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Music Therapy as Group Singing improves Geriatric Depression Scale Score and Loneliness in Institutionalized Geriatric Adults with Mild Depression: A Randomized Controlled Study

  • Chennai School of Music Therapy


Aims: This study was conducted with an aim to evaluate the effect of group music therapy in the form of group singing, led by a music therapist, on depressive symptoms and loneliness in institutionalized geriatric individuals having mild depression. Settings and Design: The study was conducted as a randomized control trial at St. Mary′s Home for the aged, Cuddalore, Tamil Nadu. The study was conducted as a randomized control trial. Subjects and Methods: The experiment group (n = 40) received daily music therapy in the form of group singing lead by a music therapist for 3 weeks. The control group (n = 40) did not receive any specific intervention. Baseline and weekly Geriatric Depression Scale-Short Form (GDS-SF) and UCLA Loneliness Scale scores were recorded in both groups. Statistical Analysis Used : Measures of Central Tendency, Mann-Whitney U-test, and Wilcoxon W value. Results: Statistically significant improvement (P < 0.05) was seen in both the scores at the end of 3 weeks in the experiment group as compared to the control group. On intragroup comparison, both scores showed statistically significant improvement (P < 0.001) in the experiment group at the end of 3 weeks as compared to baseline but not in the control group. No adverse event was reported. Conclusions: Group singing significantly improves GDS-SF scores and loneliness in institutionalized geriatric adults having mild depression at the end of 3 weeks. Further research in this area is desirable which could contribute to the well-being of the aged population.
Journal of
Educational &
Psychological Researches
Official Publication of
Islamic Azad University Isfahan(Khorasgan) Branch
VOL. 3 | Issue 1 | January-March 2017
ISSN 0000-0000
VOL. 1 | Issue 2 | April-June 2015
© 2017 International Journal of Educational and Psychological Researches | Published by Wolters Kluwer - Medknow
Music therapy as group singing improves
Geriatric Depression Scale score and loneliness
in institutionalized geriatric adults with mild
depression: A randomized controlled study
Divya Mathew, Sumathy Sundar1, Easwaran Subramaniam2, Parin N. Parmar1
Chennai School of Music Therapy, Chennai, Tamil Nadu, 1Center for Music Therapy Education and Research, Mahatma Gandhi Medical College
and Research Institute, 2Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
Depression is a common geriatric problem. The prevalence
of depression in the elderly population is estimated to be
as high as 20% by some researchers.[1]
Clinical spectrum of geriatric depression is broad as it
includes many subtypes of depression.[2] Characteristic
symptoms of depression include feelings of worthlessness
or guilt, changes in sleep (insomnia or hypersomnolence),
changes in appetite (anorexia or hyperphagia),
psychomotor retardation or irritability, low self‑esteem,
and suicidal thoughts. In addition to symptoms of
depression, comorbidities such as heart diseases,
diabetes mellitus, stroke, Alzheimer’s dementia, cancer,
Parkinsonism, and bone fractures are also common in
geriatric depression.[2,3] The severity of depression can
vary from mild to severe.
Aims: This study was conducted with an aim to evaluate the effect of group music therapy in
the form of group singing, led by a music therapist, on depressive symptoms and loneliness in
institutionalized geriatric individuals having mild depression. Settings and Design: The study was
conducted as a randomized control trial at St. Mary’s Home for the aged, Cuddalore, Tamil Nadu.
The study was conducted as a randomized control trial. Subjects and Methods: The experiment
group (n = 40) received daily music therapy in the form of group singing lead by a music therapist for
3 weeks. The control group (n=40)didnotreceiveanyspecicintervention.Baselineandweekly
Geriatric Depression Scale‑Short Form (GDS‑SF) and UCLA Loneliness Scale scores were recorded
in both groups. Statistical Analysis Used: Measures of Central Tendency, Mann–Whitney U‑test,
and Wilcoxon W value. Results: Statisticallysignicant improvement(P < 0.05) was seen in both
the scores at the end of 3 weeks in the experiment group as compared to the control group. On
intragroupcomparison,bothscoresshowedstatisticallysignicantimprovement(P < 0.001) in the
experiment group at the end of 3 weeks as compared to baseline but not in the control group. No
adverse event was reported. Conclusions: GroupsingingsignicantlyimprovesGDS‑SFscoresand
loneliness in institutionalized geriatric adults having mild depression at the end of 3 weeks. Further
research in this area is desirable which could contribute to the well‑being of the aged population.
Key words: Complementary therapies, depression, depressive disorder, geriatric psychiatry,
music therapy
Address for Correspondence:
Dr. Sumathy Sundar,
Center for Music Therapy Education
and Research, Mahatma Gandhi
Medical College and Research
Institute, Pondy‑Cuddalore Road,
Puducherry ‑ 607 402, India.
