Significant treatment effect of adjunct music therapy to standard treatment on the positive, negative, and mood symptoms of schizophrenic patients: a meta-analysis

Abstract

Background: Music therapy (MT) has been used as adjunct therapy for schizophrenia for decades. However, its role is still inconclusive. A recent meta-analysis demonstrated that MT for schizophrenic patients only significantly benefits negative symptoms and mood symptoms rather than positive symptoms. In addition, the association between specific characteristics of MT and the treatment effect remains unclear. The aim of this study was to update the published data and to explore the role of music therapy in adjunct treatment in schizophrenia with a thorough meta-analysis.

Methods: We compared the treatment effect in schizophrenic patients with standard treatment who did and did not receive adjunct MT through a meta-analysis, and investigated the clinical characteristics of MT through meta-regression.

Results: The main finding was that the treatment effect was significantly better in the patients who received adjunct MT than in those who did not, in negative symptoms, mood symptoms, and also positive symptoms (all p < 0.05). This significance did not change after dividing the patients into subgroups of different total duration of MT, amounts of sessions, or frequency of MT. Besides, the treatment effect on the general symptoms was significantly positively associated with the whole duration of illness, indicating that MT would be beneficial for schizophrenic patients with a chronic course.

Conclusions: Our meta-analysis highlights a significantly better treatment effect in schizophrenic patients who received MT than in those who did not, especially in those with a chronic course, regardless of the duration, frequency, or amounts of sessions of MT. These findings provide evidence that clinicians should apply MT for schizophrenic patients to alleviate disease severity.

Fig. 1

Flowchart of the selection strategy and inclusion/exclusion criteria for the current meta-analysis

Fig. 2

a. Forest plot showing effect sizes (Hedges’ g) and 95 % confidence intervals (CIs) from individual studies and pooled results of all included studies comparing total psychopathology between patients with schizophrenia receiving music therapy (MT) and those who did not receive music therapy (Ctr); b. Forest plot showing effect sizes (Hedges’ g) and 95 % CIs from individual studies and pooled results comparing total psychopathology between patients with schizophrenia receiving MT and the Ctr group by trial design, such as non-randomized control trials (non-RCT) and randomized control trials (RCT). *subscales in the report by Hayashi (2002): positive symptoms (p), negative symptoms (n), and general psychopathology (p). a The treatment effect was better in the MT group than in the Ctr group (p < .001). b The treatment effect was better in the MT group than in the Ctr group in both non-RCT and RCT subgroups (p = .021 and < .001, respectively). Abbreviation: MA: meta-analysis; CI: confidence interval; MT: music therapy; Ctr: control groups as schizophrenic patients without music therapy; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision; DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revision; ICD-10: international classification of disease, 10th edition; CCMD-2: Chinese Classification of Mental Disorders, 2nd edition; CCMD-3: Chinese Classification of Mental Disorders, 3rd edition; SADS: Schedule for Affective Disorders and Schizophrenia; PANSS: positive and negative syndrome scales; BPRS: brief psychiatric rating scales; SANS: Schedule for Assessment of Negative Symptoms; RCT: Randomized Controlled Trials; non-RCT: non Randomized Controlled Trials

Fig. 3

Forest plot showing effect sizes (Hedges’ g) and 95 % confident intervals (CIs) from individual studies and pooled results comparing a. positive symptoms, b. negative symptoms, and c. mood symptoms between schizophrenic patients who received music therapy (MT) and those who did not (Ctr). a The treatment effect was better in the MT group compared to the Ctr group in subscales of positive symptoms (p = .017). b. The treatment effect was better in the MT group compared to the Ctr group in subscales of negative symptoms (p < .001). c. The treatment effect was better in the MT group compared to the Ctr group in subscales of mood symptoms (p < .001). Abbreviation: MA: meta-analysis; CI: confidence interval; MT: music therapy; Ctr: control groups as schizophrenic patients without music therapy; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision; DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revision; ICD-10: international classification of disease, 10th edition; CCMD-2: Chinese Classification of Mental Disorders, 2nd edition; CCMD-3: Chinese Classification of Mental Disorders, 3rd edition; SADS: Schedule for Affective Disorders and Schizophrenia; PANSS: positive and negative syndrome scales; BPRS: brief psychiatric rating scales; SANS: Schedule for Assessment of Negative Symptoms; CDSS: depression scale for schizophrenia; SDS: Self-rating Depression Scales; HAM-D: Hamilton rating scale for depression