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Group singing fosters mental health and wellbeing: Findings from the East Kent "singing for health" network project


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Purpose This paper aims to describe the development and evaluation of an innovative community singing initiative with mental health services users and supporters in East Kent, UK. Design/methodology/approach A network of seven singing groups was established between September 2009 and June 2010. The choirs met weekly in three terms with breaks for Christmas and Easter, and joined together for two public performances in February and June 2010. In total, 137 participants were involved in the evaluation processes over this period. Of these, 42 provided complete data on the CORE questionnaire, a widely used clinical measure of mental distress, at baseline and eight months later. Findings Clinically significant improvements were observed in response to the CORE. These changes, together with qualitative feedback from participants, demonstrate that group singing can have substantial benefits in aiding the recovery of people with a history of serious and enduring mental health problems. A limited body of research has also shown that singing can be helpful for people with existing mental and physical health problems. Originality/value The research finds marked improvements in mental wellbeing on a clinically validated measure for people with a range of enduring mental health issues participating in a network of small choirs. Qualitative evidence indicates that group singing can offer a wide range of emotional and social benefits for mental health service users.
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Group singing fosters mental health and
wellbeing: findings from the East Kent
‘singing for health’ network project
Stephen Clift and Ian Morrison
Purpose This paper aims to describe the development and evaluation of an innovative community
singing initiative with mental health services users and supporters in East Kent, UK.
Design/methodology/approach A network of seven singing groups was established between
September 2009 and June 2010. The choirs met weekly in three terms with breaks for Christmas and Easter,
and joined together for two public performances in February and June 2010. In total, 137 participants were
involved in the evaluation processes over this period. Of these, 42 provided complete data on the CORE
questionnaire, a widely used clinical measure of mental distress, at baseline and eight months later.
Findings Clinically significant improvements were observed in response to the CORE. These
changes, together with qualitative feedback from participants, demonstrate that group singing can have
substantial benefits in aiding the recovery of people with a history of serious and enduring mental health
problems. A limited body of research has also shown that singing can be helpful for people with existing
mental and physical health problems.
Originality/value The research finds marked improvements in mental wellbeing on a clinically
validated measure for people with a range of enduring mental health issues participating in a network of
small choirs. Qualitative evidence indicates that group singing can offer a wide range of emotional and
social benefits for mental health service users.
Keywords Mental illness, Group singing, Recovery, Well being, Evaluation
Paper type Research paper
This paper reports on the development and evaluation of an innovative community singing
project in which a network of small choirs for mental health service users and supporters was
established in East Kent in September 2009 and ran until June 2010. Inspiration for the
project came from a small choir established in September 2007 at the Mustard Seed Centre
in Canterbury (a day centre providing services of people in need of support). The choir was
set up in late 2007 up by Elle Caldon, a service user with training in music and singing, and
came to be known as the ‘Mustard Seed Singers’ (Plate 1). An account of the development
of this choir, and two other mental health singing groups in other parts of England co-written
by service users, musicians and researchers has recently appeared in a fascinating volume
entitled Songs of Resilience (Clift et al., 2011).
The present authors joined the ‘Mustard Seed Singers’ in early 2008, and over the year had
discussions with Elle, other members of the choir and local mental health professionals
about the idea of promoting similar choirs across East Kent. We were fortunate to obtain
VOL. 15 NO. 2 2011, pp. 88-97, Q Emerald Group Publishing Limited, ISSN 2042-8308 DOI 10.1108/20428301111140930
Stephen Clift is a Professor
of Health Education and
Research Director.
Ian Morrison is a Senior
Researcher both at the
Sidney De Haan Research
Centre for Arts and Health,
Canterbury Christ Church
University, Canterbury, UK.
Thanks are due to Canterbury
Christ Church University,
Eastern and Coastal Kent
Primary Care Trust, the Roger
De Haan Charitable Trust, and
the South East Coastal
Communities Project for
funding and support which
made the East Kent ‘singing for
health’ project possible.
funding from the Eastern and Coastal Kent Primary Care Trust and the South East Coastal
Communities Project (a Higher Education Funding Council England initiative) to do this. The
‘Mustard Seed Singers’ played a key role in setting up the project, by giving performances
and running workshops in community venues providing support for mental health service
users. Practical assistance was also provided by East Kent health professionals in
occupational therapy and mental health promotion services, and staff of mental health day
services. A total of seven new choirs were established and these met for weekly rehearsals in
community centres for three terms under the direction of facilitators who received training
and support as part of the project. A common repertoire was agreed and songs were
learned by ear and sung without accompaniment. This approach made it possible to bring
the choirs together as a large chorus for public performances in February 2010 at the Astor
Theatre in Deal and in June 2010 at the Granville Theatre in Ramsgate (Plate 2).
Plate 1 The Mustard Seed Singers
Plate 2 The East Kent ‘Singing for Health’ Chorus at the Granville Theatre
VOL. 15 NO. 2 2011
The project was closely monitored and evaluated following the procedures described below
and some of the findings from this evaluation are reported here. In addition, a short film was
created based on the June 2010 performance. This paper should be read in conjunction with
this film, which communicates more graphically than any academic report, what was
achieved and the impact the project undoubtedly had on participants’ sense of mental
wellbeing and social inclusion (¼MIsoii8pxO4).
Research on singing, wellbeing and health
Systematic reviews of research on singing and wellbeing (Clift et al., 2008, 2010) have
revealed a relatively small and varied corpus of research. Of the studies reviewed, a number
stand out as particularly relevant to the question of whether group singing has a potential
role in aiding the recovery and social inclusion of people with mental health needs. Bailey
and Davidson (2002) have shown considerable wellbeing benefits from choral singing for a
small sample of homeless men and replicated these findings in further studies of singers in
choirs in disadvantaged and privileged communities. Two quasi-experimental studies have
also reported positive health impacts from group singing for elderly people using
standardised measures and objective indicators of wellbeing and health. Houston
et al.(1998) report improvements in levels of anxiety and depression in nursing home
residents, following a four-week programme of singing, and Cohen et al. (2006) found
improvements in both mental and physical health in a group of elderly people participating in
a community choir for one year.
Clift et al. (2010) report the largest study on choral singing and wellbeing undertaken to date.
Their cross-national survey took the WHO’s definition of health[1] as a starting point and
utilised the short form of the WHO quality of life questionnaire (WHOQOL-BREF)[2] to gather
data on 1,124 choral singers drawn from choirs in Australia, England and Germany. In
addition, singers completed a specially constructed 12-item ‘effects of choral singing
scale’’ and gave written accounts of the effects of choral singing on wellbeing and health in
response to open questions.
