“Music,” by Flickr user Emily Ries
Titles: (1) Music, Singing and Wellbeing in Healthy Adults; (2) Music, Singing and Wellbeing for Adults Living with Diagnosed Conditions; and (3) Music, Singing and Wellbeing for Adults Living with Dementia (three reports)
Authors: Norma Daykin, Lily Grigsby Duffy, Guy Julier, Jack Lane, Louise Mansfield, Catherine Meads, Annette Payne, Alan Tomlinson, Christina Victor (reports 1, 2, & 3); Adele Burnett, Giorgia D’Innocenzo, Paul Dolan, Tess Kay, Stefano Testoni (reports 1 & 2)
Publisher: What Works Centre for Wellbeing
Year: 2016
URL: https://www.whatworkswellbeing.org/product-category/artsculture/?filter_resource-type=full-report
Topics: music, singing, wellbeing, health, dementia, older adults, anxiety, depression, young adults
Methods: Systematic review of 145 studies exploring wellbeing outcomes of music and singing for adults, grouped into three categories: healthy adults, adults with diagnosed health conditions, and adults with dementia. (Includes empirical research published from 1996 to June 2016 and systematic reviews from 2010 to 2016.) Review of grey literature and practice reports from 2013 to 2016. Studies sourced through electronic searches. Review and analysis of data from 2,500 participants for review focusing on healthy adults; 1,364 for adults with diagnosed conditions; and 249 for adults with dementia, all from many different countries.
What it says: The authors examine the relationship between music and singing interventions and subjective wellbeing (studies that include paid professional musicians, clinical music therapy, and clinical procedures were excluded). Among healthy adults, the authors found that the evidence was strongest for the effects of music, particularly singing, for older adults on morale, mental health-related quality of life, loneliness, anxiety, and depression. Among adults with diagnosed conditions, the authors found it difficult to synthesize findings due to the heterogeneity of included studies. However, the evidence points to reductions in depression and anxiety across age groups. For adults with chronic conditions (e.g., stroke, cancer), a number of studies reported reduced stress among a range of other wellbeing outcomes. Similarly, for adults with dementia, methods used across studies were inconsistent, making it difficult for the authors to draw conclusions from studies given varying outcomes, sample sizes, and settings. Key findings across the three reports are summarized below, grouped by the quality of the evidence.
High-quality evidence:
- Among young adults, music listening alleviates anxiety and improves wellbeing
- Among older adults, regular group singing enhances moral and mental health-related quality of life and reduces loneliness, anxiety, and depression; also, singing maintains a sense of wellbeing
- Among pregnant women, structured music therapy reduces stress, anxiety, and depression
- Among college nursing students, culturally relevant music interventions decrease depression
- Among palliative care hospital patients, brief music therapy is effective in supporting wellbeing
Moderate-quality evidence:
- Among young adults, music listening for short durations enhances mood and music listening, while exercising enhances the positive effects of physical activity on state anxiety
- Among healthy adults, music listening reduces stress, negative mood, and state anxiety; among males, regular listening to a particular genre of music alleviates anxiety, stress, and depression
- Among older adults, music listening may be effective in preventing or reducing depression; participation in choirs provides positive social experiences and a vehicle for identity construction and revision later in life; and songwriting and performing contributes to happiness
- Among marginalized groups (e.g., the homeless), there is value to the therapeutic benefits of group singing and the opportunity to learn, build relationships, and engage in meaningful exchange with the broader community; among the incarcerated, listening to relaxing music alleviates anxiety and anger
- Among older people with chronic conditions in residential and community settings, culturally relevant music interventions (e.g., playing an instrument, singing) decreases depression
- Among a variety of adult populations, reported wellbeing benefits include relaxation, reduction in anxiety, spiritual uplifting, improvements in mood, emotional wellbeing, confidence, and more; also, music participation can raise awareness of the significance of music in people’s lives, which can have a positive effect on health awareness, quality of life, and behavioral change
Low-quality evidence:
- Among healthy adults, group singing fosters happiness, can enhance perceived psychological wellbeing (e.g., self-esteem, emotion, enjoyment, purpose in life, etc.) and subjective wellbeing, and supports the development of musical identity and a sense of purpose
- Among older adults, learning music may help to realize long-held ambitions and promote spiritual growth; also, motivation for music participation might be to broaden social networks and to learn
