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

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Over 600 choral singers drawn from English choirs completed the WHOQOL-BREF questionnaire to measure physical, psychological, social and environmental wellbeing, and a twelve-item wellbeing and choral singing scale. They also provided accounts of the effects of choral singing on quality of life, wellbeing and physical health in response to open questions. High average scores were found on all WHOQOL-BREF scales, and a high degree of consensus emerged on the positive benefits of choral singing. A significant sex difference was found on the choral singing scale, with women endorsing the wellbeing effects of singing more strongly than men. This finding replicates the earlier result reported by Clift & Hancox (2001) in a pilot study with a single choral society. Low correlations were found between the WHOQOL-BREF psychological wellbeing scale and perceptions of wellbeing associated with singing. However, examination of written accounts to open questions from participants with relatively low psychological wellbeing and strong perceptions of positive benefits associated with choral singing served to identify four categories of significant personal and health challenges. They also revealed six generative mechanisms by which singing may impact on wellbeing and health.
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Journal of Applied Arts and Health | Volume 1 Number 1
© 2010 Intellect Ltd Article. English language. doi: 10.1386/jaah.1.1.19/1
JAAH 1 (1) pp. 19–34 Intellect Limited 2010
19
KEYWORDS
choral singing
psychological
wellbeing
WHOQOL-BREF
cross-national survey
STEPHEN CLIFT
Canterbury Christ Church University
GRENVILLE HANCOX
Canterbury Christ Church University
IAN MORRISON
Canterbury Christ Church University
BÄRBEL HESS
Canterbury Christ Church University
GUNTER KREUTZ
Carl von Ossietzky University
DON STEWART
Griffith University
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 environ-
mental wellbeing, and a twelve-item ‘wellbeing and choral singing scale’.
They also provided accounts of the effects of choral singing on quality of life,
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Stephen Clift | Grenville Hancox | Ian Morrison | Bärbel Hess | Gunter Kreutz | Don Stewart
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wellbeing and physical health in response to open questions. High average
scores were found on all WHOQOL-BREF scales, and a high degree of consen-
sus emerged on the positive benefits of choral singing. A significant sex dif-
ference 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.
INTRODUCTION
A recent systematic review (Clift, Hancox, Staricoff & Whitmore 2008)
identified 35 research reports addressing connections between singing,
wellbeing and health in non-clinical samples and contexts, published
since the early 1960s. The literature is highly diverse theoretically and
methodologically, and low levels of cross-citation indicate an aca-
demic field in an early stage of development. Nevertheless, a number
of important findings have emerged from the more substantial studies
undertaken to date.
A range of small scale qualitative studies using ethnographic,
interview and focus group techniques with diverse samples have
shown that singers commonly report a wide range of social, psy-
chological, spiritual and health benefits associated with singing
(e.g. Bailey & Davidson 2005; Silber 2005). These findings are sup-
ported by questionnaire surveys in which choral singers are asked
to respond to a range of statements about the effects and benefits
of singing. Beck, Cesario, Yousefi & Enamoto (2000), for example,
report that 67% of semi-professional choral singers in their survey
agreed or strongly agreed that ‘Singing has contributed to my per-
sonal wellbeing’; Clift & Hancox (2001) report that 71% of singers in
a university choral society agreed or strongly agreed that singing was
beneficial for their ‘mental wellbeing’, and Hillman (2002) reports a
significant perceived improvement in ‘emotional wellbeing’ among
participants singing in a large community choir. A number of stud-
ies have also shown significant improvements in affective state after
singing, using previously validated mood questionnaires (e.g. Kreutz,
Bongard, Rohrmann, Grebe, Bastian & Hodapp 2004; Unwin, Kenny
& Davis 2002).
On a more objective level, a range of studies has assessed the
impact of singing on physiological variables assumed to have well-
being and health implications. Several studies, for example, have
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Choral singing and psychological wellbeing
21
assayed levels of immunoglobulin A in saliva taken from participants
before and after singing, and reported significant increases, pointing
to enhanced immune system activity (e.g. Beck et al. 2000; Kuhn 2002;
Kreutz et al. 2004; Beck, Gottfried, Hall, Cisler & Bozeman 2006).
Few studies have employed standardised measures of wellbeing and
health, or objective indicators of health status, in assessing the impact of
active participation in singing. However, two quasi-experimental stud-
ies have reported positive health impacts from group singing for eld-
erly people. Houston, McKee, Carroll & Marsh (1998) report significant
reductions in assessed levels of anxiety and depression in nursing home
residents using common standardised measures, following a four-week
programme of singing, and Cohen, Perlstein, Chapline, Kelly, Firth &
Simmens (2006) found significant improvements in both mental and
physical health in a group of independent elderly people participating
over one year in an especially established community choir.
Despite the interest of these studies empirically, many of them are
small-scale and essentially exploratory and only one study has specifi-
cally built upon and independently replicated a previous study (Kreutz
et al. 2004). Further major shortcomings in the literature are the lack of
a common conceptual understanding of wellbeing and health, and the
absence of a comprehensive theoretical framework that elucidates the
key contextual factors and causally generative mechanisms through
which singing can be beneficial for wellbeing and health (Harré 1972;
Pawson & Tilley 1997).
The present study aims to address these shortcomings by build-
ing on the previous work of Clift & Hancox (2001) through a large-
scale, cross-national survey assessing choral singers’ perceptions of
the effects of singing in England, Germany and Australia.
In the earlier study, a structured questionnaire was used to assess
experiences and perceived benefits associated with choral singing.
This was developed on the basis of an initial qualitative survey,
which gathered written accounts in response to open-ended ques-
tions. Factor analysis of the structured questionnaire data produced
a six-factor solution, with a substantial initial factor concerned with
‘wellbeing and relaxation.’ A scale based on this first factor had high
internal consistency, and a statistically significant sex difference was
found – with women indicating a stronger sense of wellbeing asso-
ciated with singing than men. Surprisingly, no other study iden-
tified in the systematic review, that included both sexes, reported
comparisons between responses of men and women. Two specific
objectives of the current study were to devise a new scale based on
the first factor identified by the Clift & Hancox study, and to deter-
mine whether the sex difference found in this study was confirmed
in larger cross-national investigation.
In terms of grounding the study in an established framework for
conceptualising and measuring health and wellbeing, it was considered
appropriate to work on the basis of the World Health Organization’s
definition of health (WHO 1946), and the WHO Quality of Life project
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(Power, Harper & Bullinger 1999). For the WHO, health is defined as
follows: ‘Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity’ (WHO 1946).
Quality of life is defined as: ‘A person’s perception of his/her position
in life within the context of the culture and value systems in which they
live, and in relation to their goals, expectations, standards, and con-
cerns’ (WHOQOL Group 1994).
The WHOQOL project has produced a range of validated quality
of life instruments for use in cross-national research. The WHOQOL-
BREF was developed for use in large-scale surveys to avoid too much
demand on participants completing a lengthy questionnaire. A con-
siderable body of research, in many different national contexts, has
demonstrated high levels of factorial stability, internal consistency,
reliability and discriminative validity. The WHOQOL-BREF was con-
sidered particularly appropriate for the current study as versions of
the scale are available for use in the UK, Germany and Australia, and
published data are available from previous studies with UK, German
and Australian samples (see e.g. Skevington, Lofty & O’Connell 2004;
Hawthorne, Herrman & Murphy 2006).
The present paper reports on findings from English choirs and
choral societies participating in the study. A fuller account of the sur-
vey and findings from the three national groups can be found in Clift,
Hancox, Morrison, Hess, Stewart & Kreutz (2008).
METHOD
Aim
To assess the relationships between perceived experiences and effects
associated with choral singing and broader dimensions of health-
related quality of life (as assessed by the WHOQOL-BREF) among
singers in English choirs and choral societies.
Objectives
1. To develop a new scale to assess experienced wellbeing effects
associated with choral singing.
2. To examine differences between men and women in their experi-
ences of singing using this scale.
3. To further explore the value of choral singing for wellbeing, draw-
ing on qualitative accounts gathered through written answers to
open questions.
Procedure
Questionnaires were distributed to members of participating choirs at
the start of rehearsals during May 2007 for completion at home and
return in a sealed envelope at a subsequent rehearsal.
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Choral singing and psychological wellbeing
23
Questionnaire
The questionnaire contained three main sections.
Section 1 asked for personal data (e.g. sex, age, partnership status,
employment) and experience of singing and music-making (e.g. time
in the choir, ever auditioned, singing lessons).
Section 2 included three open questions on the effects of singing
on quality of life, wellbeing and health, followed by a structured 24
item ‘Effects of Choral Singing’ questionnaire with a five-point ‘agree-
disagree’ response format. The 24 statements on the effects of singing
were based on instruments used in two previously published studies
with choral societies. Clift & Hancox (2001) developed a question-
naire based on an initial detailed qualitative analysis of choral singers’
views on the benefits of singing and impact on wellbeing and health.
Analysis identified a substantial component concerned with ‘well-
being and relaxation’. The highest loading items on this component
were selected for this survey instrument. Additional items were taken
from the ‘Singers’ Emotional Experiences Scale’ developed by Beck et
al. (2000). All items used in the earlier studies were positively worded.
To counteract possible response bias, half of the items included in the
current survey instrument were positively worded, e.g.: ‘I find singing
helps me to relax and deal with the stresses of the day’ and half were
negatively worded e.g.: ‘I wouldn’t say that singing is an activity that
has made me physically healthier’.
Section 3 contained the WHOQOL-BREF – the World Health
Organization Quality of Life Questionnaire (short version). The
WHOQOL-BREF consists of 24 questions answered on five-point
scales, which serve to measure four dimensions of life quality: phys-
ical (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 environmental (e.g. How satisfied are you with the con-
ditions of your living place?).
Sample
The sample consisted of 591 choral singers drawn from eight choral
societies and choirs in the South East and North East of England.
Response rates by choir ranged from 50–70%. The sample was sup-
plemented by a further 42 choral singers from across the South East of
England acting as volunteers in the Silver Song Club Network (www.
singforyourlife.org.uk), giving a sample of 633 choristers. See Figure 1
for an image of one of the participating choirs.
Analysis
Numerical data were analysed using SPSS PC+ Version 16. Given
the finding of a significant sex difference in responses to choral sing-
ing found by Clift and Hancox, analyses were conducted separately
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for men and women and for the total sample. Principal Components
Analysis was used to analyse the structure of the choral singing items,
resulting in a single perceived effects of choral singing scale. Pearson
correlations were used to analyse the relationships between the sing-
ing scale and WHO measures. A preliminary qualitative analysis was
undertaken with a small sub-sample of singers reporting high impact
of singing on wellbeing, but low scores on the WHOQOL-BREF psy-
chological wellbeing scale. Written answers to open questions on the
questionnaire were analysed thematically to identify sources of chal-
lenge to wellbeing and potential mechanisms linking participation in
singing with improved wellbeing and health.
RESULTS
The average age of choristers was relatively high (mean = 61 years),
and women outnumbered men 3:1 (77% versus 23%).
The 24 effects of choral singing items were subject to Principal
Components Analysis separately for males and females and for
the total sample. A strong first component emerged with substan-
tial loadings from twelve items for each sex group (see Table 1). The
main themes defining this factor were: improved mood, enhanced qual-
ity of life, greater happiness, stress reduction, and emotional wellbeing.
Substantially the same pattern was found for males and females analysed
separately. These twelve items (eight positive and four negative) were
Figure 1: The Silver Singers, The Sage Gateshead: one of the choirs participating in the English arm
of the survey. (Reproduced with the permission of The Sage Gateshead, Silver Singers.)
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Choral singing and psychological wellbeing
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used to construct a single measure of the perceived effects of singing
on wellbeing (Cronbach alpha 0.9 for both sexes). A large majority
of choristers agreed or strongly agreed with the positive items, and
disagreed or strongly disagreed with the negative items, so that while
the scale has a potential range of 12 to 60, the actual range is from
27 to 60 with a mean of 49.7 and standard deviation of 6.8. The high
scores on this scale confirm that a large majority of people singing in
choral societies agree that the effects of singing are generally positive
in terms of perceived enhancement of wellbeing. A significant sex dif-
ference was found, with women showing higher scores: men mean
= 48.0, s.d. = 6.9; women mean = 50.2, s.d. = 6.7; t = –3.39, p< 0.001
(2-tailed). This finding replicates the earlier finding by Clift & Hancox
(2001) in their initial study of a singing choral society.
The WHOQOL-BREF was scored in accordance with established
procedures to give measures of physical, psychological, social and envi-
ronmental quality of life. In line with previous research documenting
satisfactory reliability and validity, Cronbach alpha values were very
high for all scales, and mean scores on each scale were significantly
lower for participants reporting ‘long-term health problems’ compared
with those who did not (data not reported here – see Clift et al. 2008).
Total
sample
English
Men
English
Women
Helps make me a happier person .76 .716 .78
Gives a positive attitude to life .75 .74 .74
Helps improve wellbeing .75 .68 .77
Releases negative feelings .75 .74 .75
A lot happier afterwards .74 .74 .73
Positively affects quality of life .73 .66 .75
Mood more positive .71 .68 .71
Doesn’t give me a ‘high’ –.71 –.71 –.71
Doesn’t release negative feelings –.70 –.72 –.68
Relaxing and helps with stress .68 .61 .70
Doesn’t help emotional wellbeing –.68 –.69 –.68
No deep significance –.65 –.65 –.65
Variance accounted for 51.4% 48.4% 51.9%
Pair-wise deletion: Total Sample = 604–616; Men, N = 136–139; Women, N = 468–477.
Table 1: Effects of choral singing items first principal component.
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The focus of interest in this paper is on the psychological scale,
which is made up of six items scored from 1–6. The scale has a range
of 6–30, with a midpoint of 18. A majority of people in the total sam-
ple scored well above 18 indicating good to excellent psychological
wellbeing, but approximately 10 per cent of respondents had low
scores which could indicate borderline/mild mental health difficulties.
Interestingly, women scored slightly lower on this scale when com-
pared with men: men mean = 23.6, s.d. = 2.7; women mean = 23.0,
s.d. = 2.9; t = 2.13, p < 0.05 (2-tailed).
Given the sex differences apparent for the effects of choral singing
scale and the WHO psychological scale, correlations between the two
measures were calculated for sexes separately. A significant correla-
tion emerged for women (r = 0.27, p < 0.01), but not for men. These
results suggest that women with higher levels of general psychologi-
cal wellbeing are more likely to express benefits from singing, but
that this is not the case for men. However, the correlation for women
is very low, with a shared variance of just under 7 per cent and the
effective lack of a relationship suggests that some people with rela-
tively low general psychological wellbeing nevertheless experience
high levels of perceived benefit from singing. The converse may also
be the case.
In order to explore this further, scores on the psychological well-
being and effects of singing scales were recoded into three groups
at the 33rd and 67th percentiles and then cross-tabulated. This gave
nine fairly evenly sized sub-groups (Table 2). Respondents in the
lowest third on the psychological wellbeing scale, and the highest
third on the effects of singing scale were considered of particu-
lar interest for understanding the impact of singing on wellbeing
(N = 58, 48 women, 9 men, 1 sex not given). These participants
essentially report a relatively low level of general psychological
wellbeing as assessed by the WHOQOL-BREF, and yet report a
strong wellbeing effect associated with their participation in choral
singing. Their written accounts were examined for evidence of the
factors which might explain their low level of wellbeing, and for
Effects of singing
Low third Mid third High third Total
Psychological
wellbeing
Low third 90 57 58 205
Mid third 78 51 70 199
High third 34 56 83 173
Total 202 164 211 577
Table 2: Cross tabulation of psychological wellbeing and effects of choral
singing (English sample).
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insights into the ways in which singing may influence wellbeing in
a positive way for this group.
Health and personal issues within this group
The responses of this group to the open questions were examined to gain
insights into their personal circumstances and the ways in which they
accounted for the impact of singing on their wellbeing. From the infor-
mation offered by this group, approximately one quarter stand out as
having particular challenges in their lives. It should be born in mind that
the questionnaire did not specifically ask participants to provide infor-
mation on personal challenges in their lives, which could have a detri-
mental impact on their subjective wellbeing. The examples given below
should therefore be understood as indicative of such challenges within
this group rather than a definitive picture for the sub-sample. Such
accounts are invaluable, however, for providing insights into the mean-
ing of the quantitative data gathered, and for giving a concrete sense of a
range of issues accounting for low psychological wellbeing scores.
Three people disclosed a history of mental health problems, and
explained how singing helped in the process of recovery and sus-
taining a sense of mental wellbeing. The issues of self-esteem and
self-belief are especially emphasised in the first example, and the
second stresses the impact of singing on mood.
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, followed by months of
time needing support for depression and lack of self-confidence.
Being a member of this particular choir has lifted my self-esteem
again and restored self-belief.
Female, 54
Keeps me happy. Is an excellent hobby. Sociable activity. Need
no special equipment – easy to carry voice around. I have clinical
depression, so it really helps me (original emphasis).
Female, 36
Three people were affected by significant family/relationship prob-
lems, which were clearly a source of significant demand on their
personal resources, and affected their own sense of psychological
wellbeing. In the following examples, the effects of singing on mood,
and the distraction it provides are mentioned.
As a carer of two relatives stricken with schizophrenia, have
suffered from reactive depression. […] 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.
Female, 70
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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.
Female, 65
Seven people reported being affected by significant physical health
issues or disability, which in turn clearly impacted on their psycho-
logical wellbeing. The following accounts provide tangible examples
of the interplay between body and mind – physical and mental
wellbeing – and point to important ways in which the activity of singing
can be beneficial in the processes of recovery and rehabilitation.
It plays a significant part in my emotional health and well-
being. I find music uplifting. When recovering from a major
stroke, singing was one of the ways of lifting my spirits out of
depression.
Male, 65
Satisfies a love of music, improves social interaction. Recently
gave me the opportunity to perform in New York’s Carnegie
Hall. Increased social life. Singing with ‘Silver Song Group’ is
very satisfying i.e. helping people older or less fortunate than
I to enjoy a slightly better quality of life if only for a couple
of hours. I suffer from a lung problem and singing is a useful
exercise.
Male, 72 (chronic obstructive pulmonary disease,
blood pressure, cholesterol and allergy/
sinus problems, all treated by medication)
Three people had been recently bereaved and this is, of course, to
be expected given the high average age of participants in the sam-
ple. The sense of social and emotional support which membership
of a choir, and other musical groups, can provide following the loss
of a significant person is very tangibly expressed in the following
accounts.
My husband died 3 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 Silver
Singers and the other silver activities – ukulele, guitar, ocarina/
tin whistle. I think choral singing is fantastic for emotional
health.
Female, 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.
Female, 59
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Generative mechanisms linking singing with wellbeing
The accounts given by this group are also replete with intuitive hypotheses
regarding generative mechanisms linking choral singing with wellbeing
and health. A common thread running through these ‘lay constructions’
is the idea that various component elements of singing, and also being
part of a singing group, exert a counteractive influence on factors poten-
tially detrimental to wellbeing and health. Six commonly recurring pro-
posed mechanisms are identified here with illustrative quotations.
Choral singing engenders happiness and raised spirits, which counter-
act feelings of sadness and depression. In the first example, the linkage
is also made between experiences of happiness and health and well-
being more broadly. The second account suggests that when singing
‘you cannot be sad for long’; this highlights the process of counter-
action at play in mood and emotional states.
I am never happier than when I am singing. This can only have a
positive effect on my health and wellbeing.
Female, 69
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.
Female, 52
Singing involves focused concentration, which blocks preoccupation with
sources of worry. Singing is therefore a source of distraction from on-
going concerns, and participants commonly referred to being able to
forget any troubles they had, at least for a short time, while singing.
Singing in a choir puts troubles ‘on hold’, as concentrating on
the music requires all one’s attention.
Female, 65
Imperative to my wellbeing. It lifts me out of ongoing stresses,
and calls for attention to numerous details thereby absorbing me
completely.
Female, 54
Singing involves deep controlled breathing, which counteracts anxiety. It is
obvious that singing as an activity is powered by the lungs, and pro-
motes conscious awareness of depth and control of breathing. Breathing
is also highly responsive to emotional states, and anxiety and stress can
lead to rapid and shallow breathing, and relaxation can be induced
by making an effort to breathe more deeply and slowly. The follow-
ing respondents recognise the importance of this connection between
breathing and emotion, and the second account is interesting in high-
lighting the use made of controlled breathing exercises in the control of
anxiety in daily life.
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Deep breathing, essential for singing, is one method of helping
with signs of anxiety and stress.
Female, 70
Lung capacity and stamina much greater. Made me use breath-
ing exercises as a technique to reduce anxiety when in distress-
ing situations.
Female, 65 (with chronic back and leg
pain due to a road traffic accident ten years ago)
Choral singing offers a sense of social support and friendship, which amel-
iorate feelings of isolation and loneliness. Just as singing is inherently
dependent upon breathing, so membership of a group is intrinsic to
choral singing, and group membership per se can be helpful in pro-
moting a sense of wellbeing, as the following examples show.
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 gen-
eral wellbeing.
Female, 78
The choir has been a lifesaver for me. I live alone and have no
family. I belong to two choirs and enjoy them both.
Female, 69
Choral singing involves education and learning, which keeps the mind
active and counteracts decline of cognitive functions. This factor is espe-
cially important given the high average age of the participants, and
the following accounts highlight how significant singing can be in
keeping ‘the brain active’.
I think it is good at this age, to learn and remember new words
every week, keeping the brain active, in all, it gives you some-
thing to look forward to, and aim for, when everyone else thinks
you’re passed it! […] You feel that you’re more than somebody’s
old Gran! It has a great effect, and it keeps you young, and to
make the best of your appearance.
Female, 68
Apart from the relaxation benefits, I believe that for me, aged 57,
keeping the brain active and having to concentrate for long peri-
ods will delay if not completely prevent senile dementia!
Female, 57
Choral singing involves a regular commitment to attend rehearsal, which
motivates people to avoid being physically inactive. The motivational
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31
aspects of being a member of a group committed to practicing in order
to achieve a good standard in performance are highlighted in the fol-
lowing accounts.
Making the effort to attend choir practice on wet, cold evenings
instead of watching TV must be better for health.
Female, 69
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.
Female, 65
DISCUSSION
A small number of previous studies have documented potential well-
being and health benefits associated with group singing. These earlier
studies are diverse and often small-scale and exploratory, with little
consensus in theoretical perspectives and appropriate measures, and
include only one example of a planned replication to validate previous
findings (Kreutz et al. 2004).
This study contributes to a process of addressing these shortcomings
by undertaking a large-scale, cross-national survey of singers in choirs
in England, Germany and Australia, based on the WHO definition of
health, and using a rigorously developed cross-national instrument for
assessing health-related quality of life, the WHOQOL-BREF. It builds
upon the earlier surveys of Clift & Hancox (2001) and Beck et al. (2000)
in producing a simple and reliable measure of the perceived effects of
choral singing on wellbeing. Choristers’ perceptions of the effects of cho-
ral singing can therefore be examined in relation to a broader validated
framework for the assessment of wellbeing in four dimensions.
In this paper an analysis of data from over 600 English choristers is
presented. The results confirm previous findings from Clift & Hancox,
(2001) and Beck et al. (2000) that a large majority of choristers per-
ceive the experience of singing to be a positive and beneficial one. In
itself this is not too surprising given that choral singing is a voluntary
activity people undertake through a love of music and the pleasure
they derive from it. Nevertheless, there is considerable variation in
the extent to which singers endorse the idea that singing has ben-
efits for their wellbeing and even health, and an interesting finding
from the survey is that such perceptions are gendered, with women
significantly more likely to report benefits compared with men. This
difference, originally reported by Clift & Hancox (2001), has not been
explored in any of the previous research on singing and wellbeing,
even where samples have included both men and women. The find-
ing may contribute to understanding why choral societies commonly
have more female members than males, and should certainly be a
focus for further research.
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Stephen Clift | Grenville Hancox | Ian Morrison | Bärbel Hess | Gunter Kreutz | Don Stewart
32
The findings from the WHOQOL-BREF also demonstrate that a
large majority of singers rate their quality of life as good or better.
However, a minority do give low scores, which indicate that they
are not satisfied with their quality of life. For the WHO psychologi-
cal wellbeing scale, approximately 10 per cent of the sample scored
below the scale’s midpoint; this suggests that they may be coping
with significant challenges to their mental wellbeing. A small gen-
der difference emerges on this scale with women reporting lower
average levels of wellbeing. This is in line with previous large-scale
normative studies using the WHOQOL-BREF, which report signifi-
cantly lower means for women compared with men on this scale
(Skevington et al. 2004).
When choristers’ perceptions of the effects of singing are exam-
ined in relation to the WHO psychological scale, a statistically sig-
nificant correlation emerges for women only, but the value is very
low with 7 per cent shared variance. For both sexes, therefore, the
two scales show a high degree of independence. This is interesting
because it implies, for instance, that some choristers with relatively
low WHO scores are nevertheless strongly endorsing benefits from
choral singing.
This was pursued by identifying those choristers in the bottom
third of the WHO psychological score range, but with choral singing
scale scores in the top third of the range (N = 58), and then examin-
ing the qualitative data gathered for insights into their personal health
circumstances, and the ways in which they explained their experience
of the positive impacts of choral singing.
At this point the results begin to come to life as many par-
ticipants in this group disclosed personal challenges in their lives
that have clearly compromised their general sense of wellbeing.
Nevertheless, it is also clear that participation in singing has been
of considerable benefit to them, in diverse ways, depending upon
their particular circumstances and difficulties. More importantly,
however, the choristers’ accounts provide valuable insights into
various generative mechanisms (Harré 1972) that can serve to pro-
mote a sense of wellbeing, by counteracting processes potentially
detrimental to health.
This paper reports on a small fraction of the qualitative data gath-
ered in this study, and further analysis will reveal whether the quan-
titative patterns and issues emerging from this preliminary analysis
are found among choristers in German and Australian choirs too. A
fuller, systematic analysis of the qualitative data is underway using
the MAXQDA2007 software package for qualitative data analysis (see:
http://www.maxqda.com/). Guided by a realist philosophical perspec-
tive, this analysis is focused towards constructing a grounded theory
account of ‘context-mechanism-outcome configurations’ (Pawson &
Tilley 1997), which can explain the power of singing in maintaining
and promoting wellbeing and health, and provide a foundation for
further research.
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Choral singing and psychological wellbeing
33
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34
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SUGGESTED CITATION
Clift, S., Hancox, G., Morrison, I., Hess, B., Kreutz, G. and Stewart, D. (2010),
‘Choral singing and psychological wellbeing: Quantitative and qualitative
findings from English choirs in a cross-national survey’, Journal of Applied
Arts and Health 1: 1, pp. 19–34, doi: 10.1386/jaah.1.1.19/1
CONTRIBUTOR DETAILS
Stephen Clift is Professor of Health Education at Canterbury Christ Church
University, and Research Director of the Sidney De Haan Research Centre for
Arts and Health, Folkestone, United Kingdom.
Grenville Hancox is Professor of Music at Canterbury Christ Church
University, and Director of the Sidney De Haan Research Centre for Arts
and Health, Folkestone, United Kingdom.
Ian Morrison is a Senior Researcher within the Sidney De Haan Research
Centre for Arts and Health, Folkestone, United Kingdom.
Bärbel Hess is an Associate of the Sidney De Haan Research Centre for Arts
and Health, Folkestone, United Kingdom.
Donald Stewart is Professor of Health Promotion, School of Public Health,
Griffith University, Brisbane, Australia.
Gunter Kreutz is Professor of Systematic Musicology, Oldenburg University,
Oldenburg, Germany.
Contact: Sidney De Haan Research Centre for Arts and Health, University
Centre Folkestone, Mill Bay, Folkestone, Kent CT20 1JG, United Kingdom.
E-mail: stephen.clift@canterbury.ac.uk
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The choir is a community with rules, relationships and purpose. When located in a prison, it takes on the therapeutic function of providing a protected space for expression and a context for reframing, even when its manifest goal is educational. This paper documents the establishment, by a professional musician and music educator, of a multi-vocal choir for women inmates in an Israeli prison. It examines the many aspects of the multi-vocal endeavour that address the therapeutic needs of prisoners at an individual and interpersonal level, and considers the potential as well as the limits of such a choral project as a therapeutic intervention.
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A questionnaire survey was carried out in the Glasgow area in Scotland amongst people over the UK age of statutory retirement participating in the community arts project Call That Singing?, with a return rate of 75 per cent. The results demonstrate that participatory singing was perceived as providing worthwhile physical, emotional, social and cultural benefits. Participants reported no overall deterioration in their perception of health over the 12-year period since the project started: this is despite the high recorded incidence of illness and bereavement during the same period to be expected of people of this age. Participants perceived statistically significant improvements to their general quality of life, emotional wellbeing (including a marginally significant shift in self-confidence) and understanding of singing. They also reported improvements to their social well-being, although these were not statistically significant. The research shows that participatory singing is making a contribution to the cultural economy and fabric of the city of Glasgow, illustrated by the increased number of visits to theatres, shows and museums and the increased level of active participation in cultural life.
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Since publication use of the WHOQOL-Brèf has rapidly risen. However