Original Article
How to cite this article: Mathew D, Sundar S, Subramaniam E, Parmar
PN. Music therapy as group singing improves Geriatric Depression
Scale score and loneliness in institutionalized geriatric adults with mild
depression: A randomized controlled study. Int J Educ Psychol Res
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Mathew, et al.: Effect of music therapy as group singing on geriatric adults with mild depression
International Journal of Educational and Psychological Researches / Vol 3 / Issue 1 / January-March 2017 7
Music therapy has wide applications in geriatrics
including but not limited to depression, dementia,
Parkinsonism, etc.[4‑6] Conventional management of
geriatric depression consists of antidepressant drugs,
psychotherapy, or combination of both. However, the
side effects of antidepressant medications, multiple
drug interactions (which are more common in elderly
population), and economic burden are important concerns
with conventional management. Various techniques of
music therapy such as receptive music therapy, singing,
instrument playing, songwriting, and group music therapy
have been explored for elderly persons with depression.
However, there are only a few studies evaluating the
effect of group music therapy in institutionalized geriatric
Loneliness is significantly related to geriatric depression;
lonelier elderly have been reported to score higher on
Geriatric Depression Scale‑Short Form (GDS‑SF).[7] A lower
level of perceived emotional togetherness in a common
feature in both loneliness and depression.[8] Group singing
is a music therapy technique that improves social and
emotional bonding among individuals. In a study, group
singing has been shown to promote a faster bonding
among a group of unrelated individuals due to “ice‑breaker
effect.”[9] Considering the potential relationship between
institutionalized elderly persons, geriatric depression, and
loneliness, we conducted this study to evaluate the effect of
group music therapy in the form of group singing, led by
a music therapist, in institutional elderly persons having
mild depression.
Subjects and Methods
The study was conducted from June 10, 2015, to August
31, 2015, at St. Mary’s Home for the aged, Cuddalore,
Tamil Nadu, India. The design of the study was that of
a randomized control trial having experimental (n = 40)
and control groups (n = 40); total number of subjects
being eighty. The study was approved by the Institutional
Human Ethics Committee, Mahatma Gandhi Medical
College and Research Institute (MGMCRI), Puducherry,
vide letter reference no. PG DISSERTATION/2015/05
dated June 5, 2015.
The study included men and women above 65 years
having mild depression and staying at St. Mary’s Home
for the aged. Mild depression was defined as GDS‑SF[10]
score between 5 and 8. Individuals on antidepressive
medications, medications, or any other medications
affecting sleep or mood disorders, having depression with
psychotic features, having depression secondary to organic
disorders, and requiring cognitive behavioral therapy,
with hearing problems and unable to comprehend/follow
verbal instructions were excluded. Psychiatric assessment
and application of GDS were done by a psychiatrist from
Department of Psychiatry, MGMCRI, Puducherry.
Eighty subjects fulfilled the inclusion and exclusion
criteria. They were divided into experimental (n = 40)
and control (n = 40) groups by randomization by drawing
lots. Written informed consent was obtained from all the
subjects for participation in the study.
Subjects in the experimental group participated in group
singing activity conducted by one of the researchers, who
is also a music therapist. The group singing activity was
performed every day for three consecutive weeks. Duration
of each session was 30 min. Each session began with the
theme (1) de‑stressing and energizing. The other themes
were (2) self‑expression, (3) sharing and bonding, and
(4) managing emotions. In de‑stressing and energizing
theme, the researcher collected the favorite songs of
the group as a whole and initiated the singing sessions
and encouraged all the group participants to sing the
songs together, along clapping the hands and varying
the tempos gradually during a single session. Most of the
songs used were Tamil devotional songs and Bhajans.
In self‑expression, each member of the group chose
their most favorite song which they sang while playing
simple percussion instruments and also discussed with
the group why they liked that particular song. In sharing
and bonding, all the participants learned the favorite
songs of others in the group and sang together in the
group, and each participant shared his/her feelings while
singing the favorite songs of the other participants. In
managing emotions theme, the group participants sang
songs with body percussion and movements using hands
giving vent to their emotions. During each session, singing
was initiated by the music therapist researcher and the
subjects were encouraged to sing along and perform simple
movements using hands depending on the theme. The
control group received no specific intervention.
Baseline and weekly assessments of the subjects in both
groups were done using GDS‑SF[10] and UCLA Loneliness
Scale (version 3)[11] for severity of depression and loneliness,
respectively. The music therapist researcher was trained for
1 week by the Department of Psychiatry, MGMCRI, for
application of these scales to subjects. If the deterioration
in the psychological status of any subject was found during
the study, provision was made for prompt referral of
him/her to a psychiatrist for evaluation and management.
