Different arts-based interventions for depression and anxiety in college students: a network meta-analysis of...

Arts-based interventions are increasingly employed to alleviate anxiety and depression among college students; however, their relative effectiveness across modalities remains unclear. This study aimed to compare the efficacy of diverse arts-based approaches for improving mental health outcomes in this population.

This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD420251141163). A Bayesian network meta-analysis was conducted including randomized controlled trials published up to 10 September 2025, identified from the Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and APA PsycNet. Standardized mean differences (Hedges' g; negative values indicate symptom reduction) were synthesized under a random-effects model, and treatment rankings were estimated using the Surface Under the Cumulative Ranking curve (SUCRA). The certainty of evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework, potential publication bias was evaluated using Egger's regression test, and the node-splitting method was applied to assess inconsistency.

Twenty-eight trials involving 2,654 participants met the inclusion criteria. For anxiety, cognitive-behavioral therapy combined with music therapy showed the greatest improvement (SUCRA = 92.4%), followed by sandplay therapy (SUCRA = 82.4%). For depression, music therapy ranked highest (SUCRA = 82.4%), followed by cognitive-behavioral therapy combined with dance therapy (SUCRA = 79.8%). No evidence of publication bias was detected (Egger's p > 0.05), and the node-splitting analysis revealed no significant inconsistency across comparisons.

Among arts-based interventions for college students, integrating music into cognitive-behavioral therapy may offer the greatest benefit for anxiety, while standalone music therapy appears most effective for depression. These findings support the adoption of music-based programs in university settings and underscore the need for large-scale, rigorously designed trials to confirm these effects and optimize intervention strategies.