Music, therapeutic massage, train, acupuncture despair therapy


Melancholy is a standard and critical psychological well being concern amongst faculty and college college students.1 The 2019 International Burden of Sickness, Harm, and Danger Elements research confirmed that despair is likely one of the most disabling psychological problems, and amongst adolescents, despair ranked fourth on the listing of the world’s main causes of burden in 2019.2 Research have proven that despair has develop into a serious emotional downside amongst faculty college students. School college students of their early maturity are vulnerable to emotional dysregulation and despair.3 In 2021, China’s Ministry of Schooling requested for the primary time that despair screening be included amongst college students’ bodily examinations, demonstrating that the hurt of despair in faculty college students has piqued the state and society’s consideration.4 On this context, learn how to present efficient non-drug therapy to enhance depressive signs for sufferers with despair has attracted the eye and analysis of many researchers. Non-drug therapy strategies for despair are at the moment train intervention, music intervention, meditation, acupuncture, therapeutic massage, and so forth. Research have discovered that cardio train, conventional Chinese language sports activities (health qigong, tai chi, and many others.), and meditation can successfully enhance the depressive signs of faculty college students.1 Music, therapeutic massage, and acupuncture have additionally been confirmed to be efficient within the therapy of despair.5–9 A number of interventions have been evaluated individually or compared utilizing randomized managed trials.5,10–13 Nonetheless, there are just a few research evaluating the efficacy of a number of non-pharmacological interventions in community meta-analysis. Due to this fact, 4 interventions (train, music, therapeutic massage, and acupuncture) which can be frequently utilized within the therapy of despair amongst faculty college students have been chosen as analysis objects. The community meta-analysis methodology was used to combine the related medical proof of direct and oblique comparability. The completely different interventions of the identical proof have been summarized, quantitatively synthesized, and analyzed, the chance was ranked in accordance with the efficacy of the index, and the perfect remedy was screened.

Supplies and Strategies

Literature Looking out and Collection of Articles

Two investigators independently performed a literature search. The databases have been searched till 1 January 2023. The key phrases utilized for the searches have been “faculty scholar despair”, “train”, “dance”, “yoga”, “tai chi”, “qi gong”, “music”, “therapeutic massage” and “acupuncture”. Research within the Cochrane, PubMed, Embase, Internet of Science, CNKI, and Wanfang databases that have been written in Chinese language or English and have been associated to the research have been retrieved. The phrases have been grouped into three classes (intervention, end result measure, and intervention), related by Boolean logical operators (OR or AND), and utilized to 3 search ranges. The retrieved papers have been initially screened utilizing the bibliographic administration software program Endnote, resembling deduplication, studying titles, and abstracts and the remaining research have been examined intimately, in accordance with the PICOS set acceptable inclusion standards.

The next have been the analysis inclusion standards: (1) The members of the research have been particularly faculty college students who have been experiencing despair. You will need to notice that the research centered on undergraduate college students, excluding highschool college students; (2) experimental interventions associated to train, music, therapeutic massage, and acupuncture; (3) the result indicators have been the despair scores assessed by the size, and the earlier than and after indicators have been reported intimately, resembling imply, commonplace deviation, pattern dimension, and many others. to generate impact sizes; (4) the analysis sort is two-arm experimental analysis; (5) the baseline knowledge are comparable.

The next have been the analysis exclusion standards: (1) The literature is within the type of evaluations, convention abstracts, case studies, and many others.; (2) the info reported within the literature have been incomplete, the contact authors have been unsuccessful, and the unique knowledge couldn’t be obtained; (3) the baseline knowledge is incomplete; and (4) the intervention goal receives drug intervention on the similar time along with a number of interventions prescribed.

After figuring out the factors for inclusion and exclusion, two investigators started screening the literature on the similar time, in contrast the findings of the inclusion of their chosen literature, and the third investigator moderated the unpleasant materials.