Statistical analysis of collected data was done by using
Mann–Whitney U‑test and Wilcoxon W value.
Mathew, et al.: Effect of music therapy as group singing on geriatric adults with mild depression
International Journal of Educational and Psychological Researches / Vol 3 / Issue 1 / January-March 2017
Total eighty subjects were included in the study. Both
the experiment group and control group consisted of
forty subjects each. All subjects were above 65 years.
Each of the both groups comprised twenty males and
twenty females.
Comparison of GDS scores and UCLA Loneliness Scale
scores in both groups at the baseline and at the end of
1st, 2nd, and 3rd week are shown in Table 1.
In the intergroup comparison, GDS‑SF scores showed
continued improvement over 3 weeks in the experiment
group; the improvement being statistically significant
at end of 1st, 2nd, and 3rd week as compared to the
control group [Table 2]. Within the experiment group,
improvement in GDS‑SF scores at the end of 3 weeks
was also statistically significant (Chi‑square 52.70491,
P < 0.001). The control group showed no significant
improvement at the end of 3 weeks as compared to the
baseline (Chi‑square 1.82, P = 0.61).
As compared to the control group, UCLA Loneliness
Scale scores showed no statistically significant
improvement during initial 2 weeks in the experiment
group, but the improvement at the end of 3 weeks
was statistically significant at the end of the
3rd week [Table 2]. In the intragroup comparison,
UCLA Loneliness Scale scores in the experiment group
showed statistically significant improvement at the end
of 3 weeks as compared to baseline (Chi‑square 27.46,
P < 0.001); while the control group showed no
improvement at the end of 3 weeks (Chi‑square 0.0039,
P = 0.9999).
In our study, there is a significant improvement in
GDS‑SF scores in the experiment group as compared to
control group at the end of 3 weeks. This is consistent
with results of other studies that have shown that music
therapy is useful in depressive disorders, including geriatric
Music has multiple and complex effects on the brain,
involving different areas of the brain and several neural
networks, involving but not limited to frontal lobe,
parietal lobe, temporal lobe, limbic system, thalami, basal
ganglia, cerebellum, and other specific areas.[16] Music
therapy improves mood in depression by modulating
various, known and unknown, neurobiological activities
Table1: Comparison of Geriatric Depression Scale‑Short
Form scores and UCLA Loneliness Scale scores for
experiment and control groups
Experiment group Control group
Mean SD Median Mean SD Median
GDS‑SF scores
Baseline 7. 8 1.137 88 . 13 0.883 8
End of 1st week 6.92 1.095 7 7.82 1.059 8
End of 2nd week 6.32 0.829 68 .1 0.9 8
End of 3rd week 5.88 0.516 6 8.1 0.9 8
UCLA loneliness
scale scores
Baseline 41.35 3.556 41 38.93 2.526 39.5
End of 1st week 38.62 3.635 38.5 38.9 2.56 39
End of 2nd week 38.08 3.269 38 38.93 2.586 39
End of 3rd week 37.45 2.66 38 38.93 2.586 39
GDS‑SF: Geriatric Depression Scale‑ Short Form, SD: Standard deviation
Table2: Comparison of mean ranks of Geriatric Depression Scale‑Short Form and UCLA Loneliness Scale scores at the
baseline and at the end of 3weeks in both groups
Experimental Control Mann-Whitney
Wilcoxon W Z P
Mean rank Sum of ranks Median Mean rank Sum of ranks Median
GDS‑SF scores 37.58 1503 8 43.42 1737 8 683.0 1503.0 1.184 0.236
UCLA Loneliness
Scale scores
48.56 1942.5 41 32.44 1297.5 39.5 477.5 1297.5 1.12 6 0.302
End of 1st week
GDS‑SF scores 32.05 1282 7 48.95 1958 8 462.0 1282.0 −3.355 0.001*
UCLA Loneliness
Scale scores
39 1560 38.5 42 1680 39 740.0 1560.0 −0.580 0.562
End of 2nd week
GDS‑SF scores 24.15 966 6 56.85 2274 8 146.0 966.0 −6.476 0.000*
UCLA Loneliness
Scale scores
3 7.15 1486 38 43.85 1754 39 666.0 1486.0 −1.298 0.194
End of 3rd week
GDS‑SF scores 21.35 854 6 59.65 2386 8 34.0 854.0 −7.648 0.000*
UCLA Loneliness
Scale scores
34.46 1378.5 38 46.54 1861.5 39 558.5 1378.5 −2.341 0.019*
*P<0.05 is statistically significant. GDS‑SF: Geriatric Depression Scale‑ Short Form, SD: Standard deviation
Mathew, et al.: Effect of music therapy as group singing on geriatric adults with mild depression
International Journal of Educational and Psychological Researches / Vol 3 / Issue 1 / January-March 2017 9
in the brain. Antidepressive effects of music therapy
are believed to be mediated by the influence of music
on the central neural serotonergic transmission and
hippocampal brain‑derived neurotrophic factor levels, but
other mechanisms are also possible.[16]
The spectrum of music therapy approaches toward geriatric
depression is broad. Active forms of music therapy
include singing including group singing, movement
therapy, instrument playing, songwriting, etc., Active
techniques help the patients to get connected with a
therapist or other people, to articulate difficult feelings,
and to enhance their own emotional awareness. In
passive (receptive) techniques, music can act as a form
of nonverbal communication and helps the patient to
relax, to reduce stress and anxiety, to ventilate suppressed
emotions, to improve sleep quality, and to improve mood
and sense of well‑being.
