Effects of Integrating Music Therapy into Family Support System on Adolescent Depression

Abstract

Objective:

This study aims to investigate the effects and feasibility of integrating music therapy into a family support system (FSS) for adolescent depression.

Methods:

In this retrospective study, 120 adolescents with depression who visited the Wenzhou Seventh People’s Hospital between June 2022 and June 2024 were selected and categorized into the music therapy group and a conventional group (60 cases in each group). The conventional group received FSS-assisted treatment and conventional medication, whereas the music therapy group was given music therapy based on the conventional treatment. The Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Family Assessment Device (FAD), Adolescent Self-Rating Life Events Checklist (ASLEC), and Pittsburgh Sleep Quality Index (PSQI) were compared between the two groups.

Results:

After treatment, the decrease in HAMD and HAMA scores was significantly greater in the music therapy group than in the conventional group (P < 0.05). The FAD score in the music therapy group improved more significantly in dimensions such as problem-solving, communication, emotional involvement, behavior control, and overall function than that of the conventional group (P < 0.05). The ASLEC score showed a greater reduction in aspects such as interpersonal relationships, academic stress, punishment, and loss (P < 0.05). The PSQI score improved more significantly with regard to subjective sleep quality, sleep latency, sleep duration, sleep disorders, hypnotic drug use, and daytime dysfunction (P < 0.05).

Conclusion:

Integrating music therapy into FSS can effectively reduce depression and anxiety symptoms in adolescents with depression, improve the family and psychosocial function, and enhance sleep quality. However, further studies are still needed to verify and improve this approach.

KEY MESSAGES

• (1)Integrating music therapy into family support system can effectively treat adolescent depression and relieve patients’ depression and anxiety symptoms.
• (2)Integrating music therapy into family support system positively affects family function, psychosocial function, and sleep quality in adolescents with depression.
• (3)Music therapy offers a novel approach for the treatment of adolescent depression.

INTRODUCTION

Adolescent depression is an increasingly serious public health problem that not only affects adolescents’ physical and mental well-being and the academic development, but also brings great challenges to families and society.[1] Recently, the incidence of adolescent depression has been growing globally, with approximately one in five adolescents suffering from depression.[2,3]

Conventional therapies for adolescent depression mainly include antidepressant medication and psychotherapy.[4,5] Antidepressants can cause various side effects, such as gastrointestinal discomfort, sexual dysfunction, and weight gain. Moreover, they often take weeks or even months to achieve therapeutic effects. Traditional psychotherapy primarily focuses on the individual patient, disregarding the important role of family. In a family setting, family relationships, family atmosphere, and parenting styles all have a profound influence on the psychological well-being of adolescents. A family support system (FSS) is a complex system that emphasizes the interaction between family members and the overall functioning of the family.[6] FSS can help the recovery of adolescents with depression by improving family communication, resolving internal conflicts, and enhancing the family support function.[7]

Music therapy, as an auxiliary treatment method, has gradually attracted attention in the field of mental health.[8,9] Music has a unique ability to express and communicate emotions, stimulate patients’ emotions, reduce stress, and promote self-awareness and the development of interpersonal relationships.[10,11] Recent neuroscience research has shown that specific musical rhythms and melodies can stimulate the release of neurotransmitters such as dopamine and serotonin, which are closely related to mood regulation.[12,13] Moreover, music can modulate the activity of the amygdala, a key brain region involved in emotional processing, thereby reducing negative emotions and enhancing positive emotions.[14] These findings provide a scientific basis for understanding the mechanisms by which music therapy may work in treating adolescent depression. Combining music therapy with FSS can fully leverage their strengths, providing an innovative and comprehensive treatment model for adolescent depression.

This study aims to investigate the effectiveness and feasibility of combining music therapy with FSS in adolescent depression, as well as to bring hope to patients with adolescent depression and their families.