Clift et al. (2010) and Clift and Hancox (2010) examined written accounts of the effects of choral
singing on wellbeing given by participants with relatively low psychological wellbeing as
assessed by the WHOQOL-BREF, and high scores on the singing scale indicating a
strong-perceived impact of singing on a sense of personal wellbeing. A total of four categories
of significant personal and health challenges were disclosed by members of this group:
enduring mental health problems, family/relationship problems, physical health challenges and
recent bereavement, and in all cases, singing provided support in coping with such challenges.
To date, however, no research has examined the value of group singing for the recovery and
social inclusion of people with a history of serious and enduring mental health issues. The
project reported on here was an attempt to establish and evaluate a network of singing
groups using a validated and widely employed clinical assessment tool. To the best of the
authors’ knowledge, this project is unique and nothing like it has been attempted elsewhere.
A multi-method, longitudinal, observational design was adopted to monitor and evaluate this
initiative. Ethical approval was given by Canterbury Christ Church University. Participants
were invited to participate in the evaluation in November 2009 and completed
questionnaires towards the end of each term. They were also asked over the course of
the project to provide qualitative feedback on their experiences. The present paper focuses
on changes over an eight month period from the end of terms one to three.
Main outcome measure: CORE questionnaire
The CORE questionnaire[3] is widely used in clinical practice to assess the outcomes of
counselling and psychotherapy. It consists of 34 statements describing feelings and behaviours
related to mental distress, and respondents are asked to indicate how often they have felt or
VOL. 15 NO. 2 2011
behaved that way over the previous week on a five-point scale (Table II). The questionnaire is
scored by calculating the mean item rating and multiplying by ten, giving a scale from zero to 40 –
the CORE outcome measure (CORE-OM). A high score indicates mental distress. Sets of items
within the questionnaire relate to overall ‘subjective wellbeing’’, psychological ‘problems’’, daily
‘functioning’ and ‘‘risk’ to self and others and sub-scale scores can be derived, but should be
treated with caution (Lyne et al., 2006). The CORE-OM has excellent reliability and validity, and a
score of 10 has been established as a clinical cut-off point. Individuals scoring below 10 are
relatively ‘well’ and those scoring ten or above are ‘unwell’’. In addition, a change of five points
represents a reliable movement towards deterioration or improvements in wellbeing, and a
movement of five points over the cut-off value of 10 represents a change that is both reliable and
clinically significant (Connell et al., 2007; Gray and Mellor-Clark, 2007).
Given the non-normal distribution of item and summated scores on the CORE, Wilcoxon
signed rank tests were used to assess changes, with an alpha value of 0.05. The null
hypothesis was that no change will be observed in CORE-OM, sub-scales and individual
item responses over a period of eight months of engagement in choral singing.
The sample
Over the course of the first year, 137 people participated in the monitoring process and gave
feedback in the form of completed questionnaires and qualitative comments. Of these,
42 provided sufficiently complete data on the CORE towards the end of the first and third
terms (November 2009 and June 2010). This numerical difference is accounted for by the
following factors: people joining the project in terms two and three; people leaving the
project in term one; absence from sessions when questionnaires were distributed and
participants leaving items in the questionnaire unanswered.
The sample includes 31 females and 11 males. The average age of the total sample is 59.6
(SD ¼ 14.2), range 27-81 years, with no significant difference in age between men and women.
Changes in CORE-OM and sub-scales scores
Over the period of eight months the CORE-OM shows a high test-retest Spearman
correlation of 0.75 ( p , 0.001, one-tailed) supporting the reliability of the scale. Table I
reports the means for the CORE-OM and its component scales (wellbeing, problems,
functioning and risk) for November 2009 and June 2010, together with Wilcoxon Z-values.
There is clear evidence of a marked reduction in CORE values over a period of eight months.
The change seen for CORE-OM represents a moderate ‘effect size’ of 0.44.
Changes for individual items on the CORE questionnaire
In order to appreciate more clearly the character of reported mental distress, and the precise
nature of the changes observed over eight months, it is illuminating to consider responses to
Table I CORE-OM and sub-scale means (standard deviation) for November 2009 and June 2010
November 2009 June 2010 n Z
CORE-OM 9.43 (6.58) 6.85 (5.26) 42 2 3.47 0.001
Wellbeing 1.33 (0.88) 0.96 (0.74) 42 2 2.95 0.003
Problems 1.11 (0.87) 0.80 (0.65) 42 2 2.78 0.005
Functioning 1.03 (0.71) 0.74 (0.61) 42 2 3.00 0.003
Risk 0.19 (0.45) 0.15 (0.26) 42 2 0.24 ns
Based on Wilcoxon signed ranked test;
p-values are two-tailed
VOL. 15 NO. 2 2011
individual items on the CORE questionnaire. Means for each item for November 2009 and
June 2010 are given in Table II, together with Wilcoxon Z-values.
