“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.

Methodology for Rating Evidence

We use the following definitions for placement on the graph and for describing benefits in the document.

Does the evidence indicate that the benefit exists?

• Yes: the majority of the available evidence supports the claim
• No: the majority of the available evidence opposes the claim
• Mixed: neither of the above conditions is true

How strong is the quality of the evidence?

• High: multiple studies with causal designs (experimental or quasi-experimental)
• Medium: a single study with a causal design, or multiple studies that otherwise make a compelling case for causal interpretation in the judgment of our team
• Low: neither of the above conditions is met

In cases where the supporting, mixed, and opposing evidence is of differing strength, the stronger evidence is given more weight in determining whether the evidence supports the claim.

In the body of the article, we use the qualifier “probably” to describe effects in the Yes/Medium cell of the matrix, “may” to describe effects in the Yes/Low, No/Low, and all Mixed cells of the matrix, “probably not” to describe effects in the No/Medium cell of the matrix, and “does not” to describe effects in the No/High cell of the matrix.

Note: in general, we support methodological diversity, and are not dogmatic about valuing “gold standard” study designs such as randomized controlled trials at the expense of all other types of research. However, in practice, studies with causal designs tend to be much rarer than descriptive and case-study-based research, and therefore more valuable due to their scarcity and the fact that they are typically more challenging to conduct. In addition, given that the questions explored in this review are inherently causal in nature – can we trust that an activity or intervention makes some kind of benefit more likely – it is appropriate to privilege designs that make a convincing attempt to rule out alternative hypotheses for any observed effects. Our rating of evidence strength takes these considerations into account.

Full Bibliography

Below is a full list of resources which informed this research investigation. Much of our research focused on literature reviews or meta-analyses, and we have included here works that were consulted directly, as well as resources that were encountered within a review and factored into our findings. Works that received a thorough review from Createquity are marked with an asterisk (*).

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Trüby, J., Rammer, C., Müller, K., & others. (2008). The role of creative industries in industrial Innovation. ZEW-Zentrum für Europäische Wirtschaftsforschung/Center for European Economic Research. Retrieved from https://ideas.repec.org/p/zbw/zewdip/7499.html

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“Catalog” by Flickr user Beyond DC

The platitudes are on the lips of every arts supporter, ready to be recalled at the first sign of a public hearing or potential funding cut. “The arts are essential – a necessity, not a luxury.” “The arts help kids learn.” “The arts are the foundation of the knowledge economy.” It feels good to say those things, especially if you’re someone who has spent a life in the arts. But are they actually true? Are we pulling a fast one on ourselves and our audience by saying them? Or are we doing a service to the world by spreading the good news?

Over the past half century, hundreds of researchers have spent thousands of hours and millions of dollars grappling with these questions. And while the literature still has a ways to go before we can consider the answers definitive, it is becoming clear in at least several arenas that it’s not just our imagination: arts participation really does improve lives. In particular:

• Participatory arts activities help to maintain the health and quality of life of older adults. As discussed in our previous feature, singing improves mental health and subjective wellbeing; taking dance classes bolsters cognition and motor skills; dancing and playing a musical instrument reduce the risk of dementia; and visual arts generate increases in self-esteem, psychological health, and social engagement.

• Arts therapies contribute to positive clinical outcomes, such as reduction in anxiety, stress, and pain for patients. Music interventions tend to dominate studies in this area, mostly characterized by passive forms of participation (e.g., listening to music).

• Arts participation in early childhood promotes social and emotional development. For example, teachers report fewer instances of shy, aggressive, and anxious behavior among preschoolers taking dance classes, and toddlers receiving music instruction demonstrate increased social cooperation with other children.

• Student participation in structured arts activities enhances cognitive abilities and social skills that support learning, such as memory, problem-solving, and communication. (While arts participation may improve academic attainment as well, any effects are fairly small.)

We’ve catalogued these and other benefits in an interactive graphic we’ve created – the first of its kind – that explores the various benefits claimed for arts participation along with the strength of evidence backing those claims. See how the benefits stack up against each other at a glance, or zoom in to read what the research has to say about specific questions. (Read about our methodology here.) We recommend viewing in full-screen mode for best results.

