Choral singing and psychological wellbeing: Quantitative and qualitative findings from English choirs in a cross-national survey

Abstract

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.

Full text

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Article
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MusicPerformanceResearch
Copyright©2010
RoyalNorthernCollegeofMusic
Vol3(1)SpecialIssueMusicandHealth:79‐96
ISSN1755‐9219
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Thesignificanceofchoralsingingforsustaining
psychologicalwellbeing:findingsfromasurveyof
choristersinEngland,AustraliaandGermany
StephenClift
GrenvilleHancox
SidneyDeHaanResearchCentreforArtsandHealth
ABSTRACT:Previousresearchhashighlightedthepossiblebenefitsofactivepar‐
ticipationinsingingforwellbeingandhealth.Shortcomingsintheliteratureare
thelackofacommonunderstandingofwellbeingandhealth,andtheabsenceof
atheoreticalmodelofthecausalmechanismslinkingsingingwithwellbeing.The
presentstudyaimstoaddresstheseshortcomingsthroughalargecross‐national
surveyofchoralsingersbasedontheWorldHealthOrganizationdefinitionof
healthandutilizingmeasuresdevelopedbytheWHOQualityofLifeproject.A
totalof1124choralsingersdrawnfromchoirsinAustralia,EnglandandGermany
completedtheWHOQOL‐BREFquestionnairetomeasurephysical,psychological,
socialandenvironmentalwellbeing,anda12‐item‘effectsofchoralsinging
scale’.Writtenaccountsoftheeffectsofchoralsingingonwellbeingandhealth
weregiveninresponsetoopenquestions.Ahighdegreeofconsensusemerged
onthepositivebenefitsofchoralsinging,withwomensignificantlymorelikelyto
endorsethevalueofsingingforwellbeingandhealthcomparedwithmen.Asig‐
nificantbutsmallcorrelationbetweenpsychologicalwellbeingandpositiveef‐
fectsofchoralsingingalsoemergedforwomen,butnotformen.Particularat‐
tentionisgiventoqualitativeaccountsoftheeffectsofchoralsingingonwellbe‐
ingfrom85participantswithrelativelylowpsychologicalwellbeingasassessed
bytheWHOQOL‐BREF,andhighscoresonthesingingscale.Fourcategoriesof
significantpersonalandhealthchallengesweredisclosedbymembersofthis
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group:enduringmentalhealthproblems;family/relationshipproblems;physical
healthchallengesandrecentbereavement.Theiraccountsalsosuggestedsix
‘generativemechanisms’bywhichsingingmayimpactonwellbeingandhealth:
positiveaffect;focusedattention;deepbreathing;socialsupport;cognitive
stimulationandregularcommitment.
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KEYWORDS:Choralsinging,psychologicalwellbeing,WHOQOL‐BREF,survey,
cross‐national,health
Arecentsystematicmappingoftheempiricalliteratureonsingingandwellbeingidentified
35papersforreview(Clift,Hancox,Staricoff&Whitmore,2008).Thestudiesvariedconsid‐
erablyintermsoffocus,method,samplecharacteristics,samplesize,natureofthesinging
investigated,datagatheredandapproachtoanalysis.Thestudiesaresodiversethataco‐
herentsynthesisoftheevidenceonthevalueofsingingforwellbeingwasnotpossible.
Rather,studieswerecategorisedaccordingtotheirdesignandthenatureofdatagathered
andtheevidencetheyprovidedcriticallyevaluated.
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Qualitativestudiesofsingingandhealth
Anumberofqualitativestudiesonthebenefitsofcommunitysinginghavebeenundertaken
withdiversesamplesofsingers,andtheseprovideevidencefromsubjectivereportsona
rangeofsocial,psychological,andhealthbenefitsassociatedwithsinging.BaileyandDavid‐
son(2002,2005)forexample,interviewedchoirsingersfromarangeofsocialbackgrounds
inCanada;Silber(2005)exploredtheimpactofasinginggroupestablishedinawomen’s
prisoninIsrael,andWatanabe(2005)exploredtheexperienceofindividualengagement
withKaraokelessonsandperformanceinJapan.
TheworkofBaileyandDavidsonisofparticularrelevancetothestudyreportedhere.
Intheirfirststudy(2002)theyinterviewedmembersofasmallchoirsetupinMontrealfor
homelessmenandfourthemesemergedrepeatedlyinthemen’saccounts:
• Groupsingingalleviateddepressionandenhancedemotionalandphysicalwellbe‐
ing.
• Performingtoanaudienceencouragedasenseofpersonalworthandprovideda
meansofre‐engagingwithwidersocialnetworks.
• Thechoirprovidedasupportivecontextforthemeninwhichtheycoulddevelop
theirsocialskillsandachievecollectivegoals.
• Singingismentallydemanding,andrequiredthementoconcentrateandlearnnew
materialinordertoperform.Suchconcentrationalsodirectedtheirattentionaway
frominternalpreoccupationwiththeirproblems.
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Infurtherwork,BaileyandDavidson(2005)interviewedmembersofasinginggroupin
aneconomicallydisadvantagedarea,togetherwithmoresociallyadvantagedandaffluent
choralsingers.Thethemesidentifiedinthe2002paperareconsideredtobebroadlyappli‐
cabletosingersirrespectiveofsocialcontextandthecharacteroftherepertoirebeingsung,
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butsomedifferencesofemphasisdidemerge.Bothdisadvantagedandmoreprivileged
singers,forexample,highlightedthebroadly‘therapeutic’valueofparticipationinsinging,
particularlyinrelationtocreatingenergy,positiveemotionalexperienceandrelaxation.For
otherthemes,someimportantdifferencesemerged,particularlyinrelationtocognitivedi‐
mensionsandtheimpactofsinginginagroup.Forthemoremarginalisedparticipants,sing‐
ingprovidedastimulatingactivitywhichhelpedtopromoteconcentrationandanordering
oftheirinnermentalspace.Forthemiddleclasssingers,incontrast,agreaterstresswas
placedondevelopingmusicalknowledgeandskillwhichenabledthemtomeetthechal‐
lengesofclassicalrepertoireandgainasenseofachievement.