Singing as a music therapy has many beneficial effects
on psychology and emotional well‑being. Choir singing
has been shown to improve symptoms of depression
significantly in depressed elderly persons.[14] Apart
from relaxation benefits, active participation in choir
singing also improves many aspects of health including
emotional status, immunity, well‑being, social, and
spiritual aspects.[17,18] Singing has many positive effects
on respiratory and cardiovascular physiology, as well as
on some common geriatric neurological disorders such
as Parkinson’s disease and aphasia.[19] Thus, the positive
effect of group singing on geriatric depression seems to
be multifactorial.
Although UCLA loneliness scores for subjects in the
experiment group showed the beginning of improvement
from the 1st week, statistically significant improvement
was seen at the end of 3 weeks. This can be partly
explained by initial resistance in getting involved in group
singing activity, experienced by some of the subjects.
Moreover, it takes time to develop social and emotional
bonding among individuals in a group explaining the
delayed effect on loneliness. Although group music
therapy has many positive social and psychological
effects, we did not come across a study specifically
exploring the effect of group singing on loneliness in
geriatric depression.
There was no drop out from either of groups. No adverse
event was reported due to music therapy intervention.
Standard and validated tools were used in our study to
measure the objectives. The short version of GDS used in
our study adequately substitutes the long form of GDS.[20]
UCLA Loneliness Scale is also a validated tool with
acceptable internal consistency reliability.[21] An important
limitation is the absence of a placebo intervention in
the control group which was not feasible considering
methodology of our study involving a group intervention
in a community setup.
Financial support and sponsorship
Conicts of interest
There are no conflicts of interest.
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... This result is more effective than standard intervention of nursing home care (IbraheemSayied et al., 2019). In other study by Sakamoto in India (Mathew, Sundar, Subramaniam, & Parmar, 2017), the merger between music therapy with other activities such as dancing and singing was also proven effective to decrease the level of depression in the elderly. Several published studies have revealed the benefits of therapy in depression. ...
... The majority of researchers present music in accordance with participants' wishes, on the other hand, some researchers also prepared a type of music to be the choice of the elderly, such as Chinese music, Buddhist spiritual music, active and passive music (Tai et al., 2015) (Cooke, Moyle, Shum, Harrison, & Murfield, 2010). Some types of music therapy also use religious music as an intervention and also combine with some other interventions such as writing lyrics (Kalapala et al., 2017), with therapists or independently (Karmonik et al., 2016), listening passively and actively (clapping, singing, dancing) (Liu, Niu, Feng, & Liu, 2014;Mathew et al., 2017;Petrovsky et al., 2015;Kendra D. Ray & Götell, 2018). ...
... The use of music therapy is effective and does not cause side effects in the elderly such as the use of sedatives (Liu et al., 2014). Using music therapy as prescribed can reduce some symptoms, such as depression, and can increase the life expectancy of the elderly (Mathew et al., 2017). The use of music therapy should be recommended for health workers, especially nurses or healthcare workers with the elderly (Karmonik et al., 2016). ...
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Introduction: There are many non-pharmacological therapies in reducing symptoms of depression in older adult, one of which is music therapy. The aim of this article is to determine the effectiveness of the use of music therapy in reducing symptoms of depression in the elderly.Methods: A systematic approach was performed in this review using the PRISMA approach and journal sources from several databases including Scopus, ScienceDirect, SAGE, NCBI, CINAHL/EBSCO in the last 6 years from 2014 to 2019. Boolean operators were used within search process using AND and OR. The inclusion criteria are elderly aged ≥60 years with depression, either home or hospital treatment. Exclusion criteria are additional physical illness such as Diabetes Mellitus, CVA and other chronic diseases. Literature review, editorial, critical synthesis, and the like also become an exclusion criteria in this review.Results: Overall, the review consists of 13 articles with seven articles using RCT design, two quasi-experimental design, two pre-posttest design, and two exploratory design. In this review, several articles used an individual therapy and others a combination of music therapy with other activities such as singing, dancing and writing a lyric. Average time spent for a music therapy in elderly with depression was given from two weeks to six months, which may have been effective in making an impact. Every week had one or two sessions with a duration of30-60 minutes for every session.Conclusion: Music therapy is effective to reduce depression in the elderly.