Individual patt erns of change over eight months
The data reported in Tables I and II are of interest in assessing the mean effects of
choral singing on wellbeing, but it is of greater interest to consider the changes observed for
each individual in the sample. Figure 1 shows the paired scores for each participant over
the eight months period of the evaluation. The horizontal and vertical dashed lines
represent the clinical cut-off value of 10; the solid diagonal line represents no change
and the upper and lower dashed lines indicate clinically significant deterioration and
improvement, respectively. The most striking pattern in these data is a general improvement
in CORE-OM scores, with 11 of the 42 participants showing a clinically significant
Table II CORE item means (SD) for November 2009 and June 2010 (following the order in the questionnaire)
Items November 2009 June 2010 N
1. I have felt terribly alone and isolated (F)
0.93 (1.17) 0.63 (0.99) 41 2 2.00 0.049
2. I have felt tense, anxious or nervous (P) 1.29 (1.21) 0.83 (1.05) 41 2 2.82 0.005
3. I have felt I have someone to turn to for support when
needed (F) 1.63 (1.55) 1.41 (1.50) 41 2 1.01 ns
4. I have felt OK about myself (W) 1.64 (1.50) 1.26 (1.48) 42 2 1.23 ns
5. I have felt totally lacking in energy and enthusiasm (P) 1.24 (1.24) 1.00 (1.03) 41 2 1.09 ns
6. I have been physically violent to others (R) 0.02 (0.15) 0.00 (0.00) 42 2 1.00 ns
7. I have felt able to cope when things go wrong (F) 1.20 (1.40) 1.00 (1.38) 41 2 0.78 ns
8. I have been troubled by aches and pains (P) 1.46 (1.23) 1.44 (1.10) 41 2 0.06 ns
9. I have thought of hurting myself (R) 0.36 (0.96) 0.17 (0.49) 42 2 1.29 ns
10. Talking to people has felt too much for me (F) 0.81 (1.04) 0.60 (0.99) 42 2 1.88 ns
11. Tension and anxiety have prevented me doing important
things (P) 0.83 (1.10) 0.52 (1.07) 42 2 1.39 ns
12. I have been happy with things I have done (F) 1.31 (1.30) 0.76 (1.23) 42 2 2.12 0.03
13. I have been disturbed by unwanted thoughts and
feelings (P) 1.02 (1.09) 0.64 (0.98) 42 2 2.86 0.004
14. I have felt like crying (W) 1.24 (1.12) 0.86 (0.90) 42 2 2.34 0.019
15. I have felt panic or terror (P) 0.61 (1.02) 0.41 (0.87) 41 2 1.10 ns
16. I have made plans to end my life (R) 0.12 (0.50) 0.07 (0.46) 42 2 0.54 ns
17. I have felt overwhelmed by my problems (W) 0.88 (1.13) 0.64 (1.10) 42 2 1.80 ns
18. I have had difficulty going to sleep or staying asleep (P) 1.27 (1.30) 1.00 (1.16) 41 2 1.58 ns
19. I have felt warmth or affection for someone (F) 0.98 (1.20) 0.86 (1.28) 42 2 0.83 ns
20. My problems have been impossible to put to one side (P) 1.12 (1.17) 0.88 (1.14) 41 2 1.60 ns
21. I have been able to do most things I needed to (F) 0.83 (1.29) 0.60 (1.13) 42 2 1.04 ns
22. I have threatened or intimidated by another person (R) 0.14 (0.42) 0.14 (0.47) 42 2 0.06 ns
23. I have felt despairing or hopeless (P) 0.81 (1.17) 0.50 (0.86) 42 2 3.13 0.002
24. I have thought it would be better if I were dead (R) 0.33 (0.82) 0.24 (0.69) 42 2 0.95 ns
25. I have felt criticised by other people (F) 1.17 (1.15) 0.60 (0.86) 42 2 2.61 0.009
26. I have thought I have no friends (F) 0.59 (1.00) 0.37 (0.77) 41 2 1.71 ns
27. I have felt unhappy (P) 1.26 (1.19) 0.88 (0.83) 42 2 2.37 0.018
28. Unwanted memories have been distressing me (P) 1.19 (1.15) 0.64 (0.98) 42 2 2.82 0.005
29. I have been irritable with other people (F) 1.00 (1.01) 0.74 (0.77) 42 2 1.67 ns
30. I have thought I am to blame for my problems (P) 1.21 (1.16) 0.93 (1.11) 42 2 1.90 ns
31. I have felt optimistic about my future (W) 1.57 (1.40) 1.10 (1.25) 42 2 2.15 0.031
32. I have achieved things I wanted to (F) 1.32 (1.13) 0.95 (1.00) 41 2 1.98 0.048
33. I have felt humiliated or shamed by other people (F) 0.64 (0.91) 0.24 (0.53) 42 2 2.83 0.005
34. I have hurt myself physically (R) 0.17 (0.70) 0.31 (1.05) 42 2 0.69 ns
N varies due to missing values for some items;
based on Wilcoxon signed ranked test;
p-values are two-tailed;
initials indicate
the sub-scale: W, wellbeing; P, problems; F, functioning; R, risk
VOL. 15 NO. 2 2011
The sample
The sex and age characteristics of the 42 participants 26 per cent men and 74 per cent of
women, with an overall average age of 59.6 is remarkably similar to the findings from the
large-scale cross-national survey of choral singers reported by Clift and Hancox (2010). The
age range is also very wide, from late 20s to early 80s; which means that the choirs span
three or four generations and can be considered strongly ‘‘inter-generational’’ in character.
The choirs were also very socially diverse, in terms of educational levels, literacy and
employment history, although information on these characteristics was not formally
Changes in CORE-OM and sub-scales scores
Table I shows that a statistically significant improvement in CORE-OM scores occurred over
this period with an effect size of 0.44, which is generally considered to be ‘moderate’’. It
should be remembered, however, that the sample considered here is very diverse. It
includes not only people with current mental health issues, but also individuals in recovery
from previous serious periods of mental ill-health, some friends/family supporters and also
one mental health promotion specialist, all of whom gave CORE-OM scores below the
clinical cut-off point. An effect size of 0.44, for the sample as a whole, therefore, almost
certainly underestimates the strength of the impact of group singing for people above the
clinical cut-off point.
Statistically significant changes are also found for three sub-scales within the CORE
questionnaire: wellbeing, problems and functioning, suggesting that group singing helps to
create movement and improvements in all three areas equally. The risk scale, however,
showed no change, but this is clearly due to the fact that risk scores were very low. Although
we know that a few individuals who were part of the project did have a history of self-harming
Figure 1 Individual CORE-OM scores in November 2009 and June 2010 (n ¼ 42)
0.00 5.00 10.00 15.00 20.00
CORE-OM November 2009
CORE-OM June 2010
25.00 30.00
VOL. 15 NO. 2 2011
behaviour, and there was at least one person who, during the course of the evaluation was
seriously suicidal, very few people reported any risk behaviours or feelings towards
themselves or others.
Changes for individual items on the CORE questionnaire
In total, 11 out of 34 items show significant changes indicating that participants have
responded to the CORE questionnaire in a discriminating way with positive changes on
some items, but no significant change on others. Not surprisingly, given the lack of change
on the risk sub-scale, none of the risk items show significant changes. There are, however,
striking improvements on five ‘functioning’ items. Three indicate improved relationships
with others: ‘I have felt terribly alone and isolated’’, ‘‘I have felt humiliated or shamed by
other people’’ and ‘I have felt criticised by other people’’; and two suggest a greater sense
of accomplishment: ‘I have been happy with things I have done’ and ‘‘I have achieved
things I wanted to’’. These items are interesting in pointing to social acceptance and
achievement as central resources offered by participation in choral singing. Five ‘problem’
items and two ‘wellbeing’’ items also show significant changes. Three of the problem items
vary in intensity, but all point towards an improved sense of emotional wellbeing: ‘I have felt
despairing or hopeless’’, ‘‘I have felt tense, anxious or nervous’’, and ‘I have felt unhappy’’;
and this is supported by a positive change in one of the wellbeing items: ‘I have felt like
crying’’. Two further problem items are interesting in suggesting that participants were
less-troubled by negative thoughts and feelings: ‘I have been disturbed by unwanted
thoughts and feelings’ and ‘unwanted memories have been distressing me’’, which
suggests that participation in choral singing may have helped to provide a different focus for
attention and provided distraction from otherwise troubling ideas (Clift and Hancox, 2010).