Questionnairesurveysofsingingandhealth
Theideathatsingingcanbebeneficialforwellbeingandhealthisalsosupportedbysurveys
inwhichchoralsingershavebeenaskedtorespondtoarangeofstatementsabouttheef‐
fectsofsinging.Beck,Cesario,YousefiandEnamoto(2000)reportthat67percentofsemi‐
professionalchoralsingersintheirsurveyagreedorstronglyagreedthat‘Singinghascon‐
tributedtomypersonalwell‐being’,andCliftandHancox(2001)reportthat71percentof
singersinauniversitychoralsocietyagreedorstronglyagreedthatsingingwasbeneficial
fortheir‘mentalwellbeing’.CliftandHancoxidentifiedsixdimensionsofbenefitsassoci‐
atedwithchoralsingingfromaPrincipalComponentsAnalysisoftheirquestionnairedata.
Thesewerelabelled(inorder)as:‘benefitsforwell‐beingandrelaxation’,‘benefitsfor
breathingandposture’,‘socialbenefits’,‘spiritualbenefits’,‘emotionalbenefits’and‘bene‐
fitsfortheheartandimmunesystem’.Thereisalsoaclearlinkbetweenthesetofcompo‐
nentsemergingfromthisanalysisandthemodelofpositivebenefitsofgroupsinging
emergingfromtheworkofBaileyandDavidson(2002,2005).Forthefirstandmostimpor‐
tantfactorof‘wellbeingandrelaxation’,CliftandHancoxfoundthatwomenhadhigher
scoresthanmen,suggestingthatwomenexperienceorperceivegreaterwellbeingbenefits
fromsinging.
BaileyandDavidson(2003)alsoconductedaquestionnairestudytocomparetheper‐
ceivedbenefitsof‘active’participationinmusic(singinginachoir),‘passive’listeningto
musicwithothers,and‘passive’listeningtomusicalone.Choristersfromthreechoirs(N=
121)participatedinthesurveyandwereinvitedtocompletea100‐itemquestionnairede‐
scribedasmeasuringattitudesrelatedtomusic.Includedinthequestionnairewerethree
setsof22itemsconcernedwiththe‘holistichealtheffectsofmusicinthethreeparticipa‐
tioncategories’.Additionalitemsrelatingtochoirpractices,performances,voicequality
andconductingtechniqueswereincludedto‘camouflage’thepurposeofthequestionnaire.
BaileyandDavidsonreportthatanumberofthegroupsingingitemsreceivedhigher
ratingsthanequivalentlisteningitems,andindicatedthatsinging‘promotesheightened
arousalonavarietyofbehaviouraldimensions.’Theseitemswere:‘improvesmood’,‘isan
exhilaratingactivity’,‘givesmeasenseofachievement’,‘isacreativeexperience’and‘gives
meakindofhigh’.Bycontrast,thelisteningaloneitemswhichreceivedhigherratingswere
‘indicativeofprocesseswhichpromotestressreductionandrestorationofahomeostatic
state.’Theseitemswere:‘reducesstress’,‘releasessuppressedemotions’,‘isphysicallyre‐
laxing’and‘releasestension’.BaileyandDavidsonconcludefromtheirfindings“thatdiffer‐
entlevelsofmusicparticipationcanhavedifferentialyetbeneficialeffects.”(p.223).
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Experimentalstudiesofsingingandhealth
Inadditiontoqualitativestudiesandquestionnairesurveys,moreobjective,experimental
researchhasalsoassessedtheimpactofsingingonphysiologicalvariablesassumedtohave
wellbeingandhealthimplications.Severalstudies,forexample,haveassayedlevelsofim‐
munoglobulinAinsalivatakenfromparticipantsbeforeandaftersinging,andreportedsig‐
nificantincreases,pointingtoenhancedimmunesystemactivity(e.g.Becketal.,2000;
Kuhn,2002;Kreutz,Bongard,Rohrmann,Grebe,Bastian,&Hodapp,2004).
Twoquasi‐experimentalstudieshavealsoreportedpositivehealthbenefitsfromgroup
singingforelderlypeopleusingstandardisedmeasuresandobjectiveindicatorsofwellbeing
andhealth.Houston,McKee,CarrollandMarsh(1998)reportimprovementsinlevelsof
anxietyanddepressioninnursinghomeresidentsfollowingafour‐weekprogrammeofsing‐
ing,andCohen,Perlstein,Chapline,Kelly,FirthandSimmens(2006)foundimprovementsin
bothmentalandphysicalhealthinagroupofelderlypeopleparticipatinginacommunity
choirforoneyear.

Limitationsofexistingresearchandthepresentstudy
Theexistingresearchliteraturehassubstantiallimitations(seeClift,Hancox,Staricoff,etal.
2008).Manyofthestudiesaresmall‐scaleandessentiallyexploratoryandonlyonestudy
hasindependentlyreplicatedandimproveduponapreviousstudy(Kreutzetal.,2004repli‐
catingBecketal.,2000).Themainshortcomingsofthiscorpusofresearcharethelackofa
commonconceptualunderstandingofwellbeingandhealth,andtheabsenceofafully
elaboratedtheoreticalmodelofthecausalmechanismslinkingsingingwithwellbeingand
health.
Afurtherlimitationofparticularinterestandrelevancetothestudyreportedbelowis
thelackofattentiontothepotentialsignificanceofsexinrelationtochoralsingingandits
effects.Thesystematicreviewrevealedthat19ofthe35papersconsideredreportedre‐
searchongroupsinging.Threestudieswereconcernedwithsingle‐sexsinginggroups,and
therestincludedbothsexes.However,fourstudiesfailedtoreportthenumbersofmen
andwomenintheirsamples.Inthe13studiesgivingdetailsofsexcompositionatotalof
763singerswereinvestigatedwith72percentwomenand28percentmen.Theonlystudy
toexaminesexasafactorinrelationtotheirfindingsisthesurveyreportedbyCliftand
Hancox(2001).Asnotedabove,theyfoundevidencethatwomenreportedstrongerwell‐
beingbenefitsassociatedwithsingingthandidmen.
Thepresentstudyaimstoaddresstheselimitationsinthepreviousliteraturethrougha
large‐scalecross‐nationalsurveyassessingtheviewsofchoralsingersinEngland,Germany
andAustraliaonthepossibleeffectsofsingingonwellbeingandhealth.Whiletheproject
wasinitiatedbytheSidneyDeHaanResearchCentreinEngland,researchcolleaguesin
GermanyandAustraliaexpressedaninterestinusingthesameinstrumentsinacross‐
nationalcollaboration.Allthreecountriesareaffluentdemocracies,andmarkeddiffer‐
encesbetweenthemwerenotexpected.Rather,thecross‐nationaldimensiontothestudy
wasseenasprovidingabasisoftestingthegeneralityoffindingsacrossthreeindependent
nationalsamplesofsingers.

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ThestudyisbasedontheWorldHealthOrganization’sdefinitionofhealth(WHO,1946)
as“astateofcompletephysical,mentalandsocialwellbeingandnotmerelyanabsenceof
illnessorinfirmity”(p.100)(andusesacross‐nationallyvalidatedqualityoflifeinstrument–
theWHOQOL‐BREF–developedbytheWHOQualityofLifeproject(Power,Harper,Bullin‐
gerandtheWorldHealthOrganizationQualityofLifeGroup,1999).Foradetaileddescrip‐
tionofthestudy,methodsandfindingsseeClift,Hancox,Morrison,Hess,Stewartand
Kreutz(2008).
Morespecifically,thepresentpaperpresentsfindingsfromanewlyconstructedscale
assessingtheperceivedwellbeingeffectsofparticipatinginchoralsinging,andexploresthe
relationshipsbetweenthisscaleandtheWHOQOL‐BREFmeasureofpsychologicalwellbe‐
ing.Intheconstructionandanalysisofthisscale,carefulattentionisgiventothequestion
ofdifferencesattributabletosex.Itwasexpected,onthebasisofthefindingsreportedby
CliftandHancox(2001)thatwomenwouldendorsethewellbeingeffectsofsingingmore
stronglythanmen.
Inordertoexplorefurtherthevalueofchoralsingingforhealth,someillustrativeex‐
amplesaregivenofwrittencommentsaboutsinginganditseffectsfromchoristerswhore‐
portstrongwellbeingbenefitsfromsingingbutwhosegeneralpsychologicalwellbeingap‐
pearsrelativelylow.Attentionisgiventothechallengessomeofthesechoristersfacein
theirliveswhichmayaccountfortheirrelativelylowerpsychologicalwellbeing.Theircom‐
mentsalsoservetohighlightarangeofmechanisms,someofwhichhavealreadybeen
identifiedinpreviousresearch,throughwhichsingingcanacttopromotepersonalwellbe‐
ing.