MATERIALS AND METHODS

General Information

This retrospective study collected data on age, gender, body mass index, disease duration, place of residence, education level, and family composition of adolescents from the electronic medical record system of Wenzhou Seventh People’s Hospital. The system has been in use for over a decade, and it is regularly updated and maintained to ensure data accuracy and integrity. The sample size estimation formula was n = [(Z_α/2 + Z_β)² × 2 × σ²]/δ². The results showed that 25 cases were needed for each group. Considering the dropout rate of 15%, the final sample size for each group was 29. To improve reliability, we increased the sample size. In total, 190 adolescents with depression who were treated in our hospital between June 2022 and June 2024 were selected as subjects. After screening for inclusion and exclusion criteria, 37 and 33 cases were excluded, respectively, and a total of 120 cases were finally included. The patients were categorized into the music therapy group and the conventional treatment group, with 60 cases in each group.

This study was conducted in accordance with the Declaration of Helsinki, and it gained ethical approval from the Ethics Committee of Wenzhou Seventh People’s Hospital (approval number: EC-20210826-23). All patients provided signed consent after being informed.

Case Selection Criteria

The inclusion criteria were as follows: (1) first diagnosed with depression and met the diagnostic criteria for adolescent depression of the Diagnostic and Statistical Manual of Mental Disorders (5th Edition)[15]; (2) aged between 13 and 18 years; (3) patients and their families signed the informed consent form; (4) each patient had at least two guardians participating in the study; and (5) patients were in a stable stage and able to cooperate with treatment and evaluation.

The exclusion criteria were as follows: (1) complicated with other severe mental disorders or physical diseases; (2) patients with hearing impairments or those who could not understand music; (3) patients who were participating in other psychological treatments or drug trials; and (4) patients in unstable family environments and those whose family members could not ensure participation in the treatment.

Treatment Methods

Both groups were treated with conventional antidepressants such as selective serotonin reuptake inhibitors. The specific drug types, doses, and duration of use were determined by doctors based on each patient’s individual condition. During treatment, possible side effects such as gastrointestinal discomfort and weight changes were closely monitored, and the treatment plan was adjusted in time.

Conventional group: Based on conventional medication, the conventional group implemented FSS-assisted treatment by creating a good sleep environment for patients, ensuring suitable bedroom conditions, adjusting study and rest time, guiding correct sleeping postures, encouraging entertainment activities during the day, and avoiding excitement and stimulation before going to bed. In addition, parents were guided to pay attention to patients’ dietary diversity and nutritional balance. Family members provided companionship and support to patients, optimized communication with caring and encouraging words, and avoided sensitive words when talking to patients. Supervision of patients’ medication was strengthened. Wrong concepts were abandoned, and bad behaviors were avoided (e.g., parents thinking depression as laziness, avoiding discussion about it, or scolding adolescents for poor academic performance). Patients were also encouraged to develop suitable hobbies and participate in social activities. Moreover, a 1-hour education session was arranged once a week, covering knowledge of mental health, symptoms and treatment of depression, and the importance of family support.

Music therapy group: Music therapy was integrated into conventional FSS. The treatment frequency was once a week, and the total duration was 12 to 16 weeks. Music therapy was carried out for 1 h following the conventional education session. Each treatment session was attended by the patient and at least one family member. The specific methods were as follows:

• (1)Family music creation: Before the music creation, professional music teachers conducted a 15- to 20-minute basic music theory lesson for families, introducing concepts such as rhythm, melody, and harmony. For music creation, a variety of musical instruments were available, including keyboards, guitars, drums, and wind instruments such as recorders. In addition, music creation software such as GarageBand (for Mac users) or FL Studio (for Windows users) was provided, which allows families to experiment with different sounds and effects. The duration of the music creation activity was 30 to 40 minutes. There were no strict requirements for melodies and lyrics. Family members could create melodies reflecting their current moods, while lyrics could consist of simple words, phrases, or even improvised sounds.
• (2)Music appreciation and sharing: Music works suitable for adolescent patients with depression were selected, considering not only the general characteristics and therapeutic effects of music on depression but also patients’ individual preferences as much as possible. Before each session, therapists closely communicated with adolescent patients to understand their musical inclinations. If a patient expressed a strong liking for children’s songs or pop music, these types of music were incorporated into the sharing session. Parents were asked to listen attentively to their children’s chosen music and then share their thoughts and feelings, thereby enhancing emotional resonance.
• (3)Music meditation and relaxation: Meditation and relaxation sessions were designed to meet the needs of the patients, and they could choose between meditating alone or in a group with their family members. During meditation, therapists adjusted the music, instructions, and group dynamics based on patients’ preferences. This activity lasted approximately 25 to 35 minutes, aiming to help patients achieve a state of deep relaxation and mental clarity.
• (4)Music activities and games: Family music activities and games, such as music puzzles and music quizzes, were organized to increase family fun and cohesion. In music puzzles, participants used fragments of well-known musical works to piece together the melody they were familiar with. The music types included pop songs, film soundtracks, and well-known cartoon theme songs. In music quizzes, participants competed in groups to answer questions such as “Name the lead singer of the band that sang this hit song” or “What is the name of the movie that this famous soundtrack is from?” These activities usually take up the remaining 15 to 25 minutes of each session.

The music therapists participating in this study included psychotherapists, nurses, and psychiatrists. They all received additional training in working with adolescent patients with depression and integrating music therapy with FSS. This training encompassed both theoretical knowledge and practical skills.

For in-hospital patients, a dedicated music therapy room was set up, equipped with various instruments and sound systems. For out-of-hospital patients, community resources were utilized to organize relevant activities. Regular follow-ups were conducted every 2 weeks via phone calls, video conferences, or online platforms.

Observation Indicators

Assessment of Depressive Symptoms

The Hamilton Depression Rating Scale (HAMD)-17 was used to assess depressive symptoms. The total score of the sale is 52, and the result can be divided into four levels: a score of less than 7 is considered normal, 7 to 17 indicates mild depression, 18 to 24 represents moderate depression, and a score above 24 indicates severe depression.[16] The HAMD is widely applicable in adolescent depression assessment, as its factors cover multiple aspects. It demonstrates good reliability, with a Cronbach’s α coefficient of above 0.77, and it also has good content, construct and predictive validity.[17]

Assessment of Anxiety Symptoms

The Hamilton Anxiety Rating Scale (HAMA), which received a total score of 56, was used to assess anxiety symptoms. It contains 14 items covering aspects such as anxious mood and cognitive function. Items are rated 0 to 4 points based on symptom severity, where less than 7 indicates no anxiety, 7 to 13 mild anxiety, 14 to 20 moderate anxiety, 21 to 28 severe anxiety, and over 28 extremely severe anxiety.[18] It shows good reliability in test-retest consistency and internal consistency, as well as good content (matching anxiety symptoms), construct (verified factor structure), and predictive (predicting symptom improvement and treatment response) validity. The HAMA has also been adapted and validated in the Chinese cultural context.[19]

Assessment of Family Function

The Family Assessment Device (FAD) was used to assess the operating status of the family system from seven dimensions. (1) The problem-solving dimension examines the family members’ ability to solve problems and make decisions when facing problems. (2) The communication dimension focuses on the communication method and the effectiveness of information transmission among family members. (3) The role dimension evaluates whether family members are clear about their roles and responsibilities. (4) The affective responsiveness dimension measures the degree of response and understanding of family members to each other’s emotions. (5) The affective involvement dimension examines the degree of emotional investment among family members. (6) The behavior control dimension assesses the family’s capacity to regulate and constrain the behavior of members. (7) The general functioning dimension comprehensively reflects the overall functional state of the family. The answers to the items in each dimension consist of “strongly agree, agree, disagree, and strongly disagree,” which are scored as 1 to 4 points. The final score of each dimension is obtained by calculating the average value of the corresponding items. The higher the score, the greater the severity of family functioning problems.[20]

