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Table of Contents
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 15-18

Five-element music relieves the anxiety and insomnia of medical staff against COVID-19 in the period of medical observation in a single recuperation center in China

1 The Fourth Convalescent Department, The Department of Rocket Army Guangzhou Special Service Sanitarium 510515, China
2 Outpatient Department, The Department of Rocket Army Guangzhou Special Service Sanitarium 510515, China
3 School of Health Management, Southern Medical University, 510515, China
4 Youth League Committee of Xinghai Conservatory Of Music, 510500, China
5 The First Clinical College of Southern Medical University, 10515, China
6 Hematology Department and Outpatient Department, Nanfang Hospital, Southern Medical University, 510515; Institution for Hospital Management of Tsinghua University, Beijing, 100084, China
7 The Sixth Convalescent Department, The Department of Rocket Army Guangzhou Special Service Sanitarium 510515, China

Date of Submission20-Feb-2021
Date of Decision26-May-2021
Date of Acceptance01-Jun-2021
Date of Web Publication7-Jul-2021

Correspondence Address:
Prof. Qianli Jiang
Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao Bei Road, Guangzhou, 510515, Guangdong
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/QAIJ.QAIJ_1_21

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Objective: The medical staff fighting against COVID-19 virus are under great pressure. Anxiety and insomnia are common problems that are experienced and which need to be actively addressed when they returned from the epidemic front line. Five-element music (a kind of Chinese traditional music) has been tried for this purpose. Subjects and Methods: The medical staff who volunteered to participate in the trial were randomly divided into two groups. After a questionnaire and classification of their emotional type, both the groups received general music exposure. Then, Chinese five-element music is offered to the study group. After the trial, the improvement of anxiety and insomnia was evaluated by comparing the Self-Rating Anxiety Scale (SAS) and Self-Rating Scale of Sleep (SRSS) scores before and after the intervention. Results: The SAS and SRSS scores of the two groups demonstrated no obvious difference before recuperation and the number of people taking medicine was roughly the same. After the intervention of Chinese five-element music, the SAS and SRSS scores were comparatively better (P < 0.05) in the study group. The anxiety and insomnia scores significantly decreased (P = 0.001 and P = 0.000, respectively) and fewer pills were taken. Conclusion: Chinese five-element music during medical observation is effective in reducing anxiety and insomnia in medical staff treating COVID-19.

Keywords: Anxiety, COVID-19, five-element music, medical staff, sleep

How to cite this article:
Huai J, Hui X, Yan D, Xu W, Lin D, Xiong J, Jiang Q, Zhang M. Five-element music relieves the anxiety and insomnia of medical staff against COVID-19 in the period of medical observation in a single recuperation center in China. QAI J Healthc Qual Patient Saf 2020;2:15-8

How to cite this URL:
Huai J, Hui X, Yan D, Xu W, Lin D, Xiong J, Jiang Q, Zhang M. Five-element music relieves the anxiety and insomnia of medical staff against COVID-19 in the period of medical observation in a single recuperation center in China. QAI J Healthc Qual Patient Saf [serial online] 2020 [cited 2023 Mar 27];2:15-8. Available from: https://www.QAIJ.org/text.asp?2020/2/1/15/320807

  Introduction Top

The outbreak of novel coronavirus (COVID-19) has been severe, threatening health care worldwide. As of October 19, 2020, COVID-19 had affected more than 210 countries around the world, infecting over 39 million people. According to the statistics of the World Health Organization (WHO), about 14% of the globally confirmed cases are medical staff, and in some countries, the figure is as high as 35% as of September 17. Owing to the long-term exposure to the high-risk working environment, health-care workers (HCW) are forced to be isolated from their families under great pressure. It has been reported that more than half of the medical staff have had anxiety and sleep disorders,[1],[2],[3],[4] which results in burnout of the medical staff with negative consequences for anti-epidemic interventions.[5],[6]

Therefore, the Chinese government has adopted medical observation as a routine mode of recuperation for front-line medical staff after major public health emergencies. HCWs are invited to recuperation centers for 2-week quarantine and recuperation. Such arrangements can alleviate the negative psychology of medical staff and also help to detect potential COVID-19 asymptomatic carriers. The risk of transmission may be reduced, and the medical staff can enjoy a peaceful gap period to recover from the stress of the anti-epidemic environment.

Music, a media that can transcend borders and languages, has a positive effect on mental problems such as anxiety regulation, stress relief, and sleep improvement.[7] Nowadays, the rapid development of instant communication applications or APPs provided powerful functions of social interaction (e.g., WeChat, Facebook, WhatsApp, and Line). These applications provide opportunities for the rapid dissemination of music. Five-element music[8] originated from traditional Chinese medicine and is performed on traditional Chinese instruments and has been designed by Chinese Traditional medicine doctors together with music experts. The concept of five-element music came from the “Huangdi Neijing” and was created for emotion adjustment according to five “zhi” (sorrow, joy, fear, anger, and anxiety).

This study aimed to compare the impact of five-element music on medical staff's anxiety and insomnia during recuperation.

  Subjects and Methods Top

Research subjects

The medical staff in a COVID-19 recuperation center volunteered to participate the trial in April 2020. They were randomly divided into two groups of 44 individuals. Each group has had its own WeChat group for communication and distribution of the music and the questionnaire.

Anxiety and sleep rating scales

To assess anxiety, the Self-Rating Anxiety Scale (SAS) was used as it can reflect the mental health of the population.[9] The Self-Rating Scale of Sleep (SRSS) was used to assess sleep status.[10] After the medical staff completed the SAS[11] of Zung and SRSS[12] of Jianming Li, the standard total scores of SAS were obtained by summing up the scores of each item, multiplying by 1.25 and taking the integer part of the result. The SAS with a total score of 50 has 20 items rated on a 1~4 rank, and its higher score suggests more serious anxiety symptoms. The total scores of SRSS were calculated by summing up the scores of each item, ranging from 10 to 50. The SRSS has 10 items rated on a 1~5 scale, and its higher score suggests more serious insomnia. In addition, medications for anxiety and insomnia were recorded.