Finally, one wellbeing item shows an improved sense of future-orientation: ‘I have felt
optimistic about my future’’.
Individual patt erns of change
Figure 1 shows a general improvement in CORE-OM scores on an individual level, with 11
out of 42 participants showing a clinically significant improvement. This indicates that for
those individuals who engaged in the project over the course of a year, the intervention was
invariably positive (i.e. singing does no harm). However, this effect may be exaggerated
given that people who left may well have been those who did not gain benefits. Efforts were
made to contact people who joined the project and then stopped coming, but resource
constraints meant that detailed follow up was not possible. The upper right-hand quadrant of
the graph is of interest here as out of the five individuals, only one shows a clinically
significant improvement, although they remain above the clinical cut-off point. The remaining
four appear to be remarkably stable in their levels of mental distress, and it is clear that the
choral project served to maintain their involvement despite a lack of apparent improvements
in measured wellbeing.
Personal accounts of involvement and its effects
At three points during the project, members of choirs were asked to provide written
feedback about the effects of their involvement in group singing. These accounts provide
invaluable personal testimonies, which often provide insights into the ways in which singing
can be beneficial on an individual level given each person’s unique experiences,
circumstances and problems. The accounts given here are from individuals in three groups
that can be found in Figure 1: those who have scores below 10 on both occasions
‘well-well’’; those who score above 10 initially and below 10 on follow-up ‘unwell-well’’,
and those whose scores remain above 10 ‘unwell-unwell’’. The change in CORE-OM
scores is given below each account.
VOL. 15 NO. 2 2011
Karen was relatively ‘well’ on both occasions of assessment with CORE, but clearly
identified herself as having an on-going mental difficulty:
I have bipolar disorder [. . .] When I am depressed, singing in the group and coming together with
other people lifts my mood and gives me something positive and productive to focus on.
When I am manic, singing is something I can channel my extra energy into and express my
enthusiasm for life through. The choir provides structure and purpose in an otherwise sometimes
empty life [. . .] The group reminds me that there are many people with difficulties of one kind or
another. We can understand each other’s problems and support one another (Karen, 30,
CORE-OM scores 9 to 4).
Elisabeth, also with bipolar disorder shows a clear movement from being above the clinical
cut-off point to being below it:
It helps me to structure my week, to have something to keep going for. I enjoy meeting all types of
people. It has been very good to meet new people who have experiences similar to my own.
If I feel I might have a panic attack, I know how to breathe properly which helps. I would have very
little reason to leave the house if I wasn’t doing choirs (Elisabeth, 27, CORE-OM 28 to 9).
Margaret provides invaluable insights into how the singing project managed to maintain her
engagement despite on-going difficulties with depression:
Music is a very important therapeutic and enjoyment factor in my life. The singing group has
meant that I have been actively involved for once rather than in the audience and it’s been a
valuable experience. I find any group situation hard and testing. To share and experience music
with a group has enabled me to overcome some of the barriers I would usually feel. I have
managed to attend singing on several occasions when feeling extremely stressed. I found to my
surprise and delight that it did indeed not only provide a distraction but transformed my mood. I
have been reminded that I am often my own worst enemy and refuse to do things through fear of
failure (Margaret, 53, CORE-OM 24 to 27).
Limitations of the evaluation and further research directions
The most obvious limitation of the evaluation reported here is that it is uncontrolled, and
further research is warranted to compare involvement in group singing with other forms of
social intervention and usual treatment controls. In addition, we were not in a position to
consider medical histories and the extent to which participants were currently on medication
or in receipt of counselling or psychotherapy. Clearly, there is a need to investigate the
relative merits of social interventions of this kind compared with the use of anti-depressants
and psychological therapies.
The future of the ‘singing for health’ network
The Primary Care Trust was approached early in 2010 with a request to continue to support
the network for a further year, but they were unable to do so, given their financial situation.
Fortunately, the Roger De Haan Charitable Trust agreed in September 2010 to provide
funding to allow the network to restart in September 2010 and to run until July 2011, when a
public performance event will take place. We expect the choirs to grow in size with new
members, and we will continue to monitor and evaluate the project closely.
1. ‘Health is a state of complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity’ WHO (1946).
VOL. 15 NO. 2 2011
2. The WHOQOL-BREF is the short form of a quality of life questionnaire constructed by the World
Health Organization Quality of Life project on the basis of a large-scale international collaborative
project (
3. See for details of the development and use of the CORE
questionnaire in clinical services.
Bailey, B.A. and Davidson, J.W. (2002), ‘Adaptive characteristics of group singing: perceptions from
members of a choir for homeless men’’, Musicae Scientiae, Vol. 6 No. 2, pp. 221-56.
Clift, S. and Hancox, G. (2010), ‘The significance of choral singing for sustaining psychological
wellbeing: findings from a survey of choristers in England, Australia and Germany’’, Music Performance
Research, Vol. 3 No. 1, pp. 79-96, available at:
Clift, S., Hancox, G., Staricoff, R. and Whitmore, C. (2008), Singing and Health: A Systematic Mapping
and Review of Non-clinical Research, Canterbury Christ Church University, Canterbury.
Clift, S., Morrison, I., Vella-Burrows, T. and Hancox, G. (2011), ‘‘Singing for mental health and wellbeing:
community initiatives in England’’, in Brader, A. (Ed.), Songs of Resilience, Cambridge Scholars Press,
Clift, S., Hancox, G., Morrison, I., Hess, B., Kreutz, G. and Stewart, D. (2010), ‘Choral singing and
psychological wellbeing: quantitative and qualitative findings from English choirs in a cross-national
survey’’, Journal of Applied Arts and Health, Vol. 1 No. 1, pp. 19-34.
Cohen, G.D., Perlstein, S., Chapline, J., Kelly, J., Firth, K.M. and Simmoens, S. (2006), ‘‘The impact of
professionally conducted cultural programs on the physical health, mental health, and social functioning
of older adults’’, The Gerontologist, Vol. 46 No. 6, pp. 726-34.
Connell, J., Barkham, M., Stiles, W.B., Twigg, E., Singleton, N., Evans, O. and Miles, J.N. (2007),
‘Distribution of CORE-OM scores in a general population, clinical cut-off points, and comparison with
the CIS-R’’, British Journal of Psychiatry, Vol. 190 No. 1, pp. 69-74.
Gray, P. and Mellor-Clark, J. (Eds) (2007), CORE: A Decade of Development, CORE IMS, Rugby,
available at:
Houston, D.M., McKee, K.J., Carroll, L. and Marsh, H. (1998), ‘Using humour to promote psychological
wellbeing in residential homes for older people’’, Aging and Mental Health, Vol. 2 No. 4, pp. 328-32.