Evaluation of Methodological High quality

The PEDro scale developed by the Heart for Proof-Based mostly Drugs in Bodily Remedy was used to evaluate the standard of the literature.14 The dimensions contains 11 objects, together with topics, allocation concealment, blinding, and different predominant content material, and the rating ≤3 is poor high quality; the rating in 4–5 is medium high quality; the rating in 6–8 is sweet high quality; and the rating of 9 factors is top of the range. On the similar time, the Cochrane threat bias evaluation device was employed to evaluate the standard of the included research. The analysis primarily centered on seven elements, which included random sequence technology, allocation concealment, blinding of members, blinding of end result variable analysis, lack of end result knowledge, selective reporting, and different potential biases.

Knowledge Extraction and Statistical Evaluation

For the included indices, the imply, commonplace deviation, and pattern dimension of the before-and-after check knowledge have been extracted from every experimental group and management group. The analytical knowledge utilized the change from baseline as the idea for comparability. The impact dimension of various kinds of intervention on depressive signs in faculty college students was explored via a community meta-analysis.

The statistical evaluation was carried out utilizing the Stata 15.1 software program for community meta-analysis. The impact dimension of the measured knowledge was expressed in weighted imply distinction (WMD) or standardized imply distinction (SMD) with its 95% confidence interval (CI). In circumstances the place the models, measures, or ranking scales of the extracted knowledge weren’t constant, SMD was utilized to signify the impact dimension. If the 95% CIs didn’t embody zero, it indicated a statistically vital distinction between the 2 remedies. Conversely, if the distinction fell throughout the confidence interval, it was thought-about not statistically vital.15 The floor beneath the cumulative rating (SUCRA) was used to signify the popular rating of every therapy measure.16 A bigger space beneath curve signifies a larger chance that the psychotherapy would be the finest therapy. Funnel plots have been used to point publication bias, and the symmetry of the funnel plots was used to evaluate publication bias between included research. The pooled impact dimension of every included research was a research through which the x-axis intersected on the funnel plot as a perpendicular line, and the factors distributed to the left of the perpendicular line represented research with fewer impact sizes than pooled impact sizes; the dots distributed to the appropriate of the perpendicular line signify research through which the impact dimension is larger than the mixed impact dimension: the variety of dots on each side is actually the identical, indicating no publication bias, and conversely, there’s publication bias.


Literature Search outcomes

We searched Cochrane, PubMed, Embase, Internet of Science, CNKI, and Wanfang databases for references 102, 409, 544, 696, 211, and 907. The screening was carried out in accordance with the established inclusion and exclusion standards. A complete of 2845 irrelevant articles have been eliminated, leaving solely 24 for analysis. The choice course of is proven in Determine 1.

Determine 1 Research choice course of.

Traits of the Research

The 24 included papers got here from 5 completely different nations and have been divided into Randomized managed trial and Managed trial by experimental class, with 17 randomized managed trials and seven non-randomized managed trials. The intervention focused all faculty college students with various levels of despair signs, with a complete of 1458 folks and about 63% of them being ladies. After knowledge screening, the experimental group contained 117 circumstances of music intervention, 21 circumstances of therapeutic massage, 98 circumstances of cardio train, 15 circumstances of qigong, 61 circumstances of yoga, 97 circumstances of Tai Chi, 230 circumstances of ball video games, 15 circumstances of energy coaching, 101 circumstances of dance, 15 circumstances of whole-body vibration coaching, and 14 circumstances of high-intensity interval coaching (The class “motion” is refined in accordance with its sort). Concerning the period of interventions, one research lasted for 2 weeks, three research for 4 weeks, one research for six weeks, seven research for eight weeks, one research for ten weeks, seven research for twelve weeks, and 4 research for sixteen weeks. The end result measures utilized scales to evaluate the degrees of constructive response and despair, together with SDS, SCL-90, DERS, BDI, PHQ-9, CES-D, amongst others (check with Desk 1).