Assessment of Adolescent Psychosocial Function

Adolescent Self-Rating Life Events Checklist (ASLEC) consists of six factors that cover the negative life events in the growth of adolescents. These include: (1) the interpersonal relationship factor, which involves relationship problems with parents, teachers, classmates, etc. (five items); (2) the academic stress factor, which focuses on the pressure caused by academic burdens and learning difficulties (four items); (3) the punishment factor, which focuses on adverse events such as criticism and punishment (five items); (4) the personal loss factor, which encompasses losses such as the passing away of relatives and the parting of friends (four items); (5) the health adaptation factor, which assesses the impact of physical health on psychology (four items); and (6) the other factor, which covers special life events (four items). The total score reflects the overall degree of negative life events encountered by adolescents, and the degree of impact of each negative life event ranges from 0 (“not at all”) to 4 (“extremely serious”).[21]

Assessment of Sleep Quality

Pittsburgh Sleep Quality Index (PSQI) comprehensively assesses the sleep quality of adolescents from seven components. The subjective sleep quality component reflects the patient’s overall perception of their sleep; the sleep latency component examines the time required to fall asleep; the sleep time component measures the actual duration of sleep; the sleep efficiency component assesses the effectiveness of sleep; and sleep disturbances include insomnia, dreaminess, night terrors, and other sleep problems. The hypnotic drug use component focuses on whether to rely on drugs to assist sleep; the daytime dysfunction component assesses the impact of insufficient sleep on daytime activities. The total score lies between 0 and 21 points. The higher the score, the poorer the sleep quality (Cronbach’s alpha = 0.81).[22]

Statistical Methods

The data obtained from the study were analyzed using SPSS 25.0 (IBM Corporation, Armonk, NY, USA). Normality was assessed using the Shapiro–Wilk test, and the homogeneity of variance was examined. Measurement data were presented as mean ± standard deviation. Independent t-tests were used for between-group comparisons (if assumptions were met), and paired t-tests were used for within-group pre- and post-treatment comparisons (if data were normally distributed). Data that did not conform to a normal distribution were represented as M (P25, P75) and analyzed by using the Mann–Whitney U test. Count data were presented as frequency and percentage, and group comparisons were performed using the chi-square test. The Bonferroni correction was considered for multiple comparisons, and P < 0.05 was considered statistically significant.

RESULTS

General Information

Table 1 shows the general data. No significant differences in general data such as age, gender, body mass index, disease duration, place of residence, education level, and family composition were found between the music therapy group and the conventional group (P > 0.05).

Table 1.

General Demographic and Clinical Characteristics of the Music Therapy Group and the Conventional Group.

Characteristics	Music Therapy Group (n = 60)	Conventional Group (n = 60)	t/χ2	P
Age (years)	15.98 ± 2.27	15.48 ± 2.33	1.189	0.237
Gender (n, %)			0.307	0.580
Male	36 (60.0)	33 (55.0)
Female	24 (40.0)	27 (45.0)
Body mass index	20.35 ± 2.33	20.55 ± 2.45	−0.458	0.648
Disease duration (months)	10.55 ± 1.73	11.28 ± 1.46	−0.915	0.362
Place of residence (n, %)			0.139	0.709
Rural	23 (38.3)	25 (41.7)
Urban	37 (61.7)	35 (58.3)
Education level (n, %)			0.245	0.885
Junior high school	22 (36.7)	24 (40.0)
High school	34 (56.7)	33 (55.0)
Dropout or other	4 (6.6)	3 (5.0)
Family composition (n, %)			0.191	0.909
Single-parent	31 (51.7)	30 (50.0)
Two-parent	23 (38.3)	25 (41.7)
Nonparental upbringing	6 (10.0)	5 (8.3)

Depressive Symptom Assessment

Before treatment, no significant difference in HAMD scores was found between the two groups (P = 0.542). After treatment, the HAMD score of the control group and the music therapy group decreased (P < 0.001). The decrease in the music therapy group was significantly greater than that in the conventional group (t = 16.141, P < 0.001), and more patients in the music therapy group had their depressive symptoms reduced from moderate or severe depression to mild depression or the normal range [Table 2].