Lyne, K.J., Barrett, P., Evans, C. and Barkham, M. (2006), ‘‘Dimensions of variation on the CORE-OM’’,
British Journal of Clinical Psychology, Vol. 45 No. 2, pp. 185-203.
WHO (1946), Preamble to the Constitution of the World Health Organization as adopted by the International
Health Conference, New York, NY, 19-22 June, 1946; Signed on 22 July 1946 by the Representatives of
61 States (Official Records of the World Health Organization, No. 2, p. 100) and Entered into Force on 7 April
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Further reading
Bailey, B.A. and Davidson, J.W. (2005), ‘Effects of group singing and performance for marginalized and
middle-class singers’’, Psychology of Music, Vol. 33 No. 3, pp. 269-303.
Barkham, M., Culverwell, A., Spindler, K., Twigg, E. and Connell, J. (2005), ‘‘The CORE-OM in an older
adult population: psychometric status, acceptability, and feasibility’’, Ageing and Mental Health, Vol. 9,
pp. 235-45.
Cheung, K., Oemar, M., Oppe, M. and Rabin, R. (2010), User Guide: Basic Information on How to Use
the EQ-5D, Version 3, The EuroQol Group, Rotterdam, available at:
Clift, S. (2010), ‘Singing for health: a musical remedy’’, British Journal of Wellbeing, Vol. 1 No. 6,
pp. 19-21.
Clift, S., Nicols, J., Raisbeck, M., Whitmore, C. and Morrison, I. (2010), ‘‘Group singing, wellbeing and
health: a systematic mapping of research’’, UNESCO Journal, Vol. 2 No. 1, pp. 1-25, available at: www.
VOL. 15 NO. 2 2011
About the authors
Stephen Clift is a Professor of Health Education and Research Director at the Sidney
De Haan Research Centre for Arts and Health, Canterbury Christ Church University.
Stephen Clift is the corresponding author and can be contacted at: stephen.clift@canter-
Ian Morrison is a Senior Researcher at the Sidney De Haan Research Centre for Arts and
Health, Canterbury Christ Church University.
VOL. 15 NO. 2 2011
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... However, some studies did not provide age information (n = 5; 11%) or did not provide a maximum age (n = 5; 11%). A few studies included mixed age groups, such as adolescents to middle-aged adults [29,30], and young adults to older adults [31][32][33]. ...
... Well-being promotion was reported as an activity goal in 23 studies (51%), including improving quality of life. Goals related to social support and social well-being were shown in 17 studies (38%), such as supporting social inclusion and social engagement [30,31,38,54,65,67], promoting relationship and social interaction [33,37,51,52,54], and supporting community [34,56,64]. Health improvement, including both physical and mental health, was reported in 14 studies (31%). ...
... Among the 18 studies (40%) that specified activity strategies, 14 studies (31%) used strategies to minimize difficulties that could prevent participants from engaging in music activities, such as lyric sheets and song books [43,45,48,59,60,67], learning songs by ear [31,41,71], and tailoring the music piece [41,54,60,64] or music activities [29,37,53] to the participants' musical ability. Interestingly, few studies indicated strategies that structured the music piece according to participants' psychological needs, such as singing in unison to avoid feeling anxious [43] or providing harmony parts for social support [54]. ...
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The benefits of community music activities for promoting well-being have been well recognized in previous literature. However, due to their wide variability and flexible approaches, a comprehensive understanding of the research and practice of community music activities for well-being promotion is sparse. The purpose of this scoping review was to synthesize published literature pertaining to community music activities for well-being promotion and identify key implementation characteristics and strategies to inform future practice and research. Studies of community music activities that investigated well-being outcomes in participants of all ages and conditions were eligible for inclusion. Through electronic database and manual searches, a total of 45 studies were identified and included in the analysis. The main findings showed that community music activities for well-being were characterized by a wide range of populations and applications, collaborative work, an emphasis on social components, and musical accomplishments. However, this variability also revealed a lack of consistent and thorough information as well as diversity in well-being conception across studies. The review offers practical recommendations for future research and practice based on the current findings.
... Recent publications have highlighted the potential of community-based art interventions for mental and physical well-being [14,15]. Group singing, in particular, is evidenced to assist recovery in adults with serious mental illness [16] and is associated with increased social bonding [17]. In the UK, new mothers frequently engage in community group activities with their infants. ...
... Primary postnatal depressive symptoms outcome We first compared total scores on the EPDS between baseline (pre-intervention) and week 6 (end of intervention), as this was the secondary outcome of the study. Mothers experienced a significant reduction in their total EPDS score, from 16 . These results indicate that the mothers' depressive symptoms steadily reduced throughout the intervention to week 6 and that this reduction remained all the way through to 6 months post-intervention (that is, from week 6 to week 32). ...
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Background Postnatal depression (PND) affects over 12% of mothers, with numbers rising during COVID-19. Singing groups can support mothers with PND; however, online delivery has never been evaluated. SHAPER-PNDO, a single-arm clinical trial, evaluated the feasibility, clinical efficacy, and well-being outcomes of a 6-week online version of Breathe Melodies for Mums (M4M) singing intervention developed for mothers with PND during COVID-19 lockdowns. Methods The primary objective of this study was to assess the feasibility of a group online singing intervention for new mothers with postnatal depression. This was ascertained through recruitment rates, study retention rates, attendance rates to the singing sessions, and study completion rates. The secondary objective of the study was to assess the clinical efficacy and well-being outcomes of the singing intervention. Specifically, we measured change in Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Office for National Statistics Wellbeing Scale (ONS) scores from baseline to end-of-intervention (week 6); follow-up assessments were completed at weeks 3, 16, and 32. Mothers were eligible if they scored ≥10 on the baseline EPDS. Results Eighty-seven percent of the 37 recruited mothers completed the study, attending, on average, 5 of the 6 group singing sessions. With regard to secondary outcomes, at end-of-treatment, mothers experienced significant reductions in depression (EPDS, 16.6 ± 3.7 to 11.2 ± 5.3, 95% CI [0.79,1.65]), anxiety (STAI-S, 48.4 ± 27.1 to 41.7 ± 26.8, 95% CI [4.96, 17.65]) and stress (PSS, 29.0 ± 5.7 to 19.7 ± 5.3, 95% CI [1.33, 7.07]); and, furthermore, significant improvements in life satisfaction (ONS, 50.5 ± 23.0 to 72.8 ± 11.7, 95% CI [− 39.86, − 4.64]) and feelings of worthwhileness (ONS, 51.7 ± 30.4 to 78.6 ± 15.1, 95% CI [− 52.79, − 0.85]). Reduction on the EPDS correlated with a reduction on the BDI and the STAI-S and maternal childhood maltreatment was predictive of a smaller treatment response. Conclusions M4M online was feasible to mothers who partook in the programme. Furthermore, M4M online supports the mental health and well-being of new mothers experiencing PND, especially when barriers to in-person treatment are present. Trial registration NCT04857593. Registered 22 April 2021, retrospectively registered;
... The choir discourses have evolved widely from using singing techniques to achieve certain choral sound quality to the social and psychological benefits of choir singing amongst singers and the conductor. Much contemporary research focuses on how choir as musical group activity be potential to provide a safe space in terms of socialization and inclusion for refugees (Marie Schuff, 2014), homeless men (Bailey & Davidson, 2002), marginalized singers (Bailey & Davidson, 2005), homosexuals (Latimer, 2008), disadvantaged people (Dingle et al., 2013), also people with mental health disorders (Clift & Morrison, 2011). This musical group activity is also claimed to be explicitly beneficial for psychological well-being (Boldt, 2015;Clift et al., 2010;Clift & Morrison, 2011;Livesey et al., 2012) Further, the happiness and socio-emotional wellbeing also happened to adults participating in choir that is related to the activity and individual's motivation (Maury et al., 2022). ...