Desk 1 Analysis Traits Desk

High quality Evaluation Outcomes

Desk 2 presents the small print of the High quality evaluation outcomes, which included a complete of 24 articles. These articles have been rated on the PEDro scale, with one article scoring 9, fifteen articles scoring 7, and eight articles scoring 6. All of the included research happy the eligibility standards, which encompassed elements resembling supply credibility, satisfactory follow-up (85% compliance), intention-to-treat evaluation, intergroup statistical comparisons, reporting of level measurements, and variability measurements. Provided that the research employed varied self-assessment scales to measure despair, the bulk didn’t make use of double-blind trials or blinded end result evaluators. When contemplating the outcomes of the Cochrane system analysis device, it may be noticed that the included literature usually meets the standard necessities, though there’s a shortage of high-quality research (see Determine 2).

Determine 2 Outcomes of Cochrane system analysis.

Desk 2 The Physiotherapy Proof Database (PEDro) Scores for the Articles Included

Outcomes of the Community Meta-Evaluation

Community Proof Map of the Affect of Completely different Interventions on Melancholy

Within the community proof map, dots point out the pattern dimension of the intervention, with bigger dots indicating extra pattern dimension included within the intervention; traces signify direct comparisons of interventions, with thicker traces suggesting a better variety of inclusions for direct comparisons of the 2 interventions. The community proof map of the efficacy of despair concerned 11 therapy measures: music, therapeutic massage, cardio train, qigong, yoga, tai chi, ball video games, energy train, dance, complete physique vibration coaching, and high-intensity interval coaching. The community proof plot for despair scores confirmed that direct or oblique comparisons between completely different psychological interventions have been important for community meta-analysis. A community plot of proof for the efficacy of despair is proven in Determine 3.

Determine 3 Community evaluation of despair efficacy. The numbers signify the amount after intervention measures.

A Community Meta-Evaluation of Efficacy in Melancholy

Twenty-four research supplied knowledge on despair scores amongst faculty college students following varied remedies. Nonetheless, the unique research used completely different despair ranking scales, necessitating the usage of SMD and its 95% CI to point the magnitude of the impact on despair scores. You will need to notice that every one despair scores on the scales mirrored the extent of despair positively, which means {that a} decrease impact dimension corresponds to a extra favorable impact on depressive signs. Pairwise comparisons of despair scores by therapy revealed the next outcomes: high-intensity interval coaching was superior to vibration coaching [SMD = −13.61, 95% CI (−20.61 to −6.62)]; high-intensity interval coaching was superior to bop [SMD = −8.13, 95% CI (−13.44 to −2.83)]; high-intensity interval coaching was superior to energy coaching [SMD = −10.81, 95% CI (−16.77 to −4.85)]; high-intensity interval coaching was higher than ball video games [SMD = −9.39, 95% CI (−14.65 to −4.13)]; high-intensity interval coaching was higher than Tai Chi [SMD = −12.62, 95% CI (−17.81 to −7.43)]; high-intensity interval coaching was higher than qigong [SMD = −14.81, 95% CI (−20.04 to −9.59)]; high-intensity interval coaching was higher than cardio coaching [SMD = −11.60, 95% CI (−16.72 to −6.49)]; high-intensity interval coaching was higher than music [SMD = −8.52, 95% CI (−13.80 to −3.25)]; high-intensity interval coaching was superior to therapeutic massage [SMD = −14.23, 95% CI (−19.61 to −8.86)]; high-intensity interval coaching was superior to no intervention [SMD = −16.61, 95% CI (−21.78 to −11.45)].

Within the comparability of vibration coaching intervention with different remedies: vibration coaching intervention was inferior to bop [SMD = 5.48, 95% CI (0.60 to 10.37)]; vibration coaching intervention was inferior to yoga [SMD = 13.10, 95% CI (7.68 to 18.51)]; vibration coaching intervention was inferior to music [SMD = 5.09, 95% CI (0.24 to 9.94)]. For dance in comparison with different remedies: dance was superior to ball video games [SMD = −1.26, 95% CI (−2.13 to −0.38)]; dance was superior to Tai Chi [SMD = −4.49, 95% CI (−5.93 to −3.05)]; dance was superior to yoga [SMD = 7.61, 95% CI (4.77 to 10.46)]; dance was superior to qigong [SMD = −6.68, 95% CI (−8.16 to −5.20)]; dance was superior to cardio coaching [SMD = −3.47, 95% CI (−5.64 to −1.30)]; dance was superior to therapeutic massage [SMD = −6.10, 95% CI (−8.04 to −4.16)]; dance was superior to no intervention [SMD = −8.48, 95% CI (−9.72 to −7.25)].