... Nine of the fifteen trials were conducted in Asia, i.e. Hong Kong, 29,30 Taiwan, 31,36 Singapore, 37,43 India, 38 Japan, 39 and Turkey 33 ( Table 1). The remaining six trials were conducted in Australia, 42 France, 34 Italy, 41 Spain, 40 UK, 32 and the US. ...
... 31,33,40,41 Other settings include: Day care centers, 29,41 community singing clubs, 32 veterans' homes, 36 a community research center, 37 therapy room, 39 and aged care facility. 42 More than half (9 out of 15) of the included trials studied the effects of active music therapy, 31,32,36,[38][39][40][41][42][43] whereas receptive music therapy and music medicine were studied in three 33,35,37 and four trials, 29,30,34,41 respectively. It should be noted that a trial by Raglio et al 41 was a 3-arms RCT that studied the effects of active and receptive music therapy. ...
... The majority of included trials (10 out of 15) were studied in older adults with mild depression (527 participants). 29,30,[33][34][35][36]38,[41][42][43] Three trials 32,37,40 were studied in 423 older adults with an average normal level of depression; and one trial each were studied in older adults with major depression, 31 and not reported baseline level of depression among participants. 39 ...
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Background The effect of different music interventions on depression in older adults is varied. We aimed to explore the comparative effect of different music intervention features on depression in older adults. Methods We searched PubMed, EMBASE, CENTRAL, CINAHL, and ProQuest Dissertations&Theses from inception to October 2021 for randomized controlled trials (RCTs) of music interventions in participants aged ≥60 years. Music interventions were classified based on the TIP (theme, intensity, and provider/platform) framework. The theme was divided into: 1) active music therapy (ACT); 2) receptive music therapy (Recep); and 3) music medicine (MM). The intensity was classified as high (>60 minutes/week), and low (≤60 minutes/week). The provider was classified as a music therapist (MT) or a non-music therapist (NonMT). Summary standardized mean differences (SMD) of level of depression with 95% confidence interval (CI) were estimated using a frequentist framework with a random-effects model. The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) approach. This study was registered with PROSPERO (CRD42021247165). Findings Fifteen RCTs involving 1,144 older adults (mean age 67.9-86.6 years) were included. When compared with usual care, the most effective music intervention was active music therapy >60 minutes/week by music therapist (Act/High/MT) (SMD -3.00; 95%CI, -3.64,-2.35), followed by music medicine >60 minutes/week by non-music therapist (MM/High/NonMT) (SMD -2.06; 95%CI, -2.78,-1.35) with moderate and high certainty of evidence, respectively. Depression scores in older adults treated with ACT/High/MT was also significantly lower than all other interventions, except MM/High/NonMT. Low intensity music interventions other than Act/Low/MT had no impact on depression. Interpretation Although active music therapy >60 minutes/week by music therapist is the most effective intervention to alleviate depression in older adults, music medicine by listening to music of older adult's own preference >60 minutes/week is an alternative approach in settings with limited resources. Funding None.
... Furthermore, frequent engagement with museums, galleries, and exhibitions may be a protective factor against loneliness in older adults [23], and art therapy in art museums can promote social connectedness in older adults [24]. In music, a significant effect of music therapy on loneliness was shown among institutionalized older adults with mild depression compared with controls [25]. Drumming has been reported to enhance feelings of togetherness, belonging, and connectedness among soldiers experiencing PTSD [26] and mental health service users and their carers [27], while group singing has been shown to enhance emotional closeness between mothers and babies [28], and to mediate swift social bonding [29]. ...
... The second question focused on which forms of arts engagement are most reported as linked with feelings of social connectedness. While previous research has tended to focus on certain arts activitiesnotably museum/gallery attendance [21][22][23] and music [25,[28][29][30] the current study demonstrates a wider range of activities that respondents report connects them socially to others. Both live musical performance and visiting an exhibition, museum, or gallery were among the top five listed activities, but these sit alongside activities less reported in the existing literature including live theatre performance, watching a film or drama at the cinema, and reading. ...