METHOD
Participatingchoralsocietiesandchoirs
Thesampleconsistedof1124choralsingersdrawnfrom21choralsocietiesandchoirsin
England(N=633),Germany(N=325)andAustralia(N=166).InEngland,asampleofcho‐
ristersinvolvedinanon‐goingcommunitysingingprojectforelderlypeoplealsopartici‐
pated.Theoverallresponseratewas61percent.
MostofthechoirsinthesurveysingmajorchoralworksfromtheWesternclassicalrep‐
ertoirefromthefifteenthtotwentiethcentury.Somechoirssingamoreeclecticrepertoire
includingwellknownsongsfrommusicalshowsandfilms.Onlysixofthe21choirsareaudi‐
tionedandtheremainderareopentoallcomers.
Severalofthechoirshavebeenestablishedalongtime.TheStuttgarterLiederkranzin
Germanyistheoldestchoirinthesurvey,foundedin1824,followedbytheEnglishAshford
ChoralSocietyfoundedin1857,andTheQueenslandChoirinAustraliasetupin1872.So‐
cietiesthathavecontinuedinexistenceforthislengthoftimeindicatetheappealofchoral
singingfromthenineteenthtothetwenty‐firstcenturies.Therearealsosomerecentlyes‐
tablishedchoralsocietiesandchoirsinthestudy:theGermanEnsembleadlibitumStuttgart
wasformedin2002,andTheSilverSingers,Gateshead,EnglandandTheEsplanados,Bris‐
bane,Australiaweresetupin2005.
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TheQuestionnaire
Thequestionnairewasstructuredinthreeparts.Thefirstpartaskedforpersonalinforma‐
tionanddetailsoftherespondents’involvementwithmusicandsinging.Thesecondsec‐
tionfocusedspecificallyontheeffectsofchoralsingingandstartedwiththreeopenques‐
tionsontheeffectsofsingingonqualityoflife,wellbeingandhealth:

1. Whateffects,ifany,doessinginginachoirhaveonyourqualityoflife?
2. Whateffects,ifany,doessinginginachoirhaveonyourpsychologicalandsocial
wellbeing?
3. Whateffects,ifany,doessinginginachoirhaveonyourphysicalhealth?

Thesequestionswerewordedcarefullytoavoidbeingleading,andtoindicatethatef‐
fectsmightbepositiveornegativeorthattheremaybenoeffectsatall.Thequestions
werealsofocusedontherespondents’ownhealth,ratherthanaskingaboutpossibleef‐
fectsofsingingonotherpeople’shealth.
Theseopenquestionswerethenfollowedby24statementsaboutchoralsingingusing
itemsdefiningthefirstmajor‘wellbeingandrelaxation’componentreportedbyCliftand
Hancox(2001)anditemsfromthe‘Singers’EmotionalExperiencesScale’devisedbyBecket
al.(2000).TheinstrumentsdevisedbyCliftandHancox,andBecketal.couldbecriticised
forincludingonlypositivelywordeditems,whichcouldhelptoreinforceapositiveresponse
bias.Inthepresentquestionnaire,therefore,twelveitemswerepositivelywordedand
twelvenegativelyworded,andparticipantsrespondedonafive‐pointLikertscalefrom
‘stronglydisagree’to‘stronglyagree.’FollowingaPrincipalComponentsAnalysis(seebe‐
low)scoreson12oftheseitemsweresummedtoformasingle‘singingandwellbeing’scale
withahighdegreeofinternalconsistency.Scoresonthescalerangefrom12‐60(seebelow
fordetails).
ThethirdsectionofthequestionnairecontainedtheWHOQOL‐BREF.Thiswasdesigned
toassessfourmajorlifequalitydomains:physical(e.g.Howmuchdoyouneedmedical
treatmenttofunctioninyourdailylife?),psychological(e.g.Howmuchdoyouenjoylife?),
social(e.g.Howsatisfiedareyouwiththesupportyougetfromyourfriends?)andenviron‐
mental(e.g.Howsatisfiedareyouwiththeconditionsofyourlivingplace?).Thequestion‐
nairehasbeenwidelyusedinternationallyandhashighlevelsofreliabilityandvalidity(e.g.
Skevington,Lofty,&O’Connell,2004;Hawthorne,Herrman,&Murphy,2006).Itwascon‐
sideredespeciallysuitableforacross‐nationalsurveyasofficialWHOversionsoftheques‐
tionnaireareavailableforuseinAustralia,GermanyandtheUK.Attentioninthispaperis
confinedtothepsychologicalwellbeingscale.Thisconsistsofsixstatementstowhichpar‐
ticipantsrespondusingfive‐pointLikertscales(thewordingvariesbyitem).Theitemscores
weresummedtoproviderawscoresonascalerangingfrom6‐30,andtheseweretrans‐
formedfollowingWHOQOL‐BREFguidelinestoascalerangingfrom4‐20.
QuestionnairesweredistributedtomembersofparticipatingchoirsduringMay2007
forcompletionathomeandreturninasealedenvelope.

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Ethics
Thestudyreceivedethicalapprovalthroughethicscommitteesinthecollaboratinguniversi‐
tiesineachcountry.Participationwasentirelyvoluntaryandquestionnaireswerecom‐
pletedanonymously.Itwasassumedthatsingerswouldfindthesurveyofinterestandthis
wasreflectedinthecaretakentoprovideanswerstotheopenquestions.Areportbased
onapreliminaryanalysisofthedatagatheredwasmadeavailabletoallrespondentsafter
completionofthesurvey.

Analysis
NumericaldatafromthequestionnairewereanalysedusingSPSS16.PrincipalComponents
Analysiswasappliedtothe24singingitems,forthetotalsampleandforsixcountry/sex
groups.Theresultsforthefirstunrotatedcomponentprovidedjustificationforconstructing
asummedscaleusing12itemstoassessperceivedwellbeingeffectsofchoralsinging.
Comparisonsbetweenmenandwomenineachcountryandwithinthetotalsampleswere
madeusingindependentt‐tests.Productmomentcorrelationswerecomputedbetween
thesingingscaleandtheWHOQOL‐BREFpsychologicalwellbeingscale.Toexploretheis‐
suesaddressedbythissurveymoreconcretely,attentionisgiventothecommentswritten
onthequestionnairebyrespondentswithrelativelylowscoresonthepsychologicalwellbe‐
ingscale,buthighscoresonthesingingscale.Asimplethematicapproachwasadoptedto
identifyexamplesoflifechallengeswhichmayexplaintherelativelylowwellbeingscores,
togetherwithcommentsidentifyingpossiblemechanismswhichlinksingingwithbeneficial
outcomesforwellbeing.