Within the comparability of energy coaching with different remedies: energy coaching was superior to yoga [SMD = 10.30, 95% CI (6.31 to 14.28)]; energy coaching was superior to qigong [SMD = −4.00, 95% CI (−7.09 to −0.91)]; energy coaching was superior to therapeutic massage [SMD = −3.42, 95% CI (−6.75 to −0.09)]; energy coaching was superior to no intervention [SMD = −5.80, 95% CI (−8.78 to −2.82)]. For ball video games in comparison with different remedies: ball video games have been higher than Tai Chi [SMD = −3.23, 95% CI (−4.48 to −1.98)]; ball video games have been inferior to yoga [SMD = 8.87, 95% CI (6.13 to 11.61)]; ball video games have been higher than qigong [SMD = −5.42, 95% CI (−6.72 to −4.13)]; ball video games have been higher than cardio coaching [SMD = −2.21, 95% CI (−4.27 to −0.16)]; ball video games have been higher than therapeutic massage [SMD = −4.84, 95% CI (−6.64 to −3.05)]; ball video games have been higher than no intervention [SMD = −7.22, 95% CI (−8.23 to −6.22)].

Within the comparability of Tai Chi with different remedies: Tai Chi was inferior to yoga [SMD = 12.10, 95% CI (9.36 to 14.84)]; Tai Chi was higher than qigong [SMD = −2.19, 95% CI (−3.29 to −1.09)]; Tai Chi was inferior to music [SMD = 4.10, 95% CI (2.79 to 5.40)]; Tai Chi was superior to no intervention [SMD = −3.99, 95% CI (−4.73 to −3.25)]. For yoga in comparison with different remedies: yoga was superior to qigong [SMD = −14.30, 95% CI (−17.06 to −11.54)]; yoga was superior to cardio coaching [SMD = −11.08, 95% CI (−14.27 to −7.90)]; yoga was higher than music [SMD = −8.00, 95% CI (−10.85 to −5.16)]; yoga was superior to therapeutic massage [SMD = −13.72, 95% CI (−16.75 to −10.68)]; yoga was superior to no intervention [SMD = −16.10, 95% CI (−18.73 to −13.46)].

Within the comparability of qigong with different remedies: qigong was inferior to cardio coaching [SMD = 3.21, 95% CI (1.25 to 5.18)]; qigong was inferior to music [SMD = 6.29, 95% CI (4.94 to 7.64)]; qigong was superior to no intervention [SMD = −1.80, 95% CI (−2.61 to −0.99)]. For cardio coaching in comparison with different remedies: cardio coaching was inferior to music [SMD = 3.08, 95% CI (0.99 to 5.17)]; cardio coaching was superior to therapeutic massage [SMD = −2.63, 95% CI (−4.96 to −0.30)]; cardio coaching was superior to no intervention [SMD = −5.01, 95% CI (−6.80 to −3.22)].

Within the comparability of music with different remedies: music was superior to therapeutic massage [SMD = −5.71, 95% CI (−7.55 to −3.87)]; music was superior to no intervention [SMD = −8.09, 95% CI (−9.17 to −7.01)]. For therapeutic massage in comparison with no intervention: therapeutic massage was higher than no intervention [SMD = −2.38, 95% CI (−3.87 to −0.89)]. In all of the comparisons talked about above, not one of the 95% confidence intervals included 0, indicating that the variations have been statistically vital. The outcomes of the community meta-analysis of despair scores are proven in Determine 4.

Determine 4 Meta-analysis outcomes of despair rating charges.