... Much contemporary research focuses on how choir as musical group activity be potential to provide a safe space in terms of socialization and inclusion for refugees (Marie Schuff, 2014), homeless men (Bailey & Davidson, 2002), marginalized singers (Bailey & Davidson, 2005), homosexuals (Latimer, 2008), disadvantaged people (Dingle et al., 2013), also people with mental health disorders (Clift & Morrison, 2011). This musical group activity is also claimed to be explicitly beneficial for psychological well-being (Boldt, 2015;Clift et al., 2010;Clift & Morrison, 2011;Livesey et al., 2012) Further, the happiness and socio-emotional wellbeing also happened to adults participating in choir that is related to the activity and individual's motivation (Maury et al., 2022). The idea of a choir as a place of social interaction is also highlighted by research focusing on social skills enhancement through choir and musical group activity. ...
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The pandemic has forced choir practitioners and enthusiasts to shift from in-person rehearsal and performance to online and virtual choir performance. The virtual choir is seen as an alternative to choir activity during the pandemic. However, it also generates another concern related to its inclination to reduce the role of the conductor, singers, and social interaction in achieving musical targets and enhance the so-called social skills, empathy. The study employs two conductors in an in-depth interview to understand the condition and dynamics of online rehearsal and virtual choir performance. The exploration of the data emphasized three important themes: (1) the role of virtual choir to choir continuity, (2) the impact of virtual choir technology in reducing individuals’ role, and (3) the absence of in-person social interaction in empathy enhancement. Paduan Suara Virtual: Bernyanyi bersama, seorang diri Abstrak Pandemi memaksa praktisi dan penggemar paduan suara untuk beralih dari latihan dan penampilan live menjadi skema latihan online dan pertunjukan virtual. Paduan suara virtual dipandang sebagai alternatif untuk tetap menjalankan aktivitas paduan suara di kala pandemi. Namun, paduan suara virtual juga memunculkan keprihatikan dan perhatian khusus terkait kecenderungan untuk mereduksi peran konduktor, penyanyi, dan interaksi sosial dalam mencapai target musikal dan juga peningkatan keterampilan sosial, salah satunya empati. Penelitian ini berupa wawancara terfokus pada dua konduktor paduan suara yang bertujuan untuk menggali pemahaman terkait kondisi dan dinamika latihan daring dan pertunjukan paduan suara virtual. Hasil ekspolasi data dan analisis menunjukkan tiga tema penting yakni (1) peran paduan suara virtual untuk keberlanjutan aktivitas paduan suara, (2) dampak teknologi yang digunakan dalam paduan suara virtual terhadap reduksi peran humanis, dan (3) ketiadaan interaksi interpersonal secara langsung dan dampaknya terhadap peningkatan empati.
... Many studies have shown singing in particular to have a significant impact on individual wellbeing. Mental health service users who participated in a weekly singing group showed clinically significant improvements on a CORE questionnaire (a commonly used measure of mental distress) after 8 months as compared to their baseline level (Clift & Morrison, 2011). Qualitative feedback alongside this demonstrated that the act of regularly singing in a group can have notable benefits towards helping those with a history of mental health problems. ...
Technical Report
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Blyth Tall Ship offers a programme of heritage skills courses entitled ‘Learning the Ropes’. These include: traditional woodworking, Gansey knitting, shanty singing, knots and splices (ropework), sewing with sailcloth, seamanship and archiving skills. The research team were asked to develop and implement an evaluation programme which would capture the impact of these courses in terms of individual and community wellbeing. This was done in two phases: Phase 1, trialling tools, ran from January 2022 to December 2022; Phase 2, data gathering, ran from January 2023 to August 2023.
... Choral activity is a social group founded in the arts that promotes physical and mental health through an organic combination of social interaction, music listening, and group singing (Clift & Morrison, 2011). However, many choral ensembles are affiliated with non-profit social organizations. ...
Under the background of the new era, chorus, as one of the central projects of social activities, has accomplished the diversification of the participating groups, in particular the founding of the social choir with the elderly group as its core. Singing, as one of the forms of communication, can not only obtain entertainment, but also improve the experiencer's health. The choir acts as a comprehensive group of musical activities. To achieve a balance between "entertainment" and "healthy aging," the quality of choir music education must be enhanced, and a scientific music education system must be established.Consequently, this paper investigates six amateur choirs in Heilongjiang Province through a questionnaire survey, investigates and analyzes the current situation of music education for amateur choirs in Heilongjiang Province, and offers practical recommendations for the construction of a choral art education system. It is discovered that a comprehensive and scientific system of music education can be created by constructing teaching and research departments, curriculum, and instructional personnel.
... The choir has been seen as a social place for many social groups, such as refugees (Schuff, 2014), disadvantaged people (Dingle et al., 2013), homosexuals (Latimer, 2008), people with mental health disorders (Clift & Morrison, 2011), and homeless people (Bailey & Davidson, 2002). Those researches showed the characteristic of a choir as a place to socialize where individuals feel accepted, be involved in a social environment, and not be stereotyped negatively. ...
