxiety disorders are considered to be among the greatest burdens of disease in children and adolescents. Recent literature has reported music therapy to be a safe and potentially effective intervention for the treatment of depression and anxiety. This systematic review examined the effectiveness of music therapy in reducing the symptom severity of depression and/or anxiety among children and adolescents. Methods: Randomized controlled trials (RCTs) were obtained from a systematic search of nine major English databases from inception to January 2021. Studies were categorized by outcome, music therapy technique and follow-up period. Results: Seven RCTs (n = 589) were included. Four RCTs had some concern of bias, while three had high risk of bias. Statistical pooling was not appropriate due to clinical heterogeneity. Four studies (n = 428) favoured music therapy for improvement of depressive symptoms at short-and intermediate-term follow-ups compared to control. One study (n = 106) favoured music therapy for improvement of anxiety symptoms at short-term follow-up compared to control. No studies favoured any control over music therapy for symptom improvement of depression and/or anxiety. Conclusion: Limited evidence suggests music therapy is an effective treatment for improving depression and/or anxiety symptom severity in children and adolescents. More high-quality RCTs are needed to address methodological flaws of current studies. Key Practitioner Message• There is evidence that suggests music therapy is an effective intervention in improving the symptoms of depression and/or anxiety in children and adolescents.• Previous literature did not address the clinical heterogeneity between the included studies; types of music therapy interventions, various controls and follow-up periods.• This review addressed the previous limitations by updating the search strategy and including more databases, stratifying outcomes based on the type of music therapy, assessing risk of bias and addressing the clinical heterogeneity between the included studies.• There is limited evidence that active and receptive music therapy techniques are effective in reducing depression symptoms among children and adolescents.• Further high-quality RCTs that include follow-up periods and stratification based on type of music therapy intervention are necessary to provide more robust conclusions regarding its effectiveness in improving symptoms of depression and/or anxiety in children and adolescents.

A Systematic Review of Music-Based Interventions to Improve Treatment Engagement and Mental Health Outcomes for Adolescents and Young Adults

“…In contrast, the effects of music-based interventions on externalizing outcomes were less conclusive and limited by methodological constraints. Previous systematic reviews and meta-analyses have found similar results for children, younger adolescents, and adults with internalizing disorders (Belski et al, 2021 ; Geipel et al, 2018 ; Gold et al, 2004 ; Maratos et al, 2008 ; Tang et al, 2020 ). Our attention to social and emotional outcomes (e.g., emotion regulation, self-awareness, relationship skills) beyond the internalizing and externalizing symptoms dichotomy, is meaningful because the importance of these competencies has rarely been captured in previous reviews focused predominantly on specific disorders.…”

“…For example, several reviews focused on adults with depression (Chan et al, 2011 ; Maratos et al, 2008 ; Tang et al, 2020 ; Zhao et al, 2016 ) while others have examined specific subgroups including those with serious mental illness (Carr et al, 2013 ; Gold et al, 2009 ), general mental health conditions (Lee & Thyer, 2013 ), health-related quality of life (McCrary et al, 2022 ), and justice-involved youth (Daykin et al, 2013 ). Systematic reviews and meta-analyses focused on children and adolescents experiencing mental health conditions have reported medium effect sizes (Belski et al, 2021 ; Geipel et al, 2018 ; Gold et al, 2004 ). For example, Geipel and colleagues’ ( 2018 ) meta-analysis focused on internalizing disorders and included five studies; the results indicated significant effects in favor of music-based interventions with a medium effect size.…”

“…For example, Geipel and colleagues’ ( 2018 ) meta-analysis focused on internalizing disorders and included five studies; the results indicated significant effects in favor of music-based interventions with a medium effect size. Belski and colleagues ( 2021 ) focused on RCTs of interventions targeting depression and anxiety symptoms; their review of seven studies suggests symptom improvements however concerns of bias and methodological issues (e.g., lack of randomization, blinding) are noted. Taken together, these reviews contribute to our understanding of the efficacy of music-based interventions for children and adolescents, predominantly those with internalizing symptoms.…”

Music therapy for anxiety disorders in adolescents and young adults: A systematic review

“…However, there has been a recent trend in the last three years among the studies included in this review towards higher quality research in the field. A similar trend was also witnessed in the research of music therapy's effect on depression, a common comorbidity to anxiety, with an increasing number of studies focusing on adolescents and young adults in the last decade [27]. Thus, maybe in the next five to ten years there will be a larger selection of studies to include in a future systematic review.…”

A Pilot Study Examining the Effects of Music Training on Attention in Children with Fetal Alcohol Spectrum Disorders (FASD)

“…The strong evidence for differences in brain structure and function between musicians and nonmusicians has led research groups to examine the possibility of using MT to improve brain function in individuals with brain-related disorders [ 20 , 21 , 22 , 23 , 24 ]. Retrospective studies are limited in their ability to determine causality of effects, and one possible explanation for these retrospective results is that musicians have a unique aptitude for music that explains these differences in brain structure and function.…”