Findings
Theaverageageofchoristerswasrelativelyhigh(M=57years(SD=15)withathirdaged
60‐69andafifthaged70andabove).Womensubstantiallyoutnumberedmen(72vs.28
percent).Choristersreportedengagementwithchoralsingingforameanof27years(SD=
11years);42percentreportedhavinghadsinginglessons;62percentplayedamusicalin‐
strumentandonly6percentweretoldaschildrenthattheycouldnotsing.
Withrespecttohealth,79percentwere‘satisfied’or‘verysatisfied’withtheirhealth
(with21percentlessthansatisfied)and87percentdescribedtheirhealthas‘good’,‘very
good’or‘excellent’(with13percentdescribingtheirhealthaslessthangood).Justunder
halfofthesample(N=536,49%)reportedlong‐termhealthproblems,themostcommonly
expressedissuesbeingproblemswithpain,emotionalandmentalhealthproblemsand
problemswithbreathing.
PrincipalComponentsAnalysisappliedtothechoralsingingitemsidentifiedastrong
firstcomponentwithsubstantialloadingsfrom12items(e.g.improvedmood,enhanced
qualityoflife,greaterhappiness,stressreduction,andemotionalwellbeing).Table1gives
theloadingsoftheseitemsinseparateanalysesofdatafromsixcountryxsexsub‐groups
anddemonstratestherobustnessofthispattern.Itisstrikingthatasenseof‘happiness’
producedbysingingistheitemwhichachievesthehighestloadingforthetotalsample,and
isalsothehighestloadingitemforfouroutofthesixsub‐groups.
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Table1:‘Effectsofsinging’questionnaire:firstprincipalcomponentforsixcountryxsexgroups(12items)

Totalsample
EnglishMen
English
Women
Australian
Men
Australian
Women
GermanMen
German
Women
Makesmefeelalothappierafterwards.75.74.73.66.83.72.78
Singinggivesapositiveattitudetolife.74.74.74.68.78.72.74
Singinghasimprovedwell‐being/health.74.68.77.76.81.71.69
Singingreleasesnegativefeelings.73.74.75.69.82.71.73
Singinghelpsmakemeahappierperson.73.72.78.78.74.69.68
Singingdoesn'tgivemea'high'‐.70‐.71‐.71‐.74‐.61‐.73‐.67
Choirpositivelyaffectsqualityoflife.70.66.75.64.66.74.60
Relaxingandhelpsdealwithstress.69.61.70.67.70.66.74
Doesn'treleasenegativefeelingsinmylife‐.69‐.72‐.68‐.65‐
.74‐.67‐.65
Singingmakesmoodmorepositive.69.68.71.71.71.71.60
Doesn'thelpgeneralemotionalwell‐being‐.67‐.69‐.68‐.44‐.75‐.73‐.62
Singinggivesnodeepsignificance ‐.65‐.65‐.65‐.68‐.63‐.66‐.69

Varianceaccountedfor50.148.451.946.2

53.8

49.546.7

Cronbachalpha0.910.910.920.89

0.92

0.910.90
Theseitemswereusedtoconstructasinglesummedmeasureoftheperceivedeffects
ofsingingonwellbeing(Cronbachalpha=0.9forbothsexes).Ahighmeanscoreconfirmed
thatalargemajorityofchoristers,ineachcountry,andamongmenandwomen,agreed
thatsinginghasapositiveimpactonpersonalwellbeing(seeTable2).Differencesbetween
thesexeswereapparent,however,andasexpectedwomengavehigherscoresthanmenin
eachcountryandinthetotalsample.FortheEnglishandGermansamplesandforthetotal
sample,thisdifferenceisstatisticallysignificant.

Table2:Singingscalestatisticsforcountryxsexsubgroups
EnglandAustraliaGermanyTotal
Men
N=134
Women
N=449
Men
N=51
Women
N=103
Men
N=100
Women
N=192
Men
N=285
Women
N=744
MSDMSDMSDMSDMSDMSDMSDMSD
48.16.850.26.749.55.650.76.947.07.049.56.648.06.750.16.7
t(584)=3.19,p=<0.001t(154)=1.10,pnst(291)=2.99,p<0.005t(1033)=4.58,p<0.001
Rangeis12‐60
86

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Article
OntheWHOpsychologicalscale,amajorityofrespondentsscoredwellabovethescale
midpointindicating‘good’to‘excellent’self‐assessedpsychologicalwellbeing(seeTable3).
Asmallproportionofchoristers,however,gavelowscores,whichcouldindicatemental
healthdifficulties.Forthe‘frequencyofnegativefeelings’itemforexample,justoversix
percentofparticipantsgaveratingswhichindicatedthatthey‘veryoften’or‘always’ex‐
perienced‘negativefeelingssuchasbluemood,despair,anxiety,depression.’

Table3:WHOQOL‐BREFPsychologicalwellbeing–percentageresponsestoindividualitems(totalsample)


N1
Low
2345
High
Enjoylife11120.21.315.167.216.3
Lifeismeaningful10970.72.817.554.324.6
Abletoconcentrate11110.11.931.656.99.5
Acceptbodilyappearance11131.14.518.351.824.3
Satisfactionwithself11080.94.721.160.313.0
Frequencyofnegativefeelings11120.75.427.754.911.2
Itemsarescaledsuchthathighscoresreflecthighwellbeing.Forthefrequencyofnegativefeelingsitem,for
example,ahighscoremeansthatthefrequencyofnegativefeelingswaslow(1=always,2=veryoften,3=
quiteoften,4=seldom,5=never).

AsTable4indicates,womenintheEnglishandGermansamplesandthesampleoverall
scoredslightlyloweronthepsychologicalwellbeingscale.ThesedifferencesintheEnglish
andtotalsampleswerestatisticallysignificant.
Table4:WHOQOL‐BREFPsychologicalwellbeingscores
EnglandAustraliaGermanyTotal
Men
N=139
Women
N=463
Men
N=54
Women
N=106
Men
N=101
Women
N=201
Men
N=294
Women
N=770
MSDMSDMSDMSDMSDMSDMSDMSD
15.71.815.32.015.52.215.11.815.62.115.72.115.72.015.42.0
t(603)=2.17,p=<0.05t(160)=1.42,pnst(301)=.35,pnst(1065)=1.99,p<0.05
Rangeis12‐60.

Asstatisticallysignificantsexdifferenceswerefoundinthetotalsampleforboththe
singingscaleandtheWHOQOL‐BREFpsychologicalwellbeingscale,relationshipsbetween
thesetwomeasureswereexaminedwithinsex.Asignificantcorrelationwasfoundbe‐
tweenthemforwomen(totalsample)(r=0.23,p<0.001),butnotformen(r=0.06,pns).
Thispatternwasalsoreplicatedindependentlyineachnationalsample(seeClift,Hancox,
Morrisonetal.,2008fordetails).Thecorrelationsforwomenareverylow,however,with
nomorethanfivepercentsharedvariancebetweenthetwoscales.Effectively,therefore,
thereislittleornorelationshipoverallbetweenthetwoscalesforeithersex,andthissug‐
87

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Article
geststhatallpossiblecombinationsofhighandlowscoresonbothscalesarerelativelysimi‐
larinfrequency.
Toexplorethisfindingfurther,datafromtheWHOQOL‐BREFpsychologicalscaleand
theeffectsofsingingscaleweredividedasneartothe33rdand67thpercentilesaspossible
andthetworecodedscaleswerecross‐tabulated.Respondentsinthelowestthirdonthe
psychologicalwellbeingscale,andthehighestthirdontheeffectsofsingingscalewerecon‐
sideredofparticularinterestforunderstandingthepotentialimpactofsingingonwellbeing.
Thesearepeoplewhoreportthattheirgeneralpsychologicalwellbeingovertheprevious
twoweekshadbeenrelativelylowcomparedwiththesampleoverall,butwhoalsoreporta
relativelyhighimpactonwellbeingfromsinging.Eighty‐fivepeopleinthetotalsamplefell
intothiscategory:15menand69women(onerespondentdidnotdisclosetheirsex);51
English,19Germanand14Australian.
Justundertwo‐thirdsofthisgroup(N=55,65%)reportedlong‐termproblemswith
theirhealth,comparedwith49percentinthetotalsample.Withrespecttopsychological
wellbeing,overthree‐quartersofthegroup(N=66,78%)gaveanswersof‘quiteoften’,
‘veryoften’or‘always’inresponsetothequestion‘Howoftendoyouhavenegativefeel‐
ingssuchasbluemood,despair,anxiety,depression?’Thiscompareswith34percentof
thetotalsamplegivingthisrangeofanswers(seeTable3).