Full-text available
Background Loneliness is a public health challenge, associated with premature mortality and poorer health outcomes. Social connections can mitigate against loneliness, and there is evidence that the arts can support social connectedness. However, existing research on the arts and social connectedness is limited by focus on particular age groups and arts activities, as well as a reliance on typically small-scale studies. Methods This study reports survey data from 5892 adults in the United Kingdom, closely matched to the national profile in terms of sociodemographic and economic characteristics. It investigates the extent to which arts engagement is perceived to be linked with feelings of social connectedness, which forms of arts engagement are reported as most connecting, and how. Data were collected via the HEartS Survey , a newly designed tool to capture arts engagement in the United Kingdom and its associations with social and mental health outcomes. Demographic and quantitative data, pertaining to the extent to which arts engagement is perceived to be linked with social connectedness, were analysed descriptively. Qualitative data pertaining to respondents’ perceptions of how arts engagement is linked with feelings of social connectedness were analysed using inductive thematic analysis. Results Results demonstrated that the majority of respondents (82%) perceive their arts engagement to be linked with feelings of social connectedness at least some of the time. The forms of arts engagement most linked with feelings of social connectedness were attending a live music performance, watching a live theatre performance, and watching a film or drama at the cinema or other venue. Four overarching themes characterise how arts engagement is perceived to facilitate feelings of social connectedness: social opportunities, sharing, commonality and belonging, and collective understanding. Conclusions The findings suggest that arts engagement can support social connectedness among adults in the UK through multiple pathways, providing large-scale evidence of the important role that the arts can play in supporting social public health.
... Music Therapy as Group Singing Improves Geriatric Depression Scale Score and Loneliness in Institutionalized Geriatric Adults with 76 ...
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A monograph of the summaries of 76 research studies on yoga and music therapies by the ISCM of SBV team form 2010 to 2012.
... These findings provide evidence that an online songwriting intervention can reduce postnatal loneliness. They reinforce existing evidence that music can reduce loneliness 36 and support social connectedness 30 as well as support perceived mothereinfant closeness 24 and bonding. 37 As illustrated in Fig. 2, the intervention and control group significantly deviated in loneliness scores at Week 3 of the intervention, with the difference peaking at Week 4 and then stabilising through until follow-up. ...
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Objective: Loneliness is a public health challenge associated with postnatal depression (PND). This study developed and tested an online songwriting intervention, with the aim of reducing loneliness and symptoms of PND and enhancing social connectedness among women with young babies. Study design: This was a two-armed non-blinded randomised controlled trial (RCT, ISRCTN17647261). Methods: Randomisation was conducted in Excel using a 1:1 allocation, with participants (N = 89) allocated to an online 6-week songwriting intervention (Songs from Home) or to waitlist control. Inclusion criteria were women aged ≥18 years, with a baby ≤9 months old, reporting loneliness (4+ on UCLA 3-Item Loneliness Scale) and symptoms of PND (10+ on Edinburgh Postnatal Depression Scale [EPDS]). Loneliness (UCLA-3) was measured at baseline, after each intervention session and at 4-week follow-up. The secondary measures of PND (EPDS) and social connectedness (Social Connectedness Revised 15-item Scale [SC-15]) were measured at baseline, postintervention and at 4-week follow-up (Week 10). Factorial mixed analyses of variance with planned custom contrasts were conducted for each outcome variable comparing the intervention and control groups over time and across baseline, Weeks 1-6 and the follow-up at Week 10 for each outcome variable. Results: Compared with waitlist control, the intervention group reported significantly lower scores postintervention and at follow-up for loneliness (P < 0.001, η2P = 0.098) and PND (P < 0.001, η2P = 0.174) and significantly higher scores at follow-up for social connectedness (P < 0.001, η2P = 0.173). Conclusions: A 6-week online songwriting intervention for women with young babies can reduce loneliness and symptoms of PND and increase social connectedness.
... For instance, in a GS intervention with 34 sessions, which included breaks for social interaction, participants showed significantly higher levels of social well-being and positive affect and a trend toward better self-esteem than an active control group (Galinha, García-Martín et al., 2021). Likewise, in other GS RCTs, participants showed reduced depressive symptomatology, anxiety, and negative affect (Mathew et al., 2017), reductions in loneliness and increased interest in life (Johnson et al., 2020), and improved quality of life (Johnson et al., 2013). ...
Objectives: Group singing (GS), as an art-based intervention, has demonstrated a wide range of biopsychosocial benefits in older adult participants. However, the factors that predict the adherence of older adults to these programs and that moderate the intervention outcomes were not yet studied, which is the aim of this study. Methods: A randomized controlled trial was developed to test the efficacy of a GS intervention, from which pre-post intervention data was collected and analyzed. Participants: 149 retired older adults (M = 76.66, SD = 8,79 years old) users of a social care institution. Results: Principal component analysis of responses to a pre-intervention assessment yielded 10 factors. General well-being (GWB), negative mood and loneliness, blood pressure, and the participants' years of formal education predicted the number of sessions attended by the participants. GWB moderated the intervention's outcomes on life satisfaction, social identification, and systemic inflammation. Conclusions: Years of education, well-being, negative mood and loneliness, and blood pressure at baseline predicted participants' adherence to a singing group artistic intervention. Clinical implications: For future artistic interventions with older adults, screening for participants' characteristics such as formal education, health and well-being before the intervention is important as it allows predicting adherence and tailoring more adjusted and cost-effective interventions.