Table 2.

Comparison of Hamilton Depression Rating Scale Scores between the Two Groups (Points, x ± s).

Group	HAMD		t	P
	Before Treatment	After Treatment
Music therapy group (n = 60)	24.53 ± 3.90	9.73 ± 1.84	−26.590	<0.001
Conventional group (n = 60)	24.12 ± 3.57	16.75 ± 2.82	−12.551	<0.001
t	0.611	−16.141
P	0.542	<0.001

HAMD = Hamilton Depression Rating Scale

Anxiety Symptom Assessment

Before treatment, there was no significant difference in HAMA scores between the two groups (P = 0.605). After treatment, anxiety symptoms in both the control and music therapy groups were significantly alleviated. The HAMA score in the music therapy group was significantly lower than that in the conventional group (t = 15.031, P < 0.001; Table 3).

Table 3.

Comparison of Hamilton Anxiety Rating Scale Scores between the Two Groups (Points, x ± s).

Group	HAMA		t	P
	Before Treatment	After Treatment
Music therapy group (n = 60)	19.45 ± 2.36	9.17 ± 1.28	−29.672	<0.001
Conventional group (n = 60)	19.22 ± 2.57	12.97 ± 1.48	−16.337	<0.001
t	0.518	15.031
P	0.605	<0.001

HAMA = Hamilton Anxiety Rating Scale

Family Function Assessment

Before treatment, no significant differences in the FAD scores across each dimension were found between both groups (P > 0.05). After treatment, the FAD scores of both groups significantly decreased across all dimensions. However, the music therapy group showed greater improvements in dimensions such as problem-solving, communication, affective involvement, behavior control, and general functioning (P < 0.05, Table 4).

Table 4.

Comparison of Family Assessment Device Scores between the Two Groups [Points, M(P25, P75)].

FAD	Music Therapy Group (n = 60)	Conventional Group (n = 60)	Z	P	Music Therapy group (n = 60)	Conventional Group (n = 60)	t/Z	P
	Before Treatment				After Treatment
Problem solving	2.20 (1.99, 2.42)	2.22 (2.06, 2.45)	−1.544	0.125	1.03 (0.87, 1.19)*	1.53 (1.37, 1.68)*	−7.244	<0.001
Communication	2.13 (1.96, 2.33)	1.97 (1.89, 2.29)	1.364	0.175	0.92 (0.79, 1.04)*	1.43 (1.31, 1.54)*	−6.994	<0.001
Roles	1.92 (1.78, 2.10)	2.03 (1.88, 2.15)	−1.118	0.266	1.22 (1.10, 1.31)*	1.20 (1.12, 1.34)*	0.223	0.824
Affective responsiveness	2.22 (2.01, 2.29)	2.13 (2.02, 2.32)	1.573	0.119	1.13 (1.01, 1.22)*	1.27 (1.02, 1.39)*	−1.836	0.069
Affective involvement	1.93 (1.67, 2.10)	1.88 (1.72, 2.09)	0.430	0.668	0.92 ± 0.28*	1.02 ± 0.13*	−2.522	0.013
Behavior control	1.97 (1.72, 2.18)	1.90 (1.73, 2.15)	0.859	0.392	0.98 (0.81, 1.09)*	1.45 (1.22, 1.62)*	−6.978	<0.001
General functioning	2.03 (1.88, 2.18)	2.15 (1.97, 2.29)	−0.783	0.435	0.97 (0.82, 1.10)*	1.37 (1.26, 1.51)*	−6.051	<0.001

FAD = Family Assessment Device ^*Correspondence to P < 0.05, compared with before treatment.

