Depression and anxiety are prevalent mental health challenges among college students, with global statistics ranking them fourth and sixth, respectively, in the major burdens faced by individuals aged 10–24 years (Global Burden of Disease Study and Injuries, 2020). These disorders significantly contribute to self-harm and injury, particularly among adolescents and young adults (Li et al., 2023). Notably, research indicates that depression is a primary emotional concern for college students, particularly those in university settings (Pratt and Brody, 2014; Rotenstein et al., 2016). The prevalence of common mental health issues, including depression and anxiety, has been on the rise among college students in recent years (Lattie et al., 2019; Li et al., 2023). Notably, medical school students, due to the prolonged duration required for acquiring knowledge and skills in the field of medicine, face heightened levels of mental and physical stress (Adams, 2004; O'Rourke et al., 2010; Quek et al., 2019; Zeng et al., 2019). Various studies consistently show that medical school students experience a higher prevalence of depression and anxiety compared to the general population (Adams, 2004; Dyrbye et al., 2006; Khan et al., 2006; Ahmed et al., 2009; Hope and Henderson, 2014; Tabalipa et al., 2015; Azad et al., 2017; Quek et al., 2019).

Music therapy, recognized as the professional use of music and its elements for therapeutic purposes, has emerged as a promising intervention in medical, educational, and everyday settings (Maratos et al., 2008). It utilizes musical activities to stimulate individuals and elicit physical responses, with the goal of enhancing health through tools such as music, relationships, and reflection. Music therapy is comprised of active and receptive approaches that also integrate verbal processing. These approaches include various ways of engaging with music, including receptive, improvisational, compositional, and recreative (Bruscia, 2014). Research involving patients diagnosed with mental disorders has consistently shown significant improvements in mental health following interventions that utilize music as a primary tool (Edwards, 2006; Mössler et al., 2011; Rebecchini, 2021; Zhang et al., 2022). Additionally, numerous studies have highlighted the multifaceted benefits of music, ranging from enhancements physical and mental wellbeing (Fancourt et al., 2014; Khan et al., 2018; Wang and Agius, 2018). However, the potential of music therapy to improve emotional wellbeing, alleviate depression, or reduce anxiety among medical school students—a unique demographic group—remains largely unexplored. In this study, our aim was to address the psychological challenges encountered by medical school students through the use of comprehensive screening tools, including the SCL-90, SDS, and SAS scales. Our primary objective was to evaluate the efficacy of music therapy as a non-pharmacological intervention in enhancing mood and alleviating symptoms of depression and anxiety among medical school students.

By specifically targeting this demographic group, our research seeks to fill a crucial gap in the literature and provide valuable insights into the effectiveness of music therapy as a tailored intervention for improving the mental health and wellbeing of medical school students. The integration of music therapy into mental health support strategies for this population shows promise and merits further investigation.

This pioneering study is the first to utilize the SCL-90, SDS, and SAS scales to assess the impact of a 4-step structured music therapy program on medical school students. The results revealed promising outcomes, especially among male, junior grade, and clinical medicine students, indicating improvements in mood regulation and emotional wellbeing. This highlights the potential of music therapy as a non-pharmacological intervention for addressing mental health challenges among medical school students.

Medical school students are under immense academic, interpersonal, and emotional pressures, which often lead to heightened levels of anxiety and depression (Dyrbye et al., 2006; Hope and Henderson, 2014; Brenneisen Mayer et al., 2016). Our research found that the prevalence of depression and anxiety among Chinese medical school students was 55.6% and 15.6%, respectively, surpassing global rates (Brenneisen Mayer et al., 2016). While previous studies have shown the positive impact of music therapy on college students' mental wellbeing (Finnigan and Starr, 2010; Zhang et al., 2022; Finnerty et al., 2023; Nwokenna et al., 2023), no research has explored its efficacy specifically among medical school students. By focusing on this demographic, our study aims to bridge this gap in the literature and provide valuable insights into the effectiveness of music therapy as a tailored intervention.

