What plays beneath: mental health burden, personal resources, and treatment utilization among professional musicians and music students.

Introduction: Professional musicians may be exposed to distinctive occupational, psychosocial, and artistic demands, yet integrated evidence on their mental health, psychological resources, and treatment utilization remains scarce. Therefore, this study examined mental health indicators, including symptom burden and self-reported diagnosed mental disorders, personal psychological resources (resilience, self-efficacy, and self-esteem), occupational characteristics, and treatment use in a nationwide sample of professional musicians and music students in Germany. Methods: Data were collected through a large, anonymous, longitudinal online survey across different musical genres. Baseline data were obtained from 1,392 participants January-June 2024; 327 participants completed the follow-up in June 2025 (at least 1 year after baseline). Descriptive analyses, subgroup comparisons, cross-sectional regression models, and longitudinal regression models were used to examine symptom burden, diagnoses, resources, sociodemographic and occupational differences, and change over time. Results: At baseline, clinically relevant symptom levels were common: 30% of participants scored in the moderate or severe range for generalized anxiety symptoms, 32% scored in the moderate to severe range for depressive symptoms, and 22% reported a current diagnosed mental disorder. Employment status emerged as the most consistent subgroup correlate, with additional differences by gender, job role, and genre. Resilience, self-efficacy, and self-esteem were each negatively associated with depressive symptoms, generalized anxiety symptoms, and music performance anxiety, with self-esteem showing particularly strong associations. Overall, mental health indicators and personal resources were largely stable over 12 months, while music students reported higher depressive symptoms at follow-up beyond baseline levels. Treatment utilization was substantial, with half of participants reporting lifetime treatment for psychological complaints. Discussion: These findings indicate a substantial and unevenly distributed mental health burden among professional musicians in Germany. Although interpretation is limited by the observational design, non-probabilistic sampling, reliance on self-report, and substantial attrition at follow-up, the findings point to the relevance of prevention and support strategies that adequately address psychological resources and occupational conditions. Such provision may be broadly accessible while remaining responsive to differences in employment status, genre, gender-related experiences, barriers to care, support needs, and individual characteristics and contexts. These implications may guide future research and context-sensitive practice, although their effectiveness and clinical relevance require further evaluation. Clinical trial registration: The study was pre-registered in the German Clinical Trials Register in January 2024 (https://drks.de/search/en/trial/DRKS00033401).