- Among marginalized groups, active music making in groups enables them to build a sense of community and share culture and heritage; among young offenders in particular, music and singing projects have a positive effect on self-esteem; among prison inmates, participatory music making, singing, and performing in public supports perceived wellbeing
- Among pregnant women, listening to relaxing music enhances wellbeing and mood
- Among people experiencing PTSD, group drumming supports reduction in related symptoms
- Among patients with Chronic Obstructive Pulmonary Disease, singing classes are associated with improvements in areas of wellbeing such as mood
- Among post-stroke patients, music therapy has a positive effect on mood
- Among adults living with chronic conditions, participation in long-term group singing improves quality of life and social and emotional wellbeing
- Among hospice patients, music therapy contributes to improved spiritual wellbeing
- Among undergraduate students, music therapy alleviates anxiety
- Among adults with dementia, listening to music enhances overall wellbeing, and for those in nursing homes, individualized music listening reduces anxiety and/or depression
Music listening accounted for over a third of interventions across studies with healthy adults, followed by under a third examining group singing. Common methodological challenges cited by the authors included small sample sizes in quantitative studies and limited theoretical analysis in some qualitative studies. It’s likely that some people with health conditions were included in some studies on healthy adults, though they were not systematically recorded, making it difficult to account for the effect of these conditions on outcomes. The authors note the following qualitative themes: enhanced personal wellbeing, characterized by happiness and other positive emotions; social wellbeing, or increased interacting and bonding with others; and identity-related benefits, associated with shared culture, past connections, self-awareness, and the perception of music as a meaningful and important part of life. Lastly, the authors conducted a meta-analysis of five studies on anxiety and six studies on depression, which revealed that music participation had no statistically significant effect on anxiety among healthy people, but that it can reduce depression.
What I think about it: Overall, this is a strong systematic review, executed mostly without flaws, though not completely. A couple of things to note which may reduce confidence include the inconsistent date ranges used to pull the grey literature, empirical studies, and systematic reviews used in the reports, as well as use of self-reported measures among participants with dementia, as noted by the authors. Another significant drawback is the potential narrowness of the search due to a focus on specific keywords like “wellbeing,” which may have led to exclusion of relevant evidence. Despite the large number of returned citations, the authors limited the scope of the review to focus on interventions with healthy adults and those with higher quality research designs. That said, findings may seem particularly robust for healthy adult populations, but really, this was just an intentional focus for the systematic review.
What it all means: This capsule review somewhat extends Createquity’s investigation on the claims to the benefits of arts participation, and the quality of evidence to back those claims, with a deeper focus on the impact of music and singing interventions on wellbeing. Notably, even with specificity around art forms, the authors note wide variation among study characteristics and outcomes, including the duration of the interventions, passive versus active forms of participation, individualized versus group experiences, as well as the range of wellbeing outcomes measured. Addressing the aforementioned methodological shortcomings would prove useful for future research in this area. To some extent, it will almost always be difficult to synthesize findings from studies on the arts and wellbeing until there is consistency in the methods employed across studies.
Nonetheless, the reports offer added value in terms of recency of studies and population breakdowns. Createquity’s investigation of the arts and wellbeing mostly cited evidence from 2014 or earlier, with a large portion of studies published before 2010. The Music, Singing and Wellbeing reports use evidence from studies published as recently as 2016, though not all (there still is publication lag). Furthermore, very few studies that Createquity came across focused on specific populations; when they did, the evidence was mixed or of lesser quality. The exception would be older adults. The strongest evidence cited in these reports focuses on older adults, similar to our findings around the benefits of participatory arts for older adults. In fact, Music, Singing and Wellbeing is an excellent supplement to that piece in particular; it includes a new large-scale randomized controlled trial of singing among older adults that was not included in our previous reviews.