Emotion type classification

Combining the scale and face-to-face communication with Chinese physicians, the two groups of participants' emotion types were divided into five dominant emotion types as sorrow, joy, fear, anger, and anxiety.


The members of both the groups were provided general music treatment (Chopin nocturne, Bandari, etc.) daily within the WeChat groups. For the study group, five-element music was provided for 30 min/day for 16 days [Figure 1], such as “Gong” sound music for the “anxiety” emotion type.
Figure 1: Correspondence of causes and five-element music

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Statistical analysis

All data were analyzed by using SPSS 21.0. Measurement data were tested by normal distribution test and described by (x¯ ± s) to determine the effects of different music on anxiety and insomnia. The difference was statistically significant when P < 0.05.

  Results Top

Baseline characteristics of subjects

Medical staff in both the groups had been in the COVID-19 frontline for 50 consecutive days and there was no statistically significant difference in age, gender, and other general information [Table 1].
Table 1: Baseline characteristics of participants in two groups

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Emotional type

There was no significant difference between the distribution dominant emotion type between the two groups [Table 2].
Table 2: Distribution of five ”zhi” types in two groups

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Comparison of Self-rating Anxiety Scale and Self-rating Scale of Sleep scores between the two groups pre- and postintervention

There was no significant difference in the SAS and SRSS scores of preintervention between the two groups. The SAS and SRSS scores of postintervention were significantly decreased, while the score of five-element music study group was significantly lower than that of the control group [Table 3].
Table 3: Comparison of Self-Rating Anxiety Scale and Self-Rating Scale of Sleep scores between two groups pre and postintervention

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Drug consumption for insomnia between the two groups

Estazolam (a drug for insomnia) was taken by three people before and after recuperation in the control group, the total doses decreased from 15 mg to 9 mg. Two people took estazolam in the study group, the total doses decreased from 9 mg to 4 mg. None of the two groups took antianxiety drugs.

  Discussion Top

With the outbreak of the epidemic, medical staff were required to combat COVID-19, and this resulted in marked stress as evidenced by anxiety and insomnia. This stress can eventually lead to burnout and even suicide.[13] Based on the concepts of people-centered care, recuperation can improve recovery and decrease stress levels. Based on our study, the use of five-element music treatment has achieved good results in this regard.

About 2000 years ago, five-element music treatment was first proposed in the “Huangdi Neijing.” Since then, it has continuously been supplemented and developed by later generations of physicians and is now used widely in clinical practice. Many studies have shown that five-element music can treat emotional diseases.[14] Haiyan et al.[15] and Qinfen et al.[16] reported that five-element music can improve the situation of patients with anxiety and depression. Zhi-Hong, et al.,[17] reported that five-element music therapy can effectively improve the quality of sleep and reduce the anxiety of patients with chronic osteomyelitis, and the effect is enhanced with the intervention time.

Music has been widely used in the treatment of emotional disorders such as depression, anxiety, and menopausal depression.[18],[19] In our study, the SAS and SRSS scores were used to measure the severity of anxiety and insomnia. The results show that both general music and five-element music can alleviate the anxiety and insomnia of medical staff, but the five-element music intervention is more effective. The key reasons for this result may be that before the intervention, we investigated and classified the emotion and sleep of medical staff. According to the results, we used the corresponding five-element music to intervene medical staff in according emotional states. We believe that if the general music is applied in this way, similar effects may be achieved.

WeChat is an instant messaging software with functions such as online payment, online education, online meetings, multi-person voice communication, social networking, and entertainment, and can be used for free on both mobile and computer terminals. In 2017, the average daily login on WeChat reached 902 million people, and the average daily message sent reached 38 billion.[20] By launching an online Tencent Meeting on WeChat, which supports up to 300 people without a time limit, we could safely and immediately intervene in the two groups while maintaining physical distancing. After the intervention, the medical staff could still accept music treatment through WeChat, and the long-term effect of five-element music can be followed up.


As the evaluation time of this study lasted for only 2 weeks, the small sampling might cause bias. In addition, the data on drug consumption in our study are too small for statistical analysis. A multicenter research with larger number should be launched to obtain a comprehensive and objective assessment of the impact of the intervention.

  Conclusion Top

Five-element music efficiently improves anxiety and insomnia of anti-epidemic medical staff. The Director General of the WHO said at a meeting on September 17, 2021, that if health workers are safe, patients are safe. During the COVID-19 epidemic, this online intervention can play an important role to help medical staff with anxiety and insomnia. The simplicity safety and lack of side effects make five-element music online treatment an easy-to-be-accepted intervention without the limitation of time and region. Five-element music is not only applicable to medical staff in the period of medical observation but also to anyone in home isolation or in the postisolation period. In addition, as COVID-19 spreads around the world, it has the potential to improve the mental health of all those impacted by the pandemic, both the public and health-care workers.


The authors of the study would like to present their deep thanks to all participating medical staff. We thank Ms Jing Wen and Mr. Zeyu Wu, for English literature reviewing also.

Financial support and sponsorship

This work was supported by Guangdong Science and Technology Plan (2020A1414050026, 2018A070701006, 2018A030313647); Undergraduate Training Program for Innovation and Entrepreneurship in Guangdong Province (S201912121158); and Guangdong University Student Science and Technology Innovation Cultivation Special Fund (PDJH2019b0101).

Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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