Adolescent Self-rating Life Events Checklist

Before treatment, no significant differences in ASLEC scores across all factors were found between both groups (P > 0.05). After treatment, the scores of the two groups with regard to interpersonal relationships, punishment, and personal loss were significantly reduced, and the reduction in the music therapy group was greater (P < 0.05). The music therapy group also showed significant improvement in academic stress and other aspects (P < 0.05, Table 5).

Table 5.

Comparison of Adolescent Self-Rating Life Events Checklist between the Two Groups [Points, M(P25, P75)].

ASLEC	Music Therapy Group (n = 60)	Conventional Group (n = 60)	t/Z	P value	Music Therapy Group (n = 60)	Conventional Group (n = 60)	t/Z	P
	Before				After
Interpersonal relationship	9.87 (9.10, 10.32)	9.25 (8.83, 9.92)	1.678	0.096	5.18 ± 1.60*	7.38 ± 2.47*	−5.790	<0.001
Academic stress	9.15 (8.43, 10.22)	8.45 (8.02, 9.03)	1.646	0.102	6.43 ± 1.77*	8.02 ± 2.45	−4.055	<0.001
Punishment	9.10 (8.10, 9.99)	9.93 (9.12, 10.33)	−1.928	0.056	7.57 (6.88, 7.95)*	8.03 (7.45, 8.66)*	−1.527	0.129
Personal loss	6.27 (5.71, 6.82)	6.87 (6.24, 7.22)	−1.746	0.083	4.98 (4.23, 5.46)*	5.45 (5.05, 5.98)*	−2.143	0.034
Health adaptation	6.22 (5.78, 6.82)	5.93 (5.58, 6.45)	1.186	0.238	5.95 (5.54, 6.44)	6.02 (5.67, 6.54)	−0.291	0.772
Other factors	5.20 (4.67, 6.01)	4.83 (4.45, 5.23)	1.714	0.089	4.37 (4.10, 4.77)*	4.90 (4.56, 5.43)	−2.396	0.018

ASLEC = Adolescent Self-Rating Life Events Checklist ^*Correspondence to P < 0.05, compared with before treatment.

Sleep Quality Assessment

Before treatment, no significant difference in the PSQI scores was found between both groups (P > 0.05). After treatment, sleep indicators in the conventional group improved significantly. However, the music therapy group showed more significant improvements in subjective sleep quality, sleep latency, sleep time, sleep disturbances, hypnotic drug use, and daytime dysfunction. The total PSQI score also decreased more significantly (P < 0.05, Table 6).

Table 6.

Comparison of the Pittsburgh Sleep Quality Index Scores between the Two Groups [Points, M(P25, P75)].

Items	Music Therapy Group (60)	Conventional Group (60)	t	P	Music Therapy Group (60)	Conventional Group (60)	t	P
	Before				After
Sleep quality	1.63 (1.44, 1.78)	1.47 (1.33, 1.59)	1.633	0.105	0.93 (0.75, 1.11)*	1.25 (1.13, 1.39)*	−4.113	<0.001
Sleep latency	1.65 (1.49, 1.81)	1.60 (1.47, 1.72)	0.562	0.575	0.92 (0.76, 1.05)*	1.20 (1.10, 1.33)*	−2.802	0.006
Sleep efficiency	1.68 (1.51, 1.82)	1.63 (1.49, 1.76)	0.503	0.616	0.95 (0.81, 1.07)*	1.07 (0.99, 1.21)*	−1.705	0.091
Sleep time	1.77 (1.63, 1.91)	1.75 (1.64, 1.88)	0.140	0.889	1.00 (0.88, 1.10)*	1.15 (1.04, 1.30)*	−2.013	0.046
Hypnotic drugs	1.37 (1.22, 1.54)	1.47 (1.40, 1.61)	−1.107	0.270	0.72 (0.57, 0.83)*	0.87 (0.78, 1.00)*	−2.041	0.043
Sleep disturbances	1.45 (1.31, 1.58)	1.45 (1.38, 1.59)	−0.546	0.586	0.93 (0.79, 1.05)*	1.10 (0.97, 1.27)*	−2.157	0.033
Daytime dysfunction	1.57 (1.42, 1.72)	1.65 (1.49, 1.78)	−0.900	0.370	0.92 (0.77, 1.09)*	1.27 (1.13, 1.39)*	−5.155	<0.001
Total score	11.12 (10.89, 11.43)	11.02 (10.78, 11.33)	0.195	0.846	6.37 (6.11, 6.72)*	7.90 (7.67, 8.11)*	−7.516	<0.001