Writtencommentsfromchoristersrelativelylowinpsychologicalwellbeingbutstrongly
endorsingthewellbeingeffectsofsinging
Inanswerstotheopenquestionsdetailedabove,approximatelyonefifthofthisgroupgave
concreteinformationonsignificantchallengesintheirlivesimpactingontheirsenseofper‐
sonalwellbeing.Respondents’commentsaboutthesechallengescouldbereadilycatego‐
risedunderthefollowingheadings:mentalhealthproblems,significantfamilyproblems,
physicalhealthdifficultiesandbereavement.Thefollowingexamplesareindicativeofthe
issuesidentifiedandalsoclearlyexpressthebenefitswhichtherespondentsfeltthey
gainedfromsinginginachoir.

Enduringmentalhealthproblems–Thiswasthemostcommonlyexpressedchallenge,with
sixrespondentsdisclosingproblemswithclinicaldepressionoranxietyandafurthersixal‐
ludingtodifficultieswithdepression.Inthefollowingexamplessingingisdescribedasbeing
helpfulintheprocessofrecoveryorinthemanagementoftheseproblems:
Ihavehadtostopworkingduetoanon‐goingmedicalcondition(bi‐polardisorder).I
havehadseveralepisodesofthis.Requiringvaryinglengthsoftimespentinhospital,fol‐
lowedbymonthsoftimeneedingsupportfordepressionandlackofself‐confidence.Be‐
ingamemberofthisparticularchoirhasliftedmyself‐esteemagainandrestoredself‐
belief.[Englishfemale54.]
Ihadafulltimepanicattacklastweek.Triedsomeswimmingexerciseswhichmadeit
worse–thensanginthecarforhalfanhour.Bytheendmyheartrateandbreathinghad
returnedtonormal,neckandshouldersrelaxed,stomachunknotted.Generallyfindit
unwindsandrelaxesme.Alwaysfeel’looser’afterrehearsals.[Australianmale,38.]
88

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Article
Significantfamily/relationshipproblems–Problemswithinthefamilyorclosepersonalre‐
lationshipswerealsoasourceofsignificantstressforthefollowingtwoparticipants,and
singinghelpedthemtocopewiththesecontinuingchallenges:
Asacareroftworelativesstrickenwithschizophrenia,Ihavesufferedfromreactivede‐
pression.(…)HavingapleasantstarttothedayknowingIshallmeetlike‐mindedpeople
andenjoymusicmaking,hopefullyhavingalaughalongtheway.Hearingtheharmonies
helpsmeforgetfamilyworries.[Englishfemale,70.]
AbletoenjoycompanionshipandmakesmefeelIamabletodosomething.Myhusband
isdepressedandthishelpsmeto‘keepgoing’.Liftsmoodandhelpstoforgetproblems
inlife.[Englishfemale,65.]

Significantphysicalhealthissues/disability–Physicalhealthproblemscanalsoresultin
significantemotionalchallengesthatcanincreaserisksofmentalhealthdifficulties.Thefol‐
lowingparticipantsdescribetheconsequencesofstrokeandinsomnia,withthefirstindicat‐
inghowsinginghelpedhim:
Itplaysasignificantpartinmyemotionalhealthandwellbeing.Ifindmusicuplifting.
Whenrecoveringfromamajorstroke,singingwasoneofthewaysofliftingmyspiritsout
ofdepression.[Englishmale,65.]
Severeinsomnia.Iwakeupbetween3and4am.MostofthetimeIcan’tgobacktosleep
oronlyshortlybeforeIgetupagain.Consequently,Iamextremelytiredintheevenings
andsuffermoodswings.[Germanfemale,67.]

Recentbereavement–Finally,tworespondentsdisclosedrecentlossofclosefamilymem‐
bers.Bereavementsubstantiallyincreasesriskstoemotionalandmentalhealth,andfor
thesechoristerssingingclearlyhelpedthemtocopewithsignificantpersonalloss:
Myhusbanddiedthreemonthsagosoallthequestionsaboutnegativefeelingsetc.are
distortedbythisfact.Oneofthegreatestsupportsinmylifeatthisdifficulttimeisthe
[choirIbelongto].Ithinkchoralsingingisfantasticforemotionalhealth.[Englishfe‐
male,64.]
Intoday’sworld,choralsingingofferspeopleoneoutletfromstressandworry.Itisan
experiencenottobemissed,andhashelpedmethroughtherecentlossofmydaughter.
[Englishfemale,59.]
Theaccountsgivenabovealsosuggestsomeofthewaysinwhichsingingcanhelpad‐
dresschallengestopsychologicalwellbeing,andthisissuewasexploredfurtherbycodingall
examplesinwhichrespondentsthemselvesofferedsomeexplanationofhowsingingpro‐
videdpsychologicalandemotionalbenefits.Thisanalysisidentifieddescriptionsofatleast
sixgenerativemechanismslinkingchoralsingingwithwellbeingandhealth,mostofwhich
havebeenpreviouslyidentifiedintheresearchliterature(e.g.BaileyandDavidson,2003,
2005,refertoimprovementsinmoodandtheroleofdistraction).Thepurposehereisnot
topresentathorough‐goingdocumentationoftheincidenceofcommentsindicativeof
thesemechanisms,butsimplytoprovideillustrationsoftheintuitivehypothesesemployed
bysingerstoexplainhowsingingcanbebeneficial.

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Agivenmechanismmayhavemorethanoneoutcomeforwellbeing,andtwoormore
mechanismsmayhaveasimilarimpact.Themechanismsareasfollows:positiveaffect,fo‐
cusedconcentration,controlleddeepbreathing,socialsupport,cognitivestimulation,and
regularcommitment.Eachofthesemechanismsservestocounterfactorsandprocesses
thatarepotentiallydetrimentaltowellbeingandhealth.Thegeneralprincipleatworkhere
appearstobeoneofre‐balancingorcounter‐action.
Positiveaffect–Respondentsinthisgroupcommentedthatsingingmadethemfeelhappier
andimprovedtheirmood.Inthefollowingcomments,thecapacityofsingingtogenerate
positivefeelingsislinkedtoaprocessofcounteractingfeelingsofsadness,anxietyandde‐
pressioninotherareasoftheirlives:
Whenyousing,youcannotbesadforlong.Itreallyliftsyourspirits.Beinginachoir
meansyouareinateam–youallhelpeachotherwhichgivestremendoussatisfaction.
[Englishfemale,52.]
Singingimprovesmymoodandmyhealth.Ihavetobeonguardconstantlyagainstmy
medicalcondition(anxietyanddepression).[Australianfemale,49.]

Focusedattention–Inadditiontogeneratingpositivefeelings,singingcanbeaveryde‐
mandingactivityinvolvingfocusedconcentration.Thefollowingrespondentsexplicitlylink
thisfeatureofsingingasanactivitytoblockingpersonalpreoccupationswithsourcesof
worry,andpromotingrelaxationandthereliefofstress:
Singinginachoirputstroubles‘onhold’,asconcentratingonthemusicrequiresallone’s
attention.[Englishfemale,65.]
Ithasgreateffects.Ithelpsmeto‘switchoff’everydayconcernsandalsotoconcentrate.
Result:Icanrelax.[Germanfemale,56.]

