Culturally Responsive Interventions Using Music to Improve Engagement and Mental Health for Adolescents and Young Adults: A Systematic Review

Background and Purpose: Mental health disorders and suicidality are rising among adolescents and young adults (A-YA), particularly since the onset of COVID-19 (Czeisler et al., 2020; Miron et al., 2019). These trends are even higher among girls, those that identify as LGBTQ+, and A-YA of color who face elevated risks of social and environmental stressors (e.g., victimization, racism, incarceration, trauma, poverty) (Mental Health America, 2020; Alegria et al., 2015). Despite this growing problem, engaging A-YA in mental health services remains a pervasive global challenge (SAMHSA, 2020). The lack of evidence-based practices that use culturally and developmentally responsive strategies contributes to the persistence of this problem. The growing body of research that supports music and expressive arts interventions offers promise, but its efficacy remains unclear. This systematic review examines the evidence on psychosocial interventions that use music as a tool to improve engagement and mental health for A-YA.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: 1) quasi- or experimental design, 2) engagement or mental health outcomes, and 3) A-YA aged 12-28. Database searches were conducted in PsychInfo, Social Service Abstracts, and SocINDEX using a syntax of keywords synonymous to “psychosocial intervention,” “music,” and “mental health,” which were developed through consultation with a research librarian. Included studies were assessed for methodological quality and data were extracted and synthesized.

Results: A total of 1,749 records were identified and after title/abstract screening and full text reviews (N=195), a total of 29 studies were included. A typology emerged based on four distinct intervention approaches: 1) Music Therapy, 2) Hip Hop/Rap Therapy, 3) Integrated Expressive Arts, and 4) Music Psychology. Most studies reported positive changes, particularly for mental health outcomes with depression, anxiety, self-esteem, and behavioral difficulties being the most common. Few interventions operationalized engagement as a primary outcome but some focus on music as a tool to enhance engagement in the therapeutic process. With regard to the sample, most focused on younger adolescents and few targeted young adults. Quasi-experimental designs were common, and most demonstrated fair to moderate methodological quality. Intervention fidelity and monitoring protocols were not common, which poses challenges for assessing effectiveness. Most interventions were delivered in a group format and rooted in cognitive-behavioral, humanistic, and person-centered theories. Most interventions were semi-structured, some were structured, and few were improvisational. Hybrid intervention techniques were most common, which consisted of both active (i.e., musical creation, song writing) and receptive (i.e., music listening, lyrical analysis) exercises. Most interventions were delivered in schools, residential, and inpatient/outpatient mental health settings.

Conclusions and Implications: The use of music-based interventions offer promise towards improving engagement and mental health outcomes for A-YA. There is a need for more studies that use rigorous methods (i.e., randomization, larger samples, follow up, fidelity, blinding) that are developmentally and culturally tailored to A-YA subgroups. The field would benefit from more studies that conceptualize and test hypothesized mediators and moderators of action to improve understanding of how and for whom music-based interventions produce outcomes.