Before we dive in further, a little context-setting is in order. The first thing to note is that what you’re going to read below is a work in progress. The literature on the effects of arts participation is vast and of highly uneven quality. To arrive at the conclusions we express here, we’ve relied heavily on existing literature reviews and meta-analyses on the topics in question, which means that any errors of interpretation or questionable judgments in those reviews are likely repeated here. Over time, we intend to get to know the underlying studies and publications and fill in gaps or make corrections as needed. In addition, new research on these topics comes out on a regular basis, and sometimes it challenges conclusions that we had previously drawn about a topic. For both of these reasons, you can expect that we will make tweaks both to the interactive and the content below as we gain access to new information going forward.

Second, it’s important to remember that the focus of this review is quite broad, and looks for general effects on a general population. It’s likely that in practice, there is quite a bit of variation between disciplines, between different modes of artistic participation, and between participants (e.g., different personality types). We can already say, for example, that music is both the most-studied intervention and the one that seems to have the most robust evidence behind it. As we get to know the literature better via the process described above, we’ll be able to identify these kinds of nuances with more precision.

Readers interested in the details behind the evidence in the article are encouraged to take a look at our capsule reviews on participatory arts for older adults, cultural arts and dementia, arts and early childhood, and arts and at-risk youth, all of which are based on in-depth literature and systematic reviews conducted by others and outline common methodological shortcomings and recommendations for future research. Of particular note is our capsule review on the Cultural Value Project (CVP), which shares the results of the UK-based Arts and Humanities Research Council’s three-year investigation into the value of culture. While the full bibliography to this article is far more extensive, our investigation relied heavily on the above sources.

Feelin’ Good: Physical and Mental Health

Of the four broad areas of arts impact that we identified in our review, the most robust research has taken place in the areas of education and personal development and physical and mental health. In fact, the evidence underlying the benefits of the arts for older adults is so compelling that we decided to write a whole separate article about it. A variety of participatory arts activities improve older adults’ mental and physical health, and in some cases, lessen the likelihood of developing dementia later in life. For instance, weekly singing has been shown to decrease anxiety and depression; weekly dance has been shown to improve cognition and attention, posture and balance, and hand and motor skills; and lifelong engagement with music, particularly playing an instrument, is correlated with improved memory among older adults. The arts also play a role in improving the overall quality of life for older adults more generally, such as attitudes toward social life.

While this was some of the most compelling evidence uncovered by our review, older adults aren’t the only beneficiaries. Arts therapies have been shown to improve clinical outcomes among patients. For example, a 2004 review of more than 400 pieces of literature exploring the arts’ and humanities’ relationship to healthcare and the arts’ effects on health identified a number of impacts for arts therapies. This includes visual art and music helping to reduce anxiety and depression among cancer patients undergoing chemotherapy, an association between music and reduction in anxiety and blood pressure in cardiovascular care, and reduction in use of pain medicine following surgery. Music tends to dominate these studies, with a generally positive effect on anxiety, stress, and pain reduction among patients. Another strain of studies has explored the related claim that visual art and design may help to improve the quality of healthcare settings, thus improving patient satisfaction and clinical outcomes. While the methodological quality of the evidence in this area is considerably weaker than that described above, initial results support the claim..

The arts may also generate health impacts beyond dedicated healthcare settings. We found that community arts activities probably contribute to healthy living habits and improved understanding of health. Using a mixed-methods approach that included a community-randomized design, an evaluation of 100 small participatory arts projects across impoverished parts of London found increases among participants in healthy eating, physical activity, and positive feelings. Similarly, a 2003 mixed-methods evaluation of the Wrekenton Lanterns Project, a community arts project drawing attention to coronary heart disease, suggested that arts activities contributed to healthy personal development, including healthy eating and mothering, mental health improvements, and increased absorption of health information. In the absence of longitudinal studies, however, it is difficult to know if participants sustained these habits over time.