In response, we designed an 8-week, 4-step music therapy program tailored specifically for medical school students. The program included various components aimed at fostering social interaction, engaging in music activities, learning music theory, and encouraging creative expression. Step 1 focused on fostering social connections through self-introduction and communication exercises, helping students acclimate to their environment, alleviate tension, and build trust with peers and instructors. Step 2 incorporated common music therapy techniques such as playing instruments, singing, and rhythmic interventions, along with progressive relaxation exercises to directly improve students' mental state, divert attention, and reduce tension and anxiety (Robb, 2000; Kim, 2008). Step 3 involved teaching students music theory, including different music genres, Chinese pentatonic songs, and various musical instruments. This aimed to enhance students' music appreciation skills and aesthetics, thereby improving subjective wellbeing and amplifying the therapeutic effects of music therapy (Robb, 2000; Che et al., 2022; Fu and Tu, 2023). The final step encouraged students to engage in creative expression by creating rhythms, songs, or dances through improvisation. This was followed by sharing favorite songs and expressing feelings, enabling students to understand and acknowledge their own emotional states and needs, express themselves freely, and build self-confidence, ultimately alleviating stress and anxiety. This comprehensive approach addresses various aspects of psychological wellbeing, providing medical school students with a holistic therapeutic experience tailored to their unique challenges and needs.

This study employed an innovative approach by utilizing three psychological scales—SCL-90, SDS, and SAS—to screen for mental health issues among medical school students. While various psychological scales, such as the Beck Depression Inventory (BDI) (Baldassin et al., 2008) and State-Trait Anxiety Inventory (STAI) (Du et al., 2022), are commonly used to assess depression and anxiety, they primarily focus on cognitive and affective aspects. In contrast, the combination of SCL-90, SDS, and SAS offers a more comprehensive understanding of psychological symptoms and provides a broader evaluation of depression and anxiety symptoms (Zung, 1971, 1974; Dunstan et al., 2017; Dunstan and Scott, 2020).

Using these methods, we observed a significant reduction in the GSI and PST on the SCL-90 scale following music therapy intervention. These findings indicate that music therapy may effectively improve mood and regulate emotions among medical school students. Notably, there were gender differences in response to music therapy, with male students showing significant improvements in somatization, interpersonal sensibility, and hostility compared to females. This suggests the need for gender-specific approaches in mental health interventions. Furthermore, the study explored the differential effects of music therapy based on academic grade and major. Junior grade students exhibited significant improvements across various scales post-intervention, consistent with previous research (Ludwig et al., 2015). Additionally, our investigation uncovered noteworthy insights into students majoring in clinical medicine, who demonstrated significant enhancements in hostility, paranoid ideation, and other factors compared to peers from different healthcare majors. These results emphasize the importance of tailoring music therapy interventions according to both academic progression and field of study, highlighting the nuanced nature of mental health interventions within academic contexts. Recognizing the unique needs and challenges faced by students in different healthcare disciplines is crucial for designing effective intervention strategies. By acknowledging these variations, healthcare professionals can develop targeted approaches to address specific issues and promote overall wellbeing among students pursuing diverse paths within the healthcare field. Furthermore, our findings suggest the potential benefits of integrating music therapy as a complementary intervention in clinical medicine education, potentially enhancing students' mental health and overall academic experience. Such integration could contribute to their professional development, fostering a healthier and more resilient future healthcare workforce.

While the results of this study are promising, several limitations should be acknowledged. The sample size was relatively small, and the study duration was limited to 8 weeks. Long-term follow-up and larger-scale studies would provide more robust evidence of the sustained effectiveness of music therapy in this context.

In conclusion, this study underscores the potential of music therapy as a non-pharmacological intervention for mitigating mental health challenges among medical school students. The structured music therapy protocol employed here demonstrated promising outcomes in enhancing mood and emotional regulation, notably among male students, those in junior grades, and pursuing clinical medicine. By introducing an alternative or complementary treatment approach, this research contributes to addressing the mental wellbeing of students, achieving its primary aim of mood improvement.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by the Ethics Committee of the Affiliated Union Hospital in Tongji Medical College of Huazhong University of Science and Technology (no.ChiCTR2200056141). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

QC: Writing—original draft, Formal analysis, Data curation. CM: Writing—original draft, Data curation. LQ: Writing—original draft, Data curation. YL: Writing—original draft, Formal analysis, Data curation. GY: Writing—original draft, Validation, Software. LW: Writing—original draft, Investigation. CL: Writing—original draft, Resources. CZ: Writing—review & editing. JZ: Writing—review & editing. CF: Writing—review & editing, Project administration.