Music-based interventions for acute and short-term anxiety in nursing students: a systematic review and meta-analysis

Background Nursing students encounter acute anxiety during examinations, simulations, clinical skills training, and other health-related student contexts. We evaluated music-based interventions, with acute or short-term self-reported anxiety as the principal outcome and other psychological, physiological, health, and educational outcomes as secondary domains. Methods Following peer review, we repeated searches in PubMed/MEDLINE, CINAHL Complete, Embase, APA PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), the Web of Science Core Collection, and ClinicalTrials.gov from their inception to 19 September 2026, without outcome, study design, publication type, or language limits. Two reviewers independently screened, extracted, and assessed the risk of bias. The principal meta-analysis used a uniform post-intervention Hedges’ g from each eligible, individually randomized parallel-group trial. Random-effects models were estimated using Restricted Maximum Likelihood or Residual Maximum Likelihood (REML); Wald confidence intervals were the primary estimate, and Hartung–Knapp and prediction intervals were used to assess small-sample uncertainty. Results Of the 737 records identified, 337 duplicates were removed, and 400 records were screened. A total of 64 reports were sought; 39 unique complete documents were assessed; 26 reports representing 24 studies were included; and 13 full-text reports were excluded. Twenty studies were randomized, and four were non-randomized. Nine parallel-group trials (650 participants) contributed to the principal anxiety synthesis ( g = −0.31, 95% confidence interval (CI): −0.58 to −0.04; p = 0.024; I 2 = 64%; τ 2 = 0.107). The Hartung–Knapp interval (from −0.63 to 0.01; p = 0.055) and the 95% prediction interval (from −1.15 to 0.53) crossed zero. All nine principal trials were at high overall risk of bias, and certainty was very low. Conclusion Music-based interventions may reduce acute or short-term self-reported anxiety on average. However, the results are sensitive to the method used to quantify uncertainty, and the effects are likely to vary across settings. Evidence is insufficient to infer sustained psychological benefits, improved learning, or support for routine implementation. Systematic review registration The review was registered in PROSPERO (CRD420251274752). Public record URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251274752 .