Controlleddeepbreathing–Controlledbreathingisofcourse,intrinsictotheactivityof
singing,andwaswidelyidentifiedasaphysicalbenefitassociatedwithbeingamemberofa
choir.Inaddition,thefollowingrespondentsweremoreexplicitinsuggestingthatdeep
controlledbreathingcancounteractanxietyandstress,andalsogiveasenseoffitness:
Deepbreathing,essentialforsinging,isonemethodofhelpingwithsignsofanxietyand
stress.[Englishfemale,70.]
Ithinkthatyouarekeptfitbychoralsingingbecauseyoubreathecorrectlyandyouen‐
gageyourwholebodyintheactivity,likeyoudowhenpractisingyogaorwhendoing
sports(walkingforfitness).[Germanfemale,50.]

Socialsupport‐Choralsingingisalsoanintrinsicallysocialactivity,involvingprocessesof
socialco‐operationandco‐ordination.Thevalueofgroupmembershipandfriendlyrela‐
tionshipswithinthegroupwerewidelycommentedon.Inadditionthefollowingrespon‐
dentsareexplicitinsuggestingthatsinginginachoiroffersthemsocialsupport,which
servestoamelioratefeelingsofisolationandloneliness,andprovidesasenseofwider
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‘community’andsocialinclusion:
Theeffectofsingingwithagrouphelpstomakefriends,sothishaswidenedmyhorizons
quiteabit,andgetsmeoutandaboutmore.Thesupportyoureceivefromotherpeople
helpsingeneralwellbeing.[Englishfemale,78.]
The‘community’aspectofchoralsingingisparticularlysignificant.Achoirisacommu‐
nityofsingersdrawnfromallwalksoflife,comingtogethertomakeaunifiedimpact.
Thatteamworkanddisciplinedfocusonathinggreaterthanourselves(namelyachoral
work)isanexampleofhowtheworldmight/couldbe![Australianfemale,66.]

Cognitivestimulation‐Choralsinginginvolveseducationandlearning,whichkeepsthe
mindactive,andgivesasenseofachievement.Thefollowingrespondentshighlightwaysin
whichchoralsingingcanofferachallengingandworthwhileactivityandpossiblyserveto
counteractage‐relateddeclineofcognitivefunction:
[Choralsingingis]Averysatisfyingactivitytobeinvolvedinatanyage,butIthinkespe‐
ciallyvaluabletopeopleintheirlateryearswhentheyhavetimeontheirhands.Ithink
choralsingingisaparticularlyvaluableandworthwhileactivitytofillsomeofthistime
andgivearealsenseofachievementatatimewhenonemightbefeelingone’suseful‐
nessisdeclining.[Australianfemale,60.]
Apartfromtherelaxationbenefits,Ibelievethatforme,aged57,keepingthebrainactive
andhavingtoconcentrateforlongperiodswilldelayifnotcompletelypreventsenilede‐
mentia![Englishfemale,57.]

Regularcommitment–Finally,likeallworthwhileactivities,choralsingingrequiresregular
practiceandsoinvolvesaregularcommitmenttoattendrehearsal,whichmotivatespeople
toavoidbeingphysicallyinactive:
Itmakesmegetupinthemorning[rehearsalsareduringtheday]andputsmeinagood
moodfortherestofthedayandmakesmemorealert.[Englishfemale,65.]
Makingtheefforttoattendchoirpracticeonwet,coldeveningsinsteadofwatchingTV
mustbebetterforhealth.[Englishfemale,69.]