PSQI = Pittsburgh Sleep Quality Index ^*Correspondence to P < 0.05, compared with before treatment.

Adverse Reaction Monitoring

During the treatment process, two patients reported short-term emotional agitation after participating in music activities; however, the symptoms resolved spontaneously within a short time. In addition, two patients experienced a slight sense of auditory fatigue in the initial stage of treatment, but they gradually adapted as the treatment progressed. No other serious adverse reactions or unexpected effects were observed. The occurrence rates of these adverse reactions were relatively low, and they did not significantly interfere with the overall treatment process and effect assessment.

DISCUSSION

In the field of adolescent depression treatment, FSS plays a key role. It provides emotional support, cognitive guidance, and behavioral supervision for adolescents, thereby affecting their mental health in an all-round way. However, simple FSS has shortcomings in professional psychological intervention. Music therapy can regulate emotions and promote emotional expression. Thus, integrating music therapy into FSS is necessary. It not only enhances the emotional resonance among family members and optimizes communication with the help of music but also provides a new treatment method for adolescent depression and improves the treatment effect with its professional healing properties.

After treatment, the HAMD and HAMA scores in the music therapy group were significantly lower than those in the conventional group. From a theoretical perspective, music can modulate the release of neurotransmitters. For example, the activation of the reward system in the brain by music may increase dopamine levels, which can improve mood and motivation.[23] Moreover, the elements of music such as rhythm and harmony can trigger emotional resonance. This resonance enables patients feel understood and supported emotionally, further promoting emotional regulation. It is based on the ability of music to evoke human emotions, touching the deep-seated feelings within patients and providing them with emotional comfort and support during the process of enjoying music, which can alleviate depression and anxiety. In addition, the regulation of the limbic system by music can reduce anxiety and stress responses.[24]

Recently, a growing number of studies have focused on the important role of family in the mental well-being of adolescents, emphasizing the promotion of adolescents’ psychological rehabilitation by improving family function.[25] FSS emphasizes the interaction between family members and the overall functioning of the family. Professional therapists guide family members to jointly discuss family relationships, communication patterns, family rules, and other issues. This process promotes understanding and support among family members, helps resolve internal conflicts within the family, and enhances the family’s supportive function. In a study on sexually abused adolescents, researchers found that family support was positively correlated with self-efficacy and negatively correlated with symptomatology.[26] In another study on depression among adolescents from sexual and gender minorities, Bitran et al.[27] found that higher levels of family support in these adolescents remarkably improved their mood and parent–child relationships. The results of the family function assessment revealed that music therapy led to remarkable enhancements in multiple dimensions, providing further evidence for the effectiveness of FSS in managing adolescent depression.