Conference Paper
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Conventionally, choir as a group activity has its dynamics through interpersonal interaction. In many studies, even interpersonal interaction became the main focus in examining social skill enhancement. The 2020 pandemic has forced our choir society to move from in-person interaction into one that includes telecommunication media massively. The idea of media changing brought up the broad known concept of a virtual choir with its problematic terms and processes. This practice's pros and cons arise in tension, purpose, and perspective. The present study would like to portray the interpersonal interaction in a choir that has the potential to enhance empathy as a social skill and how the concept of the virtual choir proposed a different perspective to this world of empathy. Through an in-depth interview of choir conductors this study compares the form and role of empathy in the traditional choir and the virtual one. It also tries to explain the hole of interpersonal interaction in the virtual choir and predict its effect on the singer inside the group. It is showed that virtual choir and online rehearsal scheme is potent in maintain choir continuity and give alternative of flexible rehearsal. Meanwhile, in terms of learning materials dan social interaction many things is missing such as the ability to build advance musical achivement and choral sound together, the chance of building sense of team, and the collective energy that foster empathic ability.
... 6. Health promotion: the work of Harris and Caporella (2014), a clear source of inspiration for our research, involved university students, patients with early-stage dementia and their families. From the latter, a group of projects were also reviewed where singing improved transfer situations between caregivers and mentally ill patients, improving the quality of life of both (Camic et al., 2013;Clift, & Morrison, 2011;Götell et al., 2012). ...
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Esta investigación diseña, aplica y evalúa un proyecto de Aprendizaje Servicio (ApS) de canto coral intergeneracional (alumnado de Educación Secundaria y mayores de una residencia de tercera edad en una primera propuesta) para estudiar su efecto en cuestiones de aprendizaje y calidad de vida. La metodología cualitativa, mediante la investigación-acción, plantea dicho estudio a través de la réplica del proyecto inicial en cuatro centros durante dos años consecutivos. Tras el tratamiento de datos y el análisis de resultados, afloran temas recurrentes en todas las personas que participaron. Se evidencia la pertinencia del canto coral en la Educación Secundaria como elemento clave para el desarrollo emocional y personal del alumnado adolescente, la práctica educativa del ApS como facilitadora de esta actividad, el enriquecimiento que supone la relación intergeneracional y los beneficios personales, profesionales y sociales que aporta el proyecto.
... 6. Promoción a la salud: en el trabajo de Harris y Caporella (2014), clara fuente de inspiración en nuestra investigación, participaron estudiantes universitarios, pacientes con demencia en etapa temprana y sus familiares. Desde este último ámbito, se revisaron también un grupo de proyectos donde el canto mejoraba situaciones de transferencia entre cuidadores y enfermos con enfermedades mentales, mejorando la calidad de vida de ambos (Camic, Williams y Meeten, 2013;Clift y Morrison, 2011;Götell, Thunborg, Söderlund y Heideken Wågert, 2012). ...
... Group singing has been shown to have mental health benefits (Clift and Morrison, 2011;Dubinsky et al., 2017;Pullinger, 2020). Unfortunately, transgender people experience exclusion from formal singing due to implicit biases surrounding perceived voice-body mismatches (Janssen, 2018;Eidsheim andWhelden, 2019/2021;Pullinger, 2020) and this also affects cisgender singers whose voices fall outside the traditional women with high voice and small body versus men with low voice and large body dichotomy. ...
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Introduction A singer’s or speaker’s Fach (voice type) should be appraised based on acoustic cues characterizing their voice. Instead, in practice, it is often influenced by the individual’s physical appearance. This is especially distressful for transgender people who may be excluded from formal singing because of perceived mismatch between their voice and appearance. To eventually break down these visual biases, we need a better understanding of the conditions under which they occur. Specifically, we hypothesized that trans listeners (not actors) would be better able to resist such biases, relative to cis listeners, precisely because they would be more aware of appearance-voice dissociations. Methods In an online study, 85 cisgender and 81 transgender participants were presented with 18 different actors singing or speaking short sentences. These actors covered six voice categories from high/bright (traditionally feminine) to low/dark (traditionally masculine) voices: namely soprano, mezzo-soprano (referred to henceforth as mezzo), contralto (referred to henceforth as alto), tenor, baritone, and bass. Every participant provided voice type ratings for (1) Audio-only (A) stimuli to get an unbiased estimate of a given actor’s voice type, (2) Video-only (V) stimuli to get an estimate of the strength of the bias itself, and (3) combined Audio-Visual (AV) stimuli to see how much visual cues would affect the evaluation of the audio. Results Results demonstrated that visual biases are not subtle and hold across the entire scale, shifting voice appraisal by about a third of the distance between adjacent voice types (for example, a third of the bass-to-baritone distance). This shift was 30% smaller for trans than for cis listeners, confirming our main hypothesis. This pattern was largely similar whether actors sung or spoke, though singing overall led to more feminine/high/bright ratings. Conclusion This study is one of the first demonstrations that transgender listeners are in fact better judges of a singer’s or speaker’s voice type because they are better able to separate the actors’ voice from their appearance, a finding that opens exciting avenues to fight more generally against implicit (or sometimes explicit) biases in voice appraisal.
... Singing requires controlled voice production with controlled respiration, and physical, psychological, and social benefits have been reported from group and solo singing [8,10,11]. In general, singing involves holding the correct posture, executing a short, deep inspiration while contracting the diaphragm, and maintaining prolonged expiration. ...
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(1) Background: Individuals with pulmonary disease need intensive and consistent rehabilitation due to their high risk for serious illness and long-term complications. The purpose of this scoping review was to provide a comprehensive analysis of relevant research regarding the use of singing in pulmonary rehabilitation. (2) Methods: A systematic literature search was performed using the PsycINFO, CINAHL, PubMed, and Web of Science databases. A search for studies that employed singing in pulmonary rehabilitation for patients with pulmonary disease was conducted. (3) Results: Studies that met the selection criteria were summarized and analyzed. Twenty-seven studies were included in the final analysis. Results showed that research using singing in pulmonary rehabilitation generally employed an intervention with structured tasks and additional home practice or socialization time. However, the singing procedure in each intervention was not always specifically described and the findings were inconsistent. (4) Conclusions: Programmed singing interventions can support lung health and be an effective component of pulmonary rehabilitation. The therapeutic singing method in relation to respiratory exercises should be integrated into the main activity in the intervention. Overall, singing has physical and psychosocial effects, leading to improvements in symptoms, but more research is necessary to ensure that the respiratory needs of people with pulmonary disease are adequately met.