DISCUSSIONANDIMPLICATIONS
Thisstudycontributestoaprocessofaddressingtheshortcomingsofpreviousresearchby
undertakingalargescalecross‐nationalsurveyofsingersinchoirsinEngland,Germanyand
Australia.ThestudyisbasedontheWHOdefinitionofhealth,andusesarigorouslydevel‐
opedcross‐nationalinstrumentforassessinghealthrelatedqualityoflife,theWHOQOL‐
BREF.Inaddition,thestudyallowedfortheconstructionofanewscaleforassessingthe
wellbeingeffectsofchoralsinging,whichdemonstratessubstantialconstructvalidityand
internalconsistency.
TheresultsconfirmpreviousfindingsfromCliftandHancox(2001)andBecketal.(2000)
thatamajorityofchoristersexperiencesingingasbeneficialforwellbeing.Nevertheless,
thereisvariationintheextenttowhichsingersendorsetheideathatsinginghasbenefits
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fortheirwellbeing,andanimportantfindingisthatwomenaremorelikelytoreport
strongerbenefitscomparedwithmen.Thisconfirmstheearlierfindingofsuchasexdiffer‐
encereportedbyCliftandHancoxinasmall‐scalestudyofasinglechoir.Thecurrentfind‐
ingisparticularlystrong,giventhatthedifferencebetweenwomenandmenappearsinde‐
pendentlyineachnationalsampleofchoristersstudied.Inspectionofindividualitemsin
thescaleshowsthatwomenweremorelikelythanmentostronglyagreethatsingingmade
themfeelhappier,madetheirmoodmorepositive,helpedimprovewellbeingandhealth,
andhelpedthemrelaxanddealwithstress.Similarly,theyweremorelikelytostronglydis‐
agreethatsingingdoesn’thelptoreleasenegativefeelings.
Suchsexdifferencesareintriguing,andmeritfurtherstudy.Theymayreflectabroader
sexdifferenceinemotionalsensitivityandexpressiveness,withwomenandmenexperienc‐
ingsimilarbenefits,butwithwomenexpressingthemselvesmorestronglyinthisrespect.
Thesedifferencesmayalsohelptowardsexplainingwhychoralsingingshouldbeanactivity
whichtendstoattractmorewomenthanmen.Certainly,inthepresentsampleofchoirs,
womenwereinthemajority.Ontheotherhand,themeninthesampleareactivelyin‐
volvedinchoralsinging,andwhiletheyendorsethewellbeingbenefitsoftheactivity,itmay
bethatotherfactors,suchasthevalueplacedonmusicortheopportunitytosocialise,are
strongermotivatorsfortheirinvolvement.
ThefindingsfromtheWHOQOL‐BREFalsodemonstratethatalargemajorityofsingers
ratetheirqualityoflifeandtheirhealthasgoodorbetter.Thisisanimpressivefinding,es‐
peciallygiventhehighaverageageofthesample,andthefactthatalargeproportionof
peoplewereinretirement.Thismaypartlypointtothehealth‐promotingbenefitsofchoral
singing,butitshouldalsoberecognisedthatastheparticipantsgetolder,thesamplemay
increasinglyrepresentthemoreactiveandhealthymembersoftheiragegroup,asindivid‐
ualchoristersretireduetohealthandmobilityproblemsorafadingvoice.Itisnotable,
however,thataminorityofparticipantsdogivelowscoresontheWHOQOL‐BREFscales,
whichindicatethattheyarenotsatisfiedwiththeirqualityoflifeandhealth.FortheWHO
psychologicalwellbeingscale,approximately10percentofthesamplescoredbelowthe
scale’smidpointsuggestingthattheymaybecopingwithsignificantmentalhealthchal‐
lenges.Asmallsexdifferencealsoemergesonthisscalewithwomenreportingloweraver‐
agelevelsofwellbeing.
Afurtherfindingfromthissurveywhichhasnotbeenreportedsofarintheliteratureis
thesexdifferenceinthecorrelationbetweenperceptionsofthewellbeingbenefitsofsing‐
ingandself‐assessedgeneralpsychologicalwellbeing.Inthetotalsampleandforeach
countryindependently,asignificantpositivecorrelationwasobservedbetweenthetwo
scalesforwomen,butnotformen.Higherscoresonthesingingwellbeingscalewereasso‐
ciatedwithhighergeneralwellbeingscores.Correlationsareofcoursedifficulttointerpret
fromacausalperspective.Thisfindingmayindicatethatwomenwithhighergeneralwell‐
beingaremorelikelytoexperiencewellbeingbenefitsfromsinging,oritmaysuggestthat
theexperienceofwellbeingbenefitsfromsingingcontributestoabroadersenseofpsycho‐
logicalwellbeing.Itisimportantnottomaketoomuchofthecorrelationfound,however,
asitrepresentsnomorethanfivepercentofsharedvariance.Whatthefindingmore
stronglyindicatesisthatforwomenperceptionsofthebenefitsofsingingaresubstantially
independentofgeneralpsychologicalwellbeingasmeasuredbytheWHOQOL‐BREF.The
factthatnosignificantcorrelationemergedforthemenfurtherunderlinesthispoint.For
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thisreason,attentionwasgiveninthispapertoasubgroupconsideredtobeofparticular
interestinexploringthevalueofchoralsingingforwellbeingandhealth–namelythose
choristerswithlowgeneralwellbeingwhohighlyendorsedthebenefitsofsinging.
Withinthissubgroup,manyparticipantsdisclosedpersonalchallengesintheirlivesthat
havecompromisedtheirsenseofpersonalwellbeing.Nevertheless,itisclearthatparticipa‐
tioninsinginghasbeenofconsiderablebenefittothem.Moreimportantly,fromatheo‐
reticalpointofview,thechoristers’accountsprovidevaluableinsightsintoanumberof
possiblecausalmechanismslinkingsingingwithimprovedwellbeingandhealth.Thesefind‐
ingsareconsistentwithinsightscomingfrompreviousqualitativeresearchonsingingand
wellbeing(seeClift,Hancox,Staricoffetal.,2008),andreflectsomeoftheprocesseshigh‐
lightedintheworkofBaileyandDavidson(2005),Becketal.(2000)andKreutzetal.(2004).
Thisstudybuildsonpreviousresearch,however,inhighlightingthefactthatinanymain‐
streamchoirorchoralsociety,therewillbememberswithexistinghealthchallengesand
thatsingingisactivelyemployedinanumberofwaystohelpincopingwithoraddressing
thesechallenges.Thespecificmechanismsidentifiedshouldalsobethefocusofmorede‐
tailedresearchtoexploretheirsignificanceandinter‐connectednesswithinarangeofsing‐
inggroups.Howforexample,dothemechanismsofcontrolleddeepbreathingandfocused
attentionrelatetooneanotherandimpactuponexperiencesofwellbeing?Ifsingingis
widelyperceivedtohavebenefitsforbreathing,wouldsingingasanactivitybeusefulfor
peoplewithcompromisedlungfunction(e.g.asthmaorchronicobstructivepulmonarydis‐
ease)?ResearchbyEngen(2005)andarecentstudyreportedbyBonilha,Onofre,Vieira,
Prado,andMartinez(2008)providesomeevidenceinsupportofthispossibility.
Theanalysisofthemesinthequalitativedatareportedhereispreliminaryandconsiders
onlyafractionoftheavailableaccountsprovidedbythetotalsampleofchoristers.Afuller,
moresophisticatedanalysisiscurrentlyinprogressusingtheMAXQDA2007qualitative
analysissoftwareprogramme(http://www.maxqda.com),(seeClift,Hancox,Morrison,
Hess,Kreutz,&Stewart,2009forfindingsfromchoristers’accountsoftheeffectsofchoral
singingonphysicalhealth).Oncecompleted,thisanalysiswillallowforemergentthemesto
beorganisedintoamoredetailedmodelofmechanismsandbeneficialimpacts,andrelate
theinformationprovidedinresponsetoopenquestions,tothestructureddataavailable
fromtherestofthequestionnaire.
Inadditiontothisstudyhelpingtohighlightthewellbeingandhealthbenefitsassoci‐
atedwithchoralsinging,italsohasanumberofimplicationsforthewiderissueofencour‐
agingmorepeopletoparticipateinchoralsingingforthepotentialbenefitsitcanbringfor
wellbeing.
Itisclearthatmanyparticipantsinthestudyhavehadlongexperienceofinvolvement
inchoralsinging,andmanyhavehadsinginglessonsandcanplayaninstrument.Inaddi‐
tion,veryfewoftherespondentsweretoldaschildrenthattheycouldnotsing.Itisnot
difficulttoimagine,therefore,thattheabilityofpeopleintheirlateryearstobenefitfrom
groupsingingderivesinconsiderablepartfromtheskillandconfidencethatcomesfroma
life‐timeinvolvementwithmusicandsinging.Thissuggeststhatifsingingistobeapoten‐
tialresourceinlaterlifethattheearlyfoundationsarecrucial,asareopportunitiesthrough‐
outearlyandmid‐adulthoodtoengageincommunitysinging.Itisofinterestinthisrespect
thatinboththeBaileyandDavidson(2005)andSilber(2005)studies,inwhichspecialef‐
fortsweremadetorecruitdisadvantagedadultsintosingingprojects,thosemostreadyto
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engagedidhavesomebackgroundinmusic.Theissueofhavingagoodfoundationinmusic
andpositiveencouragementtosingappearstobeparticularlyrelevantforboys,asthere‐
sultsofthisstudyunderlinethewell‐knownpatternthatmenarelesslikelytobeinvolvedin
choralsingingthanwomen.
Althoughthisstudystronglyindicatestheimportanceofahistoryofengagementin
singing,thisisnottosaythatadultswithlittleornopreviousexperienceofsingingmight
notfinditenjoyableandbeneficialiftheyweretohavetheopportunityandencouragement
toparticipateintheirlocalcommunities.Andindeed,thereweremembersinthechoirs
studiedwithrelativelylittlepreviousexperienceofchoralsinging.Afurtherimplication,
therefore,isthatmoreeffortsareneededtoexpandcommunityopportunitiesforinvolve‐
mentinsinging,andtoeducateadultsaboutthevalueofsuchengagementonamusical,
personalandsociallevel,andalsoforthebenefitsitcanpotentiallybringforwellbeingand
health.
Thestudycontributestobuildinganevidencebasetosupportgreaterpublicinvestment
bylocalgovernmentandhealthauthoritiesincommunitymusicandsingingprovisioninthe
interestsofpromotingwellbeingandhealth,especiallyfrommidlifeonwards.Giventhat
throughouttheworld,increasedlifeexpectancyhasresultedinacontinuingdemographic
shifttowardslargerproportionsofelderlypeopleinnationalpopulations,thereisaneedto
lookafreshattheopportunitiesavailabletohelpencouragepeopletoremainphysically,
sociallyandmentallyactivepostretirement.Itisarguedthatsingingisavaluableactivityin
alloftheserespectsanddeservestobemorewidelyrecognisedassuch.
ACKNOWLEDGEMENTS:OurthanksareduetotheRogerDeHaanFamilyTrustforfunding
thatmadethisworkpossible;CanterburyChristChurchUniversityforsupportingthework
oftheSidneyDeHaanResearchCentreforArtsandHealth;ourcolleaguesandcollabora‐
tors:Dr.IanMorrison,Ms.BärbelHess,Dr.GunterKreutz,Prof.DonaldStewart,Mrs.Isobel
Salisbury,andnotleast,thechoralsingersinEngland,GermanyandAustraliawhoshared
theirexperiencesofchoralsingingwithus.