Rating of Efficacy

Efficacy rating: The chance that an intervention would be the finest measure is assessed utilizing the world beneath the cumulative rating chance plot (SUCRA), with bigger areas beneath the curve indicating a larger probability that the intervention would be the finest measure. SUCRA outcomes confirmed that the interventions have been ranked so as of efficacy: interval coaching (96%) > yoga (94.90%) > dance (78.30%) > Music (73.30%) > ball video games (62.50%) > energy coaching (51.70%) > cardio coaching (45 30%) > Tai Chi (35.40%)> vibration coaching (27.30%) > therapeutic massage (20.10%) > Qigong (14.30%) > no intervention (1.00%), indicating that the chance of interval coaching is the perfect therapy for despair in faculty college students. The outcomes of the popular rating of varied therapy measures for despair are proven in Desk 3.

Desk 3 Chance: Rating of Completely different Thoughts-Physique Train Therapies to Enhance Melancholy Grade in School College students

Subgroup Evaluation of Completely different Varieties of Train Interventions

We additional categorized and grouped completely different sports activities interventions and performed a traditional meta-analysis based mostly on 4 subgroups: cardio train, conventional Chinese language sports activities, ball video games, and high-intensity interval sports activities. The outcomes are depicted in Determine 5, the place 1, 2, 3, and 4 signify cardio sports activities, conventional Chinese language sports activities, ball video games, and Excessive-intensity interval coaching, respectively. By way of effectiveness, Excessive-intensity interval coaching (SMD=−2.90, [95% CI: −3.96, −1.84]) exhibited the very best impact, adopted by ball video games (SMD=−2.05, [95% CI: −2.40, −1.70]), Chinese language conventional sports activities (SMD=−1.80, [95% CI: −2.08, −1.53]), and cardio sports activities (SMD=−1.31, [95% CI: −1.73, −0.90]). Heterogeneity testing revealed an I2 worth of 75.5%, presumably attributed to elements resembling intervention period and pattern dimension.

Determine 5 Subgroup evaluation. Quantity: 1, cardio sports activities;31,32,34,37 2, conventional Chinese language sports activities;18–21,30,35 3, ball video games;23,25,30 4, high-intensity interval sports activities.34

Small Pattern Results or Publication Bias Assessments

For the research included within the community META, small pattern impact estimation and publication bias check have been carried out by correcting the comparability funnel map. The included papers have been principally symmetrical, indicating that the potential for a small pattern impact on this evaluation was small, and no apparent publication bias was discovered. (Determine 6) Moreover, an Egger’s check was carried out on the included research, yielding a P-value of 0.10, which is larger than 0.05. This means a low probability of great publication bias.

Determine 6 Calibration comparability funnel diagram. Capital: A, Placebo; B, Music; C, Therapeutic massage; D, cardio sports activities; E, Qigong; F, Yoga; G, Tai chi; H, Ball video games; I, energy train; J, Dance; Ok, complete physique vibration coaching; L, high-intensity interval sports activities.


Melancholy in younger folks is a critical psychological well being subject all around the world. Within the therapy of despair, non-pharmacological interventions wouldn’t have issues resembling drug resistance and uncomfortable side effects in comparison with pharmacological interventions.39 A research discovered that after 4 months of experimentation, the train remedy group may obtain the identical antidepressant impact as drug remedy (sertraline).40 In the meantime, bodily and psychological interventions, significantly train interventions, are hardly ever related to psychological sickness stigma.41 Due to this fact, this evaluate performed a community meta-analysis of experimental research of generally used non-pharmacological interventions for despair in faculty college students, together with music interventions, therapeutic massage, cardio train, qigong, yoga, Tai Chi, ball video games, energy coaching, dance, whole-body vibration coaching, and high-intensity interval coaching, The research synthesized data from direct and oblique comparisons of varied interventions, in contrast a number of interventions, and ranked the effectiveness of varied non-pharmacological therapies based mostly on the evaluation outcomes. The opportunity of turning into the perfect therapy was explored.