The strongest and most consistent evidence for the health impacts of the arts relate specifically to mental health: in particular, reductions in depression and anxiety. It should come as no surprise, then, that arts participation is associated with subjective wellbeing, or one’s perceived quality of life. Over the past several decades, growing scholarship on wellbeing has sought to address just how well a person thinks they’re doing, with ongoing development of indicator systems that, in more recent years, have begun to incorporate measures related to arts, culture, and creativity. Createquity has been interested in the connection between arts participation and subjective wellbeing for some time. In our own analysis of data from the 2012 General Social Survey, we found no relationship between having attended an exhibit or performance in the past year and one’s satisfaction with life. However, a subsequent research spotlight revealed that among a large sample of Americans, more active forms of cultural participation including playing a musical instrument, gardening, and craft-making were positively associated with life satisfaction.

Our current review of the literature suggests that while causal attribution remains difficult to pin down, arts and cultural participation probably improves self-reported happiness or life satisfaction. A 2010 study of 1,500 randomly selected Italians analyzed two data sets on general wellbeing and cultural participation, yielding surprising results: cultural experiences – in this instance, passive modes of participation such as cinema, theatre, concert, and museum going – were the second most important determinant of psychological wellbeing, second only to the incidence of diseases, and ranking above factors like job, income, and education. And while not all arts participants are necessarily “doing well,” there is some evidence that unhappy people might be worse off it not for their cultural activities. For instance, a 2008 study of 1,124 choral singers in England, Germany, and Australia found that among respondents who scored on the lowest third of the psychological wellbeing scale, singing in a choir had a significant impact on their ability to cope with physical and mental health issues, among other personal challenges. There is some work being done to explore these issues in the US, but existing data sets on wellbeing and arts participation are not as easy to cross-reference. For instance, a 2014 study found an association between arts participation and wellbeing, but the study design made it difficult to determine if it was indeed attributed to arts participation and not other factors.

From Jungle Gyms to Jobs: Education and Personal Development

Although some of the strongest evidence we’ve come across speaks to the value of participatory arts for older adults, one doesn’t have to be a senior citizen, or for that matter even an adult at all, to benefit. On balance, the evidence suggests that the impact of arts and culture on psychological wellbeing is consistent across the lifespan, as far back even as early childhood.

A recent NEA literature review found ample evidence that arts participation in early childhood (birth to eight years) promotes social and emotional development. For example, a 2013 randomized controlled trial of 102 toddlers found that those participating in classroom-based music education were more likely to increase their level of social cooperation, interaction, and independence (as reported by their teachers) than a control group that did not receive a music education program. Similarly, a 2006 study of 40 preschoolers found that those that met with a dance group for eight weeks had stronger improvements in social skills and showed noticeable reductions in shy, anxious and aggressive behavior compared to a control group.

For slightly older kids, student participation in structured arts activities enhances cognitive abilities and social skills that support learning (e.g., memory, problem-solving, and communication). A 2010 systematic review of the Culture and Sport Evidence (CASE) database in the UK concluded that participation in “structured arts activities” could increase young people’s performance on a range of indicators of cognitive and social ability. Perhaps even more importantly, there is good reason to believe that arts education programs are disproportionately impactful for lower-income children. The NEA literature review on early childhood mentioned above includes a Head Start arts education experiment with 88 preschoolers from low socioeconomic status families. Those who participated in music activities showed improved cognitive abilities and increased ability to pay attention than children in the control group that received regular Head Start instruction. According to the NEA literature review, other specific benefits to lower-income youth include increases in confidence, student behavior and social skills. These findings are consistent with those from the well-known randomized controlled trial to measure the impact of field trips to the Crystal Bridges Museum of American Art. Benefits such as enhanced critical thinking skills and improved measures of tolerance were two or three times higher for children attending schools in rural areas or that served predominantly low-income households.