In this study, the methods of music therapy included family music creation, music appreciation and sharing, music meditation and relaxation, and music activities and games. Family music creation guides family members in creating music together, which not only helps express emotions and inner experiences but also promotes emotional communication and cooperation among family members. By creating music together, family members can better understand each other’s feelings and strengthen family cohesion. In a study of people with severe mental illness treated with a music-writing program, researchers found that after attending a weekly 90-minute music session for 32 weeks, patients experienced considerable improvements in anxiety, self-esteem, and quality of life.[28]

Appreciating and sharing music suitable for adolescent patients with depression can enhance emotional resonance, relieve stress, and regulate emotions. Initially, we often include soothing classical music and healing folk songs, as previous research has demonstrated their positive impacts on mood regulation.[29] For example, a study reported by Kupeli and Gülnahar found that certain classical music pieces effectively reduced anxiety associated with third molar extraction in younger patients. However, we fully recognize the importance of patients’ individual music preferences. During this session, therapists first elicited patients’ thoughts and feelings about the music, guiding them to express their emotions and associations. Afterwards, other family members share their insights, but the discussion is centered on how the music affects the patients and how family members can support patients’ emotional processing. This approach ensures that the patient’s experience and needs remain the priority, rather than being overshadowed by the preferences of parents. For example, if the patient reacts strongly to a particular piece of music, then the therapist will help the family understand the importance of this reaction and use it as an opportunity to strengthen the patient’s emotional regulation and communication within the family.

Music meditation and relaxation help patients not only to reduce stress and anxiety but also to improve psychological resilience. This method allows patients to relax their body and mind in a peaceful atmosphere, enabling them to better cope with the challenges in life. The reason for involving parents in this process is that their calm and relaxed state can create a more soothing atmosphere for the patient. Parents’ participation sets an example of stress coping and provides emotional support for patients. A meta-analysis revealed that meditation strategies achieved satisfactory results in reducing stress, anxiety, and depression among adolescent students.[30]

Music activities and games, such as music puzzles and quizzes, increase family fun and cohesion. These activities allow family members to interact in a relaxed and pleasant atmosphere and improve family relationships. A Chinese study found that 4 weeks of training with music-based recreational video games led to remarkable improvements in depression, anxiety, and stress among young people with subthreshold or mild depression.[31]

Regarding the assessment of adolescent psychosocial function, the music therapy group exhibited greater improvements in multiple aspects, indicating that this treatment model helps adolescent better cope with negative life events and improve their psychosocial adaptation ability. This result is consistent with the latest research, which suggests that comprehensive treatment model can address multiple levels to comprehensively improve the mental health level of adolescents.[32]The results of the sleep quality assessment revealed that the music therapy group showed more remarkable improvements in multiple aspects. Good sleep quality is essential for the restoration of adolescent depression, and the outcomes of this research are consistent with the conclusions of other investigations on the improvement of sleep quality by using a comprehensive treatment model.[33] Such outcomes also provide a reference for further exploring the specific mechanism of music therapy in improving sleep quality.

However, this research presents some drawbacks. Firstly, we did not adequately consider the influence of conventional treatments (drug and psychotherapy) that the patients had previously undergone. Future studies should more comprehensively evaluate and control for conventional treatments to reduce potential biases. In addition, combined with techniques such as neuroimaging, the specific mechanism of music therapy in FSS can be further studied to provide a more scientific and theoretical foundation for clinical practice.

CONCLUSIONS

Integrating music therapy into FSS can effectively reduce depression and anxiety symptoms in adolescents with depression, improve the family and psychosocial function, and enhance sleep quality. However, further studies are necessary to verify and optimize this approach, as well as to better serve clinical practice and provide more help for adolescents with depression and their families.

Availability of Data and Materials

All experimental data included in this study can be obtained by contacting the first author if needed.

Author Contributions

Jie Zhou designed and conducted the research and wrote the paper. Lipeng Zheng designed the research and supervised the report. Liying Liu contributed to the analysis and provided clinical advice.

Ethics Approval and Consent to Participate

This study complied with the guidelines established in the Declaration of Helsinki and gained ethical approval from the Ethics Committee of Wenzhou Seventh People’s Hospital (Approval Number: EC-20210826-23). All patients provided their signed consent after being informed.

Conflict of Interest

No conflicts of interest are declared for this article.

Funding Statement

Nil.