The findings revealed that the 11 non-pharmacological interventions included have been helpful in decreasing despair in faculty college students, with high-intensity interval coaching having the very best chance of getting the perfect impact. The impact of the intervention was statistically vital. In accordance with scholar Zhao Hong-qin, whereas each gradual high-intensity interval train and steady train can cut back despair in faculty women, gradual high-intensity interval train has a greater constructive impression. Excessive-intensity interval train, as in comparison with steady cardio train, can considerably enhance the pleasure of train, thereby extra successfully stimulating the pituitary-adrenal axis and enhancing depressive circumstances.34 From the attitude of the mechanism of motion, train can enhance the content material of related neurotransmitters within the blood of depressed sufferers and enhance the effectivity of transmitters within the synaptic area of the central nervous system. The efficacy of most antidepressants in therapy can also be to boost the extent of amine metabolism within the mind, indicating that the mechanisms of motion of train and antidepressants are related.31 Antidepressants are at the moment extensively used, however their medical efficacy could also be affected by poor adherence to treatment regimens, which regularly have some uncomfortable side effects, or it takes as much as 6 weeks after initiation to start to have measurable results on depressive signs; thereby, non-pharmacological remedies resembling high-intensity interval coaching and yoga can be utilized as major interventions. The outcomes of SUCRA confirmed that along with the included exercise-based interventions, music interventions additionally rated highest. Michalak et al concluded that listening to acceptable and favourite music lowered members’ sympathetic nervous system exercise whereas growing parasympathetic nerve exercise, leading to peaceable respiratory, steady blood strain and coronary heart price, and the impact of sedation and hypnosis within the launch of endorphin substances within the physique, thereby considerably decreasing anxiousness and despair.42 As well as, therapeutic massage and Qigong are given low precedence, with therapeutic massage being regarded by researchers to be a synergistic measure to enhance fragrant environmental remedy, and the outcomes must be validated by additional research because of the restricted variety of members.7 Moreover, qigong and Tai Chi are sometimes labeled as conventional Chinese language health workout routines in analysis.43,44 By way of train traits, it falls throughout the class of reasonable and low-intensity cardio train.1 In accordance with the findings of this research, the low precedence of conventional health workout routines in China could also be because of the comparatively low depth of train and the lack to supply appropriate stimulation for younger folks to boost their psychological situation.

There are nonetheless a number of limitations to this research: (1) From the attitude of research traits, the diploma of despair of the themes included on this research was completely different, and there have been sure regional environments and genders Discrepancies could result in inconsistency between research. (2) From the attitude of research design, the intervention interval, depth, frequency, and time of various research designs have been additionally barely completely different. (3) From the attitude of literature screening, though this research performed a complete search of two main home databases and 4 main international databases, there was nonetheless the potential for lacking detection. On the similar time, the variety of articles on completely different interventions assorted comparatively considerably within the included literature. For instance, there is just one paper on therapeutic massage, which makes objectively explaining its intervention impression on faculty college students with despair tough, and the acupuncture remedy included within the pre-search was rejected throughout literature screening, which is regrettable. Moreover, a comparability of the measures is lacking from the ultimate end result.

(4) There’s a potential for “reporting bias” since a analysis protocol was not registered for this research. (5) Different potential biases also needs to be thought-about. Given the aforementioned limitations, it’s steered that future RCT research: (1) RCT design and reporting ought to observe worldwide requirements with a purpose to enhance the standard of analysis and reporting; (2) RCTs straight in contrast the efficacy of various interventions on despair to compensate for the shortcomings of oblique comparisons.


The community meta-analysis revealed that varied non-pharmaceutical interventions, together with music intervention, therapeutic massage, cardio train, Qigong, yoga, Tai Chi, ball video games, energy coaching, dance, whole-body vibration coaching, and high-intensity interval coaching, had a discernible impression on regulating despair in faculty college students. Amongst these interventions, high-intensity interval coaching confirmed a better chance of yielding probably the most favorable impact on despair scores in comparison with others. Nonetheless, additional high-quality analysis is critical to determine its particular results extra conclusively. Contemplating the constraints of this research, future research ought to categorize and consider the essential scenario of members (resembling despair stage), in addition to the impression of intervention time and frequency on despair. Extra high-quality medical trials are wanted to show this sooner or later.

Knowledge Sharing Assertion

Knowledge sharing shouldn’t be relevant to this text as no datasets have been generated or analyzed throughout the present research.


We acknowledge effort and nice work from all staff members and admire undertaking coordinators, investigators, and knowledge operators.


The authors report no conflicts of curiosity on this work.


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