REFERENCES
Bailey,B.A.,&Davidson,J.W.(2002).Adaptivecharacteristicsofgroupsinging:Perceptions
frommembersofachoirforhomelessmen.MusicaeScientiae,6(2),221‐256.
Bailey,B.A.,&Davidson,J.W.(2003).Perceivedholistichealtheffectsofthreelevelsofmu‐
sicparticipation.InR.Kopiez,A.C.Lehmann,I.Wolther,&C.Wolf(Eds.),Proceedings
ofthe5thTriennialESCOMConference(pp.220‐23).HanoverUniversityofMusicand
Drama,Germany.
Bailey,B.A.,&Davidson,J.W.(2005).Effectsofgroupsingingandperformanceformarginal‐
izedandmiddle‐classsingers.PsychologyofMusic,33(3),269‐303.
Beck,R.J.,Cesario,T.C.,Yousefi,A.,&Enamoto,H.(2000).Choralsinging,performanceper‐
ception,andimmunesystemchangesinsalivaryimmunoglobulinAandcortisol.Music
Perception,18(1),87‐106.
94


Article
Bonilha,A.G.,Onofre,F.,Vieira,L.M.,Prado,M.Y.A.,&Martinez,J.A.B.(2008).Effectsof
singingclassesonpulmonaryfunctionandqualityoflifeofCOPDpatients.Interna‐
tionalJournalofCOPD,4(1),1‐8.
Clift,S.,&Hancox,G.(2001).Theperceivedbenefitsofsinging:Findingsfrompreliminary
surveysofauniversitycollegechoralsociety.JournaloftheRoyalSocietyforthePro‐
motionofHealth,121(4),248‐256.
Clift,S.,Hancox,G.,Morrison,I.,Hess,B.,Stewart,D.,&Kreutz,G.(2008).Choralsinging,
wellbeingandhealth:Findingsfromacross‐nationalsurvey.Canterbury:Canterbury
ChristChurchUniversity.Retrieved23June2009fromhttp://www.canterbury.ac.uk/
centres/sidney‐de‐haan‐research.
Clift,S.,Hancox,G.,Morrison,I.,Hess,B.,Stewart,D.,&Kreutz,G.(August2009).Whatdo
singerssayabouttheeffectsonchoralsingingonphysicalhealth?Paperpresentedat
the7thTriennialConferenceofEuropeanSocietyfortheCognitiveSciencesofMusic,
UniversityofJyväskylä,Finland, August12‐16.
Clift,S.,Hancox,G.,Staricoff,R.,&Whitmore,C.(2008).Singingandhealth:Asystematic
mappingandreviewofnon‐clinicalresearch.Canterbury:CanterburyChristChurch
University.Retrieved23June2009fromhttp://www.canterbury.ac.uk/centres/sidney
‐de‐haan‐research.
Cohen,G.D.,Perlstein,S.,Chapline,J.,Kelly,J.,Firth,K.M.,&Simmens,S.(2006).Theimpact
ofprofessionallyconductedculturalprogramsonthephysicalhealth,mentalhealth,
andsocialfunctioningofolderadults.TheGerontologist,46(6),726‐734.
EngenR.L.(2005).Thesinger'sbreath:Implicationsfortreatmentofpersonswithemphy‐
sema.JournalofMusicTherapy,42(1),20‐48.
Hawthorne,G.,Herrman,H.,&Murphy,B.(2006).InterpretingtheWHOQOL‐Bref:Prelimi‐
narypopulationnormsandeffectsizes.SocialIndicatorsResearch,77(1),37‐59.
Houston,D.M.,McKee,K.J.,Carroll,L.,&Marsh,H.(1998).Usinghumourtopromotepsy‐
chologicalwellbeinginresidentialhomesforolderpeople.AgingandMentalHealth,2
(4),328‐332.
Kreutz,G.,Bongard,S.,Rohrmann,S.,Grebe,D.,Bastian,H.G.,&Hodapp,V.(2004).Effects
ofchoirsingingorlisteningonsecretoryimmunoglobulinA,cortisolandemotional
state.JournalofBehavioralMedicine,27(6),623‐635.
Kuhn,D.(2002).Theeffectsofactiveandpassiveparticipationinmusicalactivityonthe
immunesystemasmeasuredbysalivaryimmunoglobulinA(SigA).JournalofMusic
Therapy,39(1),30‐39.
Power,M.,Harper,A.,Bullinger,M.,&TheWorldHealthOrganizationQualityofLifeGroup
(1999).TheWorldHealthOrganizationWHOQOL‐100:Testsoftheuniversalityofqual‐
ityoflifein15differentculturalgroupsworldwide.HealthPsychology,18(5),495‐
505.
Silber,L.(2005).Barsbehindbars:Theimpactofawomen’sprisonchoironsocialharmony,
MusicEducationResearch,7(2),251‐271.
Skevington,S.,Lofty,M.,&O’Connell,K.A.(2004).TheWorldHealthOrganization’s
WHOQOL‐BREFqualityoflifeassessment:Psychometricpropertiesandresultsofthe
internationalfieldtrial.AReportfromtheWHOQOLGroup.QualityofLifeResearch,
13,299‐310.

95


Article
Watanabe,H.(2005).ChangingadultlearninginJapan:Theshiftfromtraditionalsingingto
karaoke.InternationalJournalofLifelongEducation,24(3),257‐267.
WHO(1946).TheWHOdefinitionofhealthistobefoundinthePreambletotheConstitu‐
tionoftheWorldHealthOrganizationasadoptedbytheInternationalHealthConfer‐
ence,NewYork,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1948.
ForfurtherinformationabouttheworkoftheSidneyDeHaanResearchCentreforArtsand
Health,see:http://www.canterbury.ac.uk/centres/sidney‐de‐haan‐research/index.asp

STEPHENCLIFT,FRSPH,isProfessorofHealthEducationintheFacultyofHealthandSocial
Care,CanterburyChristChurchUniversity,co‐DirectoroftheSidneyDeHaanResearchCen‐
treforArtsandHealthandDirectorofacharitablecompany‘SingForYourLifeLtd’which
promotesopportunitiesforcommunitymusicandsingingamongelderlypeople.Contact:
SidneyDeHaanResearchCentreforArtsandHealth,UniversityCentreFolkestone,Folke‐
stone,KentCT201JG,UK.[E‐mail:Stephen.clift@canterbury.ac.uk]
GRENVILLEHANCOX,MBE,FRSA,isProfessorofMusicintheFacultyofArtsandHumani‐
ties,CanterburyChristChurchUniversity,UniversityDirectorofMusicandco‐Directorofthe
SidneyDeHaanResearchCentreforArtsandHealth.Heisachoralconductorandclarinet
player.Contact:SidneyDeHaanResearchCentreforArtsandHealth,UniversityCentre
Folkestone,Folkestone,KentCT201JG,UK.[E‐mail:Grenville.hancox@canterbury.ac.uk]
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