An earlier systematic literature review of 188 studies, the landmark 2001 Reviewing Education and the Arts Project (REAP) study, offers another perspective on the evidence base for non-arts academic outcomes of arts education. After comparing 275 effect sizes across groups of comparable studies, the researchers found strong causal evidence for the impact of music listening on spatial-temporal reasoning; learning to play music on spatial reasoning; and classroom drama instruction on verbal skills. However, the evidence was weaker in several other areas, including most effects on reading and math performance.

Indeed, one puzzle embedded in the extensive literature on arts education is how little the aforementioned benefits to learning and cognitive capabilities seem to translate to traditional measures of academic attainment such as standardized tests. Evidence from a wide body of literature suggests that even if there is a positive effect, it is so small as to be practically meaningless. The CASE systematic review cited above found that overall, participation in structured arts activities only improved attainment in high-school-aged students (as measured by standardized tests) by one to two percent. Similarly, a review from the Education Endowment Foundation in the UK concluded that arts participation had “positive but low” effects on academic learning in English, math, and science.

A major drawback within this literature is a lack of longitudinal studies. Short-term experimental designs that assign some students to an arts program and others to a control group are useful for isolating the effects of that particular program, but they usually only measure temporary effects on participants. Both the NEA’s early childhood literature review and the Cultural Value Project note the dearth of research that might isolate the long-term effects of arts participation in childhood over a lifetime.

Arts as Economic Engine, Sort of

In contrast to the health and educational literature described above, research on the economic and social impacts of the arts does not paint as straightforward a picture of benefit to society. In some cases this is because the available research simply is not very robust (unsurprising, given that measuring effects at a community level is far more difficult than doing so at an individual level); in others, it is because the evidence is conflicting, or the implications of it unclear.

Arguably the most convincing case to be made here is that cultural assets (organizations, venues, etc.) probably contribute to higher real estate values at a neighborhood level, but this insight is complicated by questions around the potential negative impacts of gentrification. For instance, a 2013 study on how cultural districts reshape neighborhoods found evidence that cultural districts “have significant impacts on property values,” although the evidence of effects on poverty, education, and families was weaker. A 2006 case study of MASS MoCA and its surrounding neighborhood in rural Massachusetts found significant increases in property values following the opening of the contemporary art museum. Similarly, between 2006 and 2008, a multi-pronged investigation by Mark Stern and Susan Seifert’s Social Impact of the Arts Project (SIAP) revealed a relationship between concentrated cultural assets and rising real estate values. It remains unclear, however, whether this effect generates benefits for existing, non-property-owning residents, like rising income levels or job prospects, or alternatively, brings potential harm through disruption of existing population dynamics. Perhaps surprisingly, there is a general lack of evidence that the arts contribute to concrete negative neighborhood revitalization impacts like displacement, but little attention has been devoted to “fuzzier” outcomes like feeling a loss of ownership.

Another common type of research in cultural economics is the much-touted (and much-criticized) economic impact study. If you work in the arts, chances are you’ve seen a press release at some point in the past decade announcing that the arts generate some large dollar amount in revenue and impressive number of jobs in your community. Claims of this nature may be true in a literal sense, but are usually far less meaningful than they first appear. Sure, the arts industry creates jobs, but so does literally every other industry. The more relevant question is this: “do the arts spur spending in the economy that wouldn’t have happened otherwise?” Evidence for that more ambitious proposal is mixed. For example, a review of 36 studies by the UK-based What Works Centre for Local Economic Growth found that the effects of large-scale facilities on local employment are limited at best; however, the review included both cultural and sports facilities, and was heavily weighted toward the latter.

Speaking of employment, one of the few studies that examines the longer-term effects of arts and cultural participation suggests that cultural participation may contribute to capacity for innovation within the workforce. In an analysis of the 1979 National Longitudinal Survey of Youth, Laura Niemi compared more than 7,000 Americans’ history of arts participation as children to their career history as adults. Niemi found a strong association between interest in the visual arts in adolescence and later innovation and entrepreneurship, which held true even when controlling for personality traits associated with innovation (like a willingness to take risks) and educational attainment. Family income, however, was not tested as a control factor.

