How do mental health challenges affect the performance of professional musicians? A systematic review.

This systematic review examines the relationship between mental health challenges and performance quality among professional musicians. The study was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The review protocol was registered in PROSPERO (CRD42025636469). Through an analysis of 18 primary research articles published between 2009 and 2024, we investigate how various mental health issues, particularly Music Performance Anxiety (MPA), affect both objective and subjective aspects of musical performance. The review reveals that mental health challenges significantly impact performance through multiple pathways, including physiological responses (increased heart rate, muscle tension), psychological reactions (anxiety, rumination), and behavioral changes (practice habits, career choices). While moderate levels of anxiety can sometimes enhance performance, excessive anxiety typically leads to deterioration in both technical and artistic aspects of playing. The findings highlight that early life experiences, personality traits, and performance conditions significantly moderate these effects. The review also identifies important research gaps, particularly regarding the impact of depression, burnout, and sleep disorders on musical performance. These findings have important implications for music education, performance preparation, and healthcare support for musicians, suggesting the need for early intervention and personalized anxiety management strategies.