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Amid escalating environmental stressors, early intervention is essential. Digital music therapy (dMT) shows promise; however, stress\u2010context randomized controlled trials examining its effectiveness and mechanisms are lacking. A total of 1581 youths were identified with depressive symptoms via survey. In a randomized trial, 105 participants were 1:1 assigned to the dMT or control (CON) group. The dMT group received 3\u00a0weeks of intervention, while the CON group received none. The primary outcome will assess depression changes () of pre\u2010 and post\u2010intervention, compared to CON group. Secondary outcomes will evaluate Stress and Insomnia, compared to CON group. Mediation analysis examined depressive symptoms' role in mediating stress and insomnia, further assessed dMT efficacy's mediating role in these outcomes. There were significant differences in Depression, Stress, and Insomnia between dMT group (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a030) and CON group (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a030). Depressive symptoms directly and indirectly mediated the relationship between stress and insomnia among depressive youth identified via survey. The therapeutic effect of the dMT intervention on Depression indirectly mediated the relationship between Stress and Insomnia. Digital MT\u2010driven depression improvement mediates stress and insomnia alleviation, filling a crucial gap in early\u2010stage mental health interventions with potential social and clinical impact.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The clinical trial registration was ClinicalTrials.gov NCT05949736.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/smi.70156","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T14:46:50Z","timestamp":1772981210000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Mediating Effects of Digital Music Therapy on Depressive Symptoms in Youth During the COVID\u201019 Pandemic: A Randomized Controlled 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