... It has been observed that therapies aimed at reducing loneliness with the elderly led to a decrease in the feelings of loneliness, meaninglessness, and the levels of blood pressure and depression, and an increase in social contact, selfesteem, and confidence (Andersen, 1985: Kahaki et al., 2014Mathew et al., 2017;Syed Elias et al., 2020;Yazdanbakhsh et al., 2016). ...
This study aims to reduce the loneliness level of university students using group therapy. UCLA Loneliness Scale was applied to a sample of 42 university students. Ten students with the highest score were interviewed one-to-one and informed about the aims and stages of the group work. Six students who agreed to participate in therapy were subjected to a five-session study. At the end of the study period, UCLA Loneliness Scale was re-applied to the students. The outcomes of the group work revealed a downward trend in the loneliness scale scores of the participants. It was observed that the students participating in the group work had a reduced perception of loneliness.
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Introduction International research evidence on the physical, cognitive and social benefits of group singing for older people is growing rapidly. However, singing interventions are inconsistently reported, with details of intervention development, musical content and structure often omitted, impeding replicability and synthesis. This paper poses two research questions: (a) What specific guidelines for singing groups can the research team recommend for older people aged over 65 living in the community who have health and well-being concerns? (b) What recommendations can the research team make for singing group facilitators, building on two pilot studies and over 20 years of experience running singing groups? Method A detailed three-stage process of intervention development and evaluation was undertaken, following Medical Research Council (MRC) guidance. Results The findings of each stage of intervention development and the resultant tested intervention, which aims to meet the physical and psychological health and well-being needs of older people, are presented. Key features of the final intervention include flexible, person-centred musical content; opportunities for social interaction; and appropriate resources, such as large print songbooks. The results of the pilot studies indicate the capacity of group singing to benefit interpersonal relationships and social connection among older people, contributing to increased well-being. Discussion This intervention aims to contribute to the possibility of replicable large-scale studies of the impact of singing for health groups on the health and well-being of older people.
Group singing may be an optimal intervention strategy to promote active ageing and well‐being; however, evidence with experimental validity is scarce. This study aims to fill this gap by analysing the effects of a 34‐session singing group programme (SGP) on participants' subjective and social well‐being and the mediating roles of social identification with the singing group and of self‐esteem. An RCT with intervention (n = 89) and active waiting‐list control (n = 60) conditions was conducted, and a mixed method quantitative and qualitative data collection and analysis were performed. Participants were mostly elderly day‐care centre users (M = 76.66 years old; SD = 8.79) with low average levels of education and income. Structured measures of life satisfaction, positive and negative affect, self‐esteem, loneliness, social identification and social well‐being were collected, as well as interviews on the perceived benefits of participating in the SGP. Results showed significant effects of the SGP on the positive affect, social well‐being and marginally on the self‐esteem of the participants. The observed effects were sustained at the follow‐up. Qualitative analysis corroborated the quantitative results. Mediation analysis showed indirect effects of social identification with the singing group on loneliness and social identification with the social care institution group; and of self‐esteem on positive and negative affect.
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It has been proposed that singing evolved to facilitate social cohesion. However, it remains unclear whether bonding arises out of properties intrinsic to singing or whether any social engagement can have a similar effect. Furthermore, previous research has used one-off singing sessions without exploring the emergence of social bonding over time. In this semi-naturalistic study, we followed newly formed singing and non-singing (crafts or creative writing) adult education classes over seven months. Participants rated their closeness to their group and their affect, and were given a proxy measure of endorphin release, before and after their class, at three timepoints (months 1, 3 and 7). We show that although singers and non-singers felt equally connected by timepoint 3, singers experienced much faster bonding: singers demonstrated a significantly greater increase in closeness at timepoint 1, but the more gradual increase shown by non-singers caught up over time. This represents the first evidence for an 'ice-breaker effect' of singing in promoting fast cohesion between unfamiliar individuals, which bypasses the need for personal knowledge of group members gained through prolonged interaction. We argue that singing may have evolved to quickly bond large human groups of relative strangers, potentially through encouraging willingness to coordinate by enhancing positive affect.
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Music making (playing an instrument or singing) is a multimodal activity that involves the integration of auditory and sensorimotor processes. The ability to sing in humans is evident from infancy, and does not depend on formal vocal training but can be enhanced by training. Given the behavioral similarities between singing and speaking, as well as the shared and distinct neural correlates of both, researchers have begun to examine whether singing can be used to treat some of the speech-motor abnormalities associated with various neurological conditions. This paper reviews recent evidence on the therapeutic effects of singing, and how it can potentially ameliorate some of the speech deficits associated with conditions such as stuttering, Parkinson's disease, acquired brain lesions, and autism. By reviewing the status quo, it is hoped that future research can help to disentangle the relative contribution of factors to why singing works. This may ultimately lead to the development of specialized or "gold-standard" treatments for these disorders, and to an improvement in the quality of life for patients.
