Effects of music therapy on anxiety and depression symptoms in adults diagnosed with mental disorders: a systematic review

Ibiapina, Aline Raquel de Sousa; Lopes-Junior, Luís Carlos; Veloso, Lorena Uchôa Portela; Costa, Ana Paula Cardoso; Silva Júnior, Fernando José Guedes da; Sales, Jaqueline Carvalho e Silva; Monteiro, Claudete Ferreira de Souza

doi:10.37689/acta-ape/2022AR02212

Brasil

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Review Article • Acta Paul Enferm 35 • 2022 • https://doi.org/10.37689/acta-ape/2022AR02212 linkcopy

Effects of music therapy on anxiety and depression symptoms in adults diagnosed with mental disorders: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective To identify and synthesize evidence from randomized clinical trials that assessed the effects of music therapy on anxiety and depression symptoms in adults with mental disorders.

Methods This is a systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. The search for articles in the MEDLINE, Embase, CENTRAL Cohcrane, CINAHL, PsycINFO and LILACS databases, as well as manual search, selection of studies, data extraction and methodological assessment using the Jadad Scale and the Cochrane risk-of-bias, was performed by two reviewers independently.

Results 1,649 studies were identified, eight of which were selected and analyzed. The findings showed a positive effect of music therapy on anxiety and depression symptoms in the adult population in different contexts. According to the Cochrane risk-of-bias, four studies were classified as low risk of bias, and the other four as high risk of bias. Adults who received music therapy showed physical and mental relaxation, reduced anxiety and depressive symptoms, promoting well-being in a conscious and healthy way.

Conclusion Music therapy presents itself as a potential strategy to reduce anxiety and depression as well as to help maintain and recover the health of adults with mental disorders.

Database	Search expression
MEDLINE*/PubMed	(“adult” [MeSH† Terms]) AND (“depressive disorder” [MeSH† Terms] OR (“depressive”[All Fields] AND “disorder”[All Fields]) OR “depressive disorder”[All Fields] OR “depression”[All Fields] OR “depression”[MeSH† Terms]) AND (“anxiety”[MeSH† Terms] OR “anxiety”[All Fields]) AND (“music therapy”[MeSH † Terms] OR (“music”[All Fields] AND “therapy”[All Fields]) OR “music therapy”[All Fields])
‡Embase	adult AND depression OR anxiety OR ‘music therapy’
§CENTRAL Cohcrane	(“adult” [MeSH† Terms]) AND (“depressive disorder”[MeSH Terms] OR (“depressive”[All Fields] AND “disorder”[All Fields]) OR “depressive disorder”[All Fields] OR “depression”[All Fields] OR “depression”[MeSH Terms]) AND (“anxiety”[MeSH Terms] OR “anxiety”[All Fields]) AND (“music therapy”[MeSH Terms] OR (“music”[All Fields] AND “therapy”[All Fields]) OR “music therapy”[All Fields])
^\|\|PsycINFO	adult [Thesaurus] AND depression [Thesaurus] OR anxiety [Thesaurus] AND music therapy [Thesaurus]
**CINAHL	adult AND depression OR anxiety AND music therapy
‡‡LILACS	adulto OR adult OR adulto AND depressão OR depression OR depresión [Words] AND ansiedade OR anxiety OR ansiedad [Words] AND musicoterapia OR music therapy OR musicoterapia [Words]

