The effectiveness of the Chinese Five-Element Music intervention on older adults with depression and anxiety disorder: A systematic review and meta-analysis.

Background: Depression and anxiety are among the most prevalent mood disorders worldwide, affecting hundreds of millions of people and contributing to significant disability, particularly in older adults. Conventional treatments such as pharmacotherapy and psychotherapy are effective but often limited by side effects or accessibility. As a complementary approach, Chinese Five-Element Music (CFEM), rooted in Traditional Chinese Medicine, aims to restore emotional balance through the connection between musical tones, organ systems, and emotions. Recent studies suggest its potential to alleviate psychological symptoms, yet evidence in older populations remains limited.

Methods: The systematic review identified and mapped available literature on CFEM interventions, guiding the selection and analysis of randomized controlled trials (RCTs) for meta-analysis. Databases including Web of Science, PubMed, CNKI, Wanfang, and CQVIP were searched in March 2025. Eighteen RCTs were included. Outcome measures assessed included the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Zung Self-Rating Depression and Anxiety Scales (SDS and SAS), Pittsburgh Sleep Quality Index (PSQI), overall response rate (ORR), and Quality of Life (QOL). The risk of bias was assessed using the Cochrane Handbook criteria. Most studies reported adequate randomization, but blinding methods were often unclear.

Results: A meta-analysis using a random-effects model was conducted on 18 RCTs. The results indicated that, compared to conventional care, the CFEM intervention significantly alleviated symptoms in older adults with depression and anxiety. Specifically, the outcomes were as follows: HAMD score (MD = -3.63, 95% CI: -4.97 to -2.3, P < .00001), HAMA score (MD = -3.89, 95% CI: -5.80 to -1.97, P < .0001), SAD score (MD = -6.69, 95% CI: -8.32 to -5.07, P < .00001), SAS score (MD = -6.84, 95% CI: -10.76 to -2.92, P = .0006), ORR score (95% CI: 1.61 to 4.89, P = .0003), QOL score (MD = -0.58, 95% CI: -15.65 to 14.48, P = .94), PSQI score (MD = -1.86, 95% CI: -2.54 to -1.17, P < .00001).

Conclusion: CFEM may be an effective complementary intervention to alleviate depression, anxiety, and sleep problems in older adults. However, due to moderate study quality and lack of blinding, further high-quality trials are needed.