Music Therapy Effectively Alleviates Public Anxiety, Depression, and Sleep Disorders Caused by the COVID-19 Pandemic: an online survey and evaluation across China Running title：Psychological stress during the COVID-19 pandemic across China

IMPORTANCE The COVID-19 pandemic has brought about widespread health and even mortality anxiety, exacerbating negative emotions such as anxiety, depression, insomnia. OBJECTIVE To determine whether online emotional assessment supported by musicians, psychological experts, and psychiatrists, as well as music therapy applications, can reduce negative emotions during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective study collected user data from the “Y-muse” WeChat mini-program across 34 provinces in China from January 31 to February 29, 2020. Eligible respondentss were between 12 and 70 years old, regular access to a smartphone and WeChat, able to understand the contents of the survey and complete the psychological assessment. Data analysis was conducted between March and June 2024. INTERVENTIONS This study included a total of 61753 eligible respondents. Y-muse delivered music to respondents at scheduled times based on their daily scale scores. Respondents who had baseline and subsequent,7 ± 2 days scale scores. The SDS group enrolled 462 respondents (Music therapy: 292 Respondents, Non-music therapy: 170 Respondents). The SAS group enrolled 669 respondents (Music therapy: 501 Respondents, Non-music therapy: 168 Respondents). MAIN OUTCOMES AND MEASURES The primary outcome was the change in scores on the Zung’s self-rating anxiety scale (SAS), Zung’s self-rating depression scale (SDS), and the Pittsburgh sleep quality index (PSQI) before and after music therapy use. RESULTS The SAS, SDS, and PSQI were completed by 39 529, 54 061 and 2151 respondents, respectively, from 34 provinces, municipalities, or autonomous regions in China. A total of 28.43%, 40.59% and 88.70% of respondents reached the score for anxiety, depression and poor sleep quality, respectively. Anxiety and depression levels significantly correlated with changes in the COVID-19 situation in China, showing decreased SAS and SDS scores as proactive measures were implemented by the government. Music therapy (vs. non-music therapy, p  < 0.001 in the SDS and SAS groups) was significantly associated with a reduction in the global score. In the SDS group, there was a significant association between the time period and a reduction in the global score. In the SAS group, time period and age were significantly associated with a reduction in the global score. CONCLUSIONS AND RELEVANCE Severe psychological stress has emerged in the public during the COVID-19 pandemic. Taking proactive measures to control the pandemic has protective psychological effects on the general population. Group music therapy is beneficial to relieve the extensive psychological stress.