Authors / Country	Objective	Sample	Intervention		Variables/ Instruments	Main results	Jadad Score
Authors / Country	Objective	Sample	Experimental Group (EG)	Control Group (CG)	Variables/ Instruments	Main results	Jadad Score
Cassileth et al. 2003⁽³³⁾ USA	Determine the effects of music therapy on mood compared to standard care during hospitalizations for high-dose therapy with autologous stem cell transplantation	69 patients with hematologic malignancy admitted for high-dose therapy with autologous stem cell transplantation	(n=36) allocated to the music therapy group - Intervention: 20 to 30 minutes; sessions; 2-3 times/week); Follow-up: 6 months	(n=33) allocated to standard treatment without music therapy	Mood - POMS*	During hospitalization, patients in the EG (music therapy) had a 28% lower score on the Anxiety/Depression scale (p=0.065) and 37% lower (p=0.01) on the total score for mood disorders compared to patients of the CG	2
Choi et al. 2008⁽³⁴⁾ South Korea	Test the effectiveness of group music therapy to improve depression, anxiety and relationships in psychiatric patients	26 psychiatric patients	(n=13) allocated to the music therapy group - Intervention: 60 minutes; 15 sessions (once to twice a week); Follow-up: 15 weeks	(n=13) allocated to standard treatment without music therapy	Anxiety - STAI^† Depression - HADS^‡ Social relationships - RCS^§	After 15 sessions, the group music therapy intervention significantly improved scores for depression (F [1.25]=257.7; p=0.001), anxiety (F [1.25]=202.7; p=0.001), and social relationships (F [1.25]=450.6; p=0.001) in psychiatric patients compared to the CG	1
Erkkilä et al. 2011⁽³⁵⁾ Finland	Determine the effectiveness of music therapy added to standard usual care compared to just standard usual care in depression treatment among people of working age	79 adults with unipolar depression	(n=33) patients allocated to receive music therapy and standard treatment - Intervention: 60 minutes; 20 sessions (twice a week); Follow-up: 6 months	(n=46) patients allocated only to standard treatment without music therapy	Anxiety and Depression - MADRS^¶ - HADS‡ - GAF** Quality of Life - RAND36^††	The EG showed higher rates of improvement in depressive symptoms than those who received only standard care (mean difference 4.65, 95%CI^‡‡ 0.59 to 8.70, p=0.03) and anxiety symptoms (1.82, 95%CI^‡‡ 0.09 to 3.55, p=0.04) in the three-month follow-up	3
Guétin et al. 2012⁽³⁶⁾ France	Assess the usefulness of music therapy in the treatment of patients with chronic pain	87 patients with low back pain, fibromyalgia, inflammatory disease or neurological disease	(n=44) allocated to the music therapy group - Intervention: 20 minutes; (twice a day); Follow-up: 3 months	(n=43) allocated to the standard treatment group without music therapy	Pain - VAS^\|\| Anxiety and Depression - HADS^‡	In the EG (music therapy), there was a more significant reduction in pain (p<0.001) when compared to the CG. Also, music therapy contributed to significantly reduce anxiety, depression and the consumption of anxiolytic agents	3
Gold et al. 2014⁽³⁷⁾ Norway	Examine the effects of music therapy on aspects of mental health, specifically depression, anxiety and social relationships in adults deprived of liberty	113 adult men deprived of liberty	(n=56) allocated to music therapy - Intervention: time not reported; sessions (2 to 3 times/week); Follow-up: 6 months	(n=57) allocated to standard treatment without music therapy	Anxiety - STAI^† Depression - HADS^‡ Social relationships - Q-LES-Q^§§	Music therapy was well accepted by adults deprived of freedom. Post-hoc analysis of changes within the experimental group suggested a reduction in anxiety after 2 weeks of music therapy (d=0.33, p=0.025)	2
Salehi et al. 2016⁽³⁸⁾ Iran	Determine the effect of selected relaxing music on hospitalized patients with anxiety and depression during hemodialysis	102 patients in hemodialysis	(n=83) received music therapy - Intervention: 3 hours; 1 session; Follow-up: 1 day	(n=83) did not receive music therapy (standard care)	Anxiety -STAI^† Depression - BDI^\|\|\|\|	There were no significant differences between groups before hemodialysis BDI^\|\|\|\| (p=0.253), t-anxiety (p=0.546) and s-anxiety (p=0.253), T-Anxiety (p=0.546) and S-Anxiety (p=0.776). There was also no significant difference in the BDI^\|\|\|\| (p=0.253) and T-anxiety (p=0.253) and T-Anxiety (p=0.546) between the two groups after hemodialysis	2
Dóro et al. 2017⁽³⁹⁾ Brazil	Assess the effect of music therapy about pain, mood and anxiety	100 patients undergoing allogeneic hematopoietic stem cell transplantation	(n=50) patients were selected for experimental music therapy - Intervention: 30 minutes; sessions based on clinical need (twice a week); Follow up: not reported	(n=50) patients who received only the standard treatment without music therapy	Pain, anxiety and mood - VAS^\|\|	Significant differences were observed when comparing the groups, improving mood in the EG (p<0.001)	4
Trimmer et al. 2018⁽⁴⁰⁾ Canada	Test the feasibility of low-intensity music based cognitive-behavioral therapy for depression and anxiety symptoms	28 patients with symptoms of depression and anxiety attended at a community mental health service	(n=14) allocated to the intervention group with music therapy - Intervention: 90 minutes; 9 sessions; Follow-up: 9 weeks	(n=14) allocated to the standard treatment group without music therapy	Anxiety and Depression- - HADS^‡ Disabilities - WHO^¶¶ Disability Assessment Schedule 2.0	EG participants (music therapy) showed improvement in disability (p=0.027). Despite the reduction in depression and anxiety scores, these differences were not statistically significant.	3

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Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
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[TFN1001] *MEDLINE - Medical Literature Analysis and Retrieval System Online; †MeSH - Medical Subject Headings; ‡Embase - Excerpta Medica database; §CENTRAL - Cochrane Central Register of Controlled Trials; ^||PsycINFO - Psychology Information. **CINAHL – Cumulative Index to Nursing and Allied Health Literature; ‡‡LILACS – Latin American Caribbean Literature in Health Sciences. 12/09/2019 - Date on which the search strategy was carried out.