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A music-facilitated psychoeducational strategy was developed as a cost-effective and accessible intervention for older adults experiencing symptoms of depression, distress, and anxiety. Thirty older adults who had been diagnosed with major or minor depressive disorder were randomly assigned to one of three 8-week conditions: (1) a home-based program where participants learned music listening stress reduction techniques at weekly home visits by a music therapist; (2) a self-administered program where participants applied these same techniques with moderate therapist intervention (a weekly telephone call); or (3) a wait list control. Participants in both music conditions performed significantly better than the controls on standardized tests of depression, distress, self-esteem, and mood. These improvements were clinically significant and maintained over a 9-month follow-up period. The potential for this type of intervention with homebound elders and others who have limited access to services is discussed.
A music therapy strategy for depressed older adults involves eight music-listening programs facilitated by a music therapist for use in the home environment. Body relaxation, imagery, stimulation, and sleep enhancement are included in these programs that use music to cue relaxation and positive thinking. Four case studies describing successful application of this approach to older adults with depression and/or anxiety offer encouragement for this type of programming.
To determine the effect of music on depression levels in older adults. Background.  Depression is a common psychiatric disorder in older adults, and its impacts on this group of people, along with its conventional treatment, merit our attention. Conventional pharmacological methods might result in dependence and impairment in psychomotor and cognitive functioning. Listening to music, which is a non-pharmacological method, might reduce depression. A randomised controlled study. The study was conducted from July 2009-June 2010 at participants' home in Singapore. In total, 50 older adults (24 using music and 26 control) completed the study after being recruited. Participants listened to their choice of music for 30 minutes per week for eight weeks. Depression scores were collected once a week for eight weeks. Depression levels reduced weekly in the music group, indicating a cumulative dose effect, and a statistically significant reduction in depression levels was found over time in the music group compared with non-music group. Listening to music can help older people to reduce their depression level. Music is a non-invasive, simple and inexpensive therapeutic method of improving life quality in community-dwelling older people.
Music therapy (MT) has been proposed as valid approach for behavioral and psychologic symptoms (BPSD) of dementia. However, studies demonstrating the effectiveness of this approach are lacking. To assess MT effectiveness in reducing BPSD in subjects with dementia. Fifty-nine persons with dementia were enrolled in this study. All of them underwent a multidimensional assessment including Mini Mental State Examination, Barthel Index and Neuropsychiatry Inventory at enrollment and after 8, 16, and 20 weeks. Subjects were randomly assigned to experimental (n=30) or control (n=29) group. The MT sessions were evaluated with standardized criteria. The experimental group received 30 MT sessions (16 wk of treatment), whereas the control group received educational support or entertainment activities. NPI total score significantly decreased in the experimental group at 8th, 16th, and 20th weeks (interaction time x group: F3,165=5.06, P=0.002). Specific BPSD (ie, delusions, agitation, anxiety, apathy, irritability, aberrant motor activity, and night-time disturbances) significantly improved. The empathetic relationship and the patients' active participation in the MT approach, also improved in the experimental group. The study shows that MT is effective to reduce BPSD in patients with moderate-severe dementia.
Neuroscientific and clinical studies of music over the past two decades have substantially increased our understanding of its use as a means of therapy. The authors briefly review current literature related to music's effect on people with different mental illnesses, and examine several neurobiological theories that may explain its effectiveness or lack thereof in treating psychiatric disorders. Neuroscientific studies have shown music to be an agent capable of influencing complex neurobiological processes in the brain and suggest that it can potentially play an important role in treatment. Clinical studies provide some evidence that music therapy can be used as an alternative therapy in treating depression, autism, schizophrenia, and dementia, as well as problems of agitation, anxiety, sleeplessness, and substance misuse, though whether it can actually replace other modes of treatment remains undetermined. Future research should include translational studies involving both neuroscience and clinical medicine that investigate the long-term effects of music intervention and that lead to the development of new strategies for music therapy.
Little is known about the diagnostic validity of the 15-item Geriatric Depression Scale-Short Form (GDS-SF), especially when compared to the original 30-item version (Geriatric Depression Scale-Long Form; GDS-LF). This study compared the GDS-SF and GDS-LF with a sample of depressed, demented, and thought-disordered inpatients. The GDS-SF and GDS-LF were found to be highly correlated (r = .89) and to have similar high sensitivity rates. The specificity rates for both forms were similar, but lower than desirable. Overall, the GDS-SF was found to be an adequate substitute for the GDS-LF.