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This paper provides a systematic mapping of existing research literature on group singing, wellbeing and health. It covers both community singing groups, groups especially established for research purposes and group singing used as a music therapy intervention for conditions such as chronic lung disease, Parkinson's disease and dementias. A systematic approach to identifying published research in English from 1985 served to identify 51 papers reporting on 48 studies worldwide. Given the developing nature of the field, no selection was made within the research identified on the basis of a quality screen and no attempt was made to synthesise findings as this would be premature. Studies were categorised into four groups and details of objectives, context, sample, methods and findings are reported in tabular form. Most studies were conducted in English speaking and Nordic countries and reported from 2000 onwards. There is evidence of increased research interest in this field over the last ten years. However, many studies are small scale and exploratory, with only a few large-scale surveys or well-designed experimental studies. The diversity and variations in quality of the research corpus makes it difficult
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In western society music performance is generally considered from the perspective of the elite performer, and the performance literature within the psychology of music has been representative of this preoccupation. But, in spite of much attention being directed to the 'how' of creating exceptional performances, little attention has been given to the 'why' of performance. Results of an investigation with members of a choir for homeless men indicated that group singing and performance, at the most amateur levels of musicality, yielded considerable emotional, social and cognitive benefits. The present article further explores the effects of group singing and performance with (a) a second choir formed for homeless and other marginalized individuals who had little or no music training or group singing experience, and (b) middle-class singers with low to high levels of music training and choral singing experience. Results indicate that the emotional effects of participation in group singing are similar regardless of training or socioeconomic status, but the interpersonal and cognitive components of the choral experience have different meanings for the marginalized and middle-class singers. Whereas the marginalized individuals appear to embrace all aspects of the group singing experience, the middle-class choristers are inhibited by prevalent social expectations of musicianship. The outcomes may be of relevance to music educators, therapists and choral conductors who wish to create a choral environment in which the benefits of singing and performance override elitist concerns. Copyright
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The impact of a structured humorous activity on the psychological wellbeing of older people in residential settings was assessed. Residents who participated in the humorous activity were found to have significantly reduced levels of anxiety, as measured by the General Health Questionnaire, and significantly reduced levels of anxiety and depression, as measured by the Hospital Anxiety and Depression Scale, when compared to residents who received no intervention.
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Over 600 choral singers drawn from English choirs completed the WHOQOL-BREF questionnaire to measure physical, psychological, social and environmental wellbeing, and a twelve-item wellbeing and choral singing scale. They also provided accounts of the effects of choral singing on quality of life, wellbeing and physical health in response to open questions. High average scores were found on all WHOQOL-BREF scales, and a high degree of consensus emerged on the positive benefits of choral singing. A significant sex difference was found on the choral singing scale, with women endorsing the wellbeing effects of singing more strongly than men. This finding replicates the earlier result reported by Clift & Hancox (2001) in a pilot study with a single choral society. Low correlations were found between the WHOQOL-BREF psychological wellbeing scale and perceptions of wellbeing associated with singing. However, examination of written accounts to open questions from participants with relatively low psychological wellbeing and strong perceptions of positive benefits associated with choral singing served to identify four categories of significant personal and health challenges. They also revealed six generative mechanisms by which singing may impact on wellbeing and health.
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There is a need to extend and test the feasibility and acceptability of mental health outcome measures in the older population (i.e., aged 65-100). We present data on the CORE-OM (Clinical Outcomes in Routine Evaluation-Outcome Measure) on a sample of 118 people aged 65-97 presenting for mental health treatment and 214 people aged 65-94 drawn from a non-clinical population. Results show the CORE-OM to be a reliable measure in both samples when the overall mean item is used but the reliability is not as high for the specific domains as psychometrically stable structures. The CORE-OM showed large overall differences between the non-clinical and clinical samples indicating that it is equally as sensitive to these differing populations across this older age band as with working-age adults. However, the norms for the clinical sample were consistently lower than the equivalent clinical norms for a working-age sample. These findings suggest that the collection and compilation of age-specific norms is crucial in ensuring that appropriately referenced norms are used rather than assuming that norms are generalizable across the whole adult life-span.
Stephen Clift examines findings from the Sidney De Haan Research Centre which suggest that the arts—such as music—can have a positive influence on mental and physical wellbeing
There is considerable evidence to suggest that music has adaptive characteristics. Individuals use recorded music to transform the emotional landscape to coincide with transitory needs and desires. Also, music has frequently been reported to provoke uncommon emotional and physical reactions often referred to as peak experiences. In many cultures, that have limited industrial and technological development, active participation in musical activities is pervasive and all individuals are considered musical. In contrast, the musical elitism that has evolved in the Western world intimates that musical ability is specific to a talented minority. The elitist notion of musicality restricts the majority to procurers of rather than producers of music. However, experimental and theoretical sources indicate that music is an innate and universal ability and, therefore, active participation in music may have adaptive characteristics at many levels of proficiency. Positive life transformations that occurred for members of a choir for homeless men, since joining the choir, provided an opportunity to determine if group singing was a factor in promoting adaptive behaviour. A phenomenological approach utilizing a semi-structured interview wasemployed to explore the choristers' group singing experience. Analysis of the interviews indicated that group singing appears positively to influence emotional, social and cognitive processes. The choristers' perceptions of the adaptive characteristics of group singing fell within four principal categories: clinical-type benefits, benefits derived from audience-choir reciprocity, benefits associated with group process and benefits related tomental engagement. Active participation in singing may act to alleviate depression, increase self-esteem, improve social interaction skills and induce cognitive stimulation. The themes adhere to the tenets of flow theory which advocate the importance of mental stimulation and social interaction in increased life satisfaction. The emergent themes provide a preliminary basis for the development of a theory of the adaptive characteristics of group singing and also provide a framework for further investigation in this area.
The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a self-report measure comprising 28 items tapping three domains; subjective well-being, psychological problems and functioning. In addition to the potential theoretical value of the domains for operationalizing the phase model of psychotherapy, when consulted, managers and clinicians considered the distinction between problems and functioning important for assessing case-mix and clinical outcomes. A further domain comprising six items was included to indicate possible risk. Subsequent analysis has suggested an alternative structure for CORE-OM with factors for risk and positively and negatively worded items (Evans et al., 2002). This study compares models for the interpersonal factor structure in data from the CORE-OM in 2,140 patients receiving psychological therapy in the UK. A multi-method, multi-trait, nested factors solution accounted optimally for the CORE-OM item covariance, with a first-order general factor latent and residualized first-order factors of subjective well-being, psychological problems, functioning and risk and with positively and negatively worded methods factors. The general factor was labelled psychological distress. Scale quality for CORE-OM, using a scoring method in which non-risk items are treated as a single scale and risk items as a second scale is satisfactory. The CORE-OM has a complex factor structure and may be best scored as 2 scales for risk and psychological distress. The distinct measurement of psychological problems and functioning is problematic, partly because many patients receiving out-patient psychological therapies and counselling services function relatively well in comparison with patients receiving general psychiatric services. In addition, a clear distinction between self-report scales for these variables is overshadowed by their common variance with a general factor for psychological distress. An alternative strategy for operationalizing this distinction is proposed.