If the arts help produce more innovative individuals, it stands to reason that the presence of arts and cultural activities and creative industries in a region may contribute to increased productivity and innovation in other industries in that region. For example, a 2015 empirical study of 2,000 creative enterprises in Austria found evidence to support three theories for how creative industries affect an economy’s overall innovation performance: being a major source of innovative ideas, products and services; offering services that lend themselves to innovative activities in other enterprises; and using new technologies to encourage further development in tech production. Do creative industries similarly make a region wealthier? Maybe: a 2011 study examining the relationship between manufacturing, service, and creative industry agglomerations and the wealth of 250 European regions found that for every percent increase in employment in the creative industries, there is a little over a half-percent increase in GDP. As with much of this literature, though, including that seeking to test Richard Florida’s hypothesis that creative industries draw talented workers and employers to a region and increase wealth that way, causation and correlation are difficult to tease out.

Come Together: On the Arts and Social Cohesion

The state of the evidence is even muddier when it comes to the impact of the arts on the social fabric between and among communities. As with economic vitality, evidence in this arena suffers from a lack of experimental and quasi-experimental designs that would help us better understand the social benefits of the arts. However, much of the difficulty is also rooted in the theoretical complexities that complicate coming to a shared definition of terms in this area. Social benefits of the arts have been described by many names, including social capital, social wellbeing, social inclusion, arts for social change, and more. We even struggled with what label to use to describe benefits in this area, and consider “social cohesion” to be a preliminary designation.

One of the better-studied research topics in this area is the relationship between participation in the arts and pro-social or civic behaviors like voting, volunteering, or attending community meetings. A 2014 Arts Council England evidence review found “growing evidence that children and young people’s engagement with arts and culture has a knock-on impact on their wider social and civic participation.” More specifically, based on British and American systematic reviews, high school students who participate in the arts “are twice as likely to volunteer than those that don’t…and 20 percent more likely to vote as young adults.” However, the major problem with research of this nature is that it does not test the very plausible counter-hypothesis that a common personality trait or set of values drives both arts engagement and civic behavior. Experimental work in this area would be extremely valuable for answering that question.

What about the relationship between arts assets and indicators of social wellbeing at a neighborhood level? The best work on this front has been conducted by SIAP’s Stern and Seifert, who attempted in a recent project to analyze multiple dimensions of economic and social wellbeing in Philadelphia. Their investigation, however, failed to find correlations between cultural assets and most indicators of social wellbeing after controlling for race and economic vitality, casting significant doubt on this effect.

Can the arts help increase trust and understanding between people of different backgrounds through dialogue or creating spaces for storytelling? In the United States, Animating Democracy and SIAP have both conducted qualitative and descriptive research into this phenomenon. However, the literature is almost entirely bereft of control groups, making it difficult to draw firm conclusions. One of the few exceptions is the aforementioned Crystal Bridges study on field trip attendance, which reported an increase in tolerance and “historical empathy” among students who attended the museum compared to students who didn’t. It’s difficult to know, however, how meaningful the proxy measure used in this study is in practice. Furthermore, one of the problems for this area of research is that it seemingly matters a lot what messages are being communicated through the artwork when it comes to building bridges across social divides, complicating attempts like this one to assess in general terms whether this type of intervention “works.”

What It All Adds Up To

Last year, Createquity explored the literature on wellbeing and quality of life in general, and noted that culture is often missing from frameworks that seek to capture a holistic definition of wellbeing. This investigation, and the ongoing work that will flow from it, demonstrates how and where the arts fit most naturally into such a framework.

• Arts participation contributes directly to quality of life by increasing self-reported happiness and life satisfaction. This is probably the case for the population in general, and is almost certainly true for the subset of that population that pursues sustained engagement in arts activities over time. In addition, robust effects of arts participation on reducing anxiety and depression have been demonstrated for people in healthcare settings and older adults, two potentially vulnerable populations. This research validates Createquity’s thematic focus on ensuring equitable access to opportunities to participate in the arts across society as a whole.
• Arts participation contributes indirectly to wellbeing via, at a minimum, its effects on education and personal development (particularly the development of emotional and social skills in early childhood, and the development of cognitive capabilities and communication skills in later childhood), and physical health (particularly in healthcare settings). Other indirect effects to wellbeing may exist as well, but the research is not yet at a place where these can be demonstrated conclusively.

This review likewise highlights where additional investments in research would be especially productive. Experimental and quasi-experimental designs are extremely rare in the research on the economic and social impacts of the arts; initiatives to fill this gap, though likely expensive and difficult to implement, would prove enormously helpful in resolving many of the causation vs. correlation conundrums that currently pervade this literature. Even in the health and education areas where these techniques are more common, however, there remains considerable room for further research and greater methodological ambition. There is a strong need in these areas for studies that examine the effects of arts participation over a long period of time, and for randomized controlled trials that use larger sample sizes.

As stated in the beginning of this article, both the research literature itself and our understanding of it are works in progress. We will continue to update and adjust the infographic describing benefits as new research comes to light in the months and years to come. As we learn more about how the arts benefit lives, the knowledge will inform our ongoing inquiry into the most important issues in the arts and what we can do about them.

• Singing improves mental health and subjective wellbeing (i.e., perceived quality of life)
• Taking dance classes bolsters cognition and motor skills, and even lessens the likelihood of developing dementia later in life
• Playing a musical instrument has myriad positive effects, including dementia risk reduction
• Visual arts practice generates increases in social engagement, psychological health and self-esteem

Just how the arts benefit society is one of the most studied topics in arts research, to the extent that multiple literature reviews, most notably the RAND Corporation’s decade-old landmark Gifts of the Muse, have sought to compile our collective knowledge on the subject. In recent years, several important initiatives and publications have added to this evidence base, including the final report earlier this year from the UK-based Arts and Humanities Research Council’s Cultural Value Project and National Endowment for the Arts’s 2011 literature review on the arts and human development. Over the past few months, Createquity has been reviewing these and other publications with an eye toward creating a continually-updated catalogue of demonstrated impacts for arts activities. What are all of the ways in which the arts contribute to or detract from wellbeing, and how strong is the evidence supporting each of those claims?

Our review of the literature addressing these questions yielded a surprising result: the most compelling evidence of the value of the arts revolves around improving the lives of older adults. Better understanding the relationship between the arts and aging may help to identify areas for improvement in future research into wellbeing, as well as opportunities for investing in the quality of life of older individuals.

Painter — photo by Flickr user M-n-M

The global population is aging in unprecedented numbers and living longer than ever. Between 1980 and 2010, a period marking most of millennials’ present lifetimes, the number of U.S. centenarians increased by nearly two-thirds! Longer lifespans bring immediate implications for many and eventual implications for us all, if we’re lucky. While extending the so-called golden years can be a blessing, challenges include deteriorating health, social isolation, loss of loved ones, and life transitions.

Fortunately, research shows that arts-related interventions can help (in some cases, more so than traditional Western medicine). In particular, there is substantial causal evidence that participatory arts activities help to maintain the health and quality of life of older adults. These benefits, detailed below, include improvements in cognitive and tactile abilities, subjective wellbeing, and dementia risk reduction (although the effects on managing dementia are less clear).

Jamming and Grooving Towards Better Health

The literature on the effects of participatory arts engagement within aging populations is significant not only for the breadth of demonstrated benefits to older adults, but also the relatively high quality of evidence supporting these claims.

Most of the literature we encountered involved making music, although a number were focused on dance. Music and movement activities (playing instruments, singing, dancing) have been shown to improve mental and physical health among older adults. In a randomized controlled trial of 212 British adults over the age of 60, those who participated in weekly singing groups over three months were found to have had improved mental health (decreased anxiety and depression) compared to those who didn’t. These health effects were mostly sustained over a period of at least three months after the weekly singing ended. By contrast, the positive effects of instrument playing do not always persist over the longer term following participation, unless participants have trained or practiced over an extended period of their lives. This might explain why lifelong engagement with music, particularly playing an instrument, is correlated with improved memory among older adults ─ and why some older musicians, like Herbie Hancock at a solid 76, still perform with as much gusto now as they did in their prime. Despite a smaller sample size, another randomized controlled trial of 35 adults aged 60 and over suggested health benefits of dance for older adults. Those who took weekly dance classes over a six-month period showed improved cognition and attention, posture and balance, and hand/motor skills like steadiness and aim in comparison to the control group.

Other research points to the role of the arts in improving overall quality of life for older adults more generally, such as attitudes toward social life. For example, an evaluation of a different, yearlong weekly singing program for adults aged 60 and over revealed marked improvements in emotional wellbeing, especially for those who had been widowed. A mixed-methods study of the effects of painting lessons among older adults in the same age range documented similar improvements in both mental health and social wellbeing. After having participated in these professionally conducted lessons, participants noted increases in social engagement, their sense of belonging, and self awareness and understanding. Likewise, a randomized controlled trial of 50 older adults who participated in 12 visual art sessions over a month showed improvements in self-esteem and anxiety reduction. No wonder your grandmother was always in a good mood after watercoloring class, treating you to ice cream when you picked her up!

Doses of Art to Stay Lucid?

Every 66 seconds, an American develops Alzheimer’s disease. It is the sixth leading cause of death in the United States, and kills more people than breast cancer and prostate cancer combined. As the population ages, millions will be affected: the number of Americans with the disease will double between 2015 and 2050. With soaring diagnoses come soaring costs ─ financial, emotional, and social ─ for patients and their caregivers. Establishment of accessible and cost-effective methods of delaying Alzheimer’s disease and other dementia-related illnesses is crucial.

A 21-year longitudinal study of 469 older adults aged 75 and over published in 2003 found that playing an instrument, reading, and playing board games were strongly associated with lower incidence of dementia. In fact, those who scored in the highest third on the study’s cognitive-activity scale had a 63 percent lower risk of dementia than those in the lowest third. Dancing was the only physical activity to show similar effects.

Arts engagement also seems to benefit older adults who already have dementia, providing improved communication, cognitive function, self-esteem and social participation. TimeSlips, a creative storytelling program for people with dementia, appears to promote engagement, alertness and social interaction among participating adults, as well as improved attitudes among caregivers towards their patients. On the other hand, a 2013 report from the National Endowment for the Arts cites a review of 24 studies that presents a more mixed picture of the evidence, with music interventions leading to both positive and negative outcomes for individuals in severe stages of dementia-related illness. It’s also important to note that methodological challenges abound in this area of research, including confounding external factors related to social context, interrelated variables, and inconsistent outcome measures, all of which makes drawing firm conclusions difficult.

In fact, a separate literature review by Tony Noice et al. notes similar shortcomings in a broader set of research on participatory arts for older adults. As a general rule, research on the benefits of the arts lags behind the level of rigor frequently encountered in the broader universe of scientific research. So while the evidence described above is quite strong by arts research standards, it nevertheless has limitations. Other opportunities for improvement, according to Noice et al., include introducing more standardized assessment of interventions across art forms and measuring effects over a longer period of time. Though the work to date has been promising, until studies on the effectiveness of arts interventions for older adults more consistently meet rigorous standards, their ability to shape perception of the value of such programs will remain limited.

Music has powers — photo by Flickr user Jinx McCombs

As mentioned earlier, we discovered this wealth of literature on arts and aging as part of a larger inquiry into the benefits of the arts in general. That inquiry, in turn, extends a longer-term initiative on Createquity’s part to reconcile the benefits of arts and culture with broader theories of wellbeing (or quality of life), such as the capability approach. Our next article will explore some of the other areas of benefit that have been claimed for arts participation, along with an assessment of the evidence backing up those claims.

In the meantime, rest assured knowing the older people in your life who participate in the arts are not just pursuing a silly pastime. For some, it might just be the key to a worry-free life or a still-taut mind ─ all the more reason to encourage them to channel their inner Aretha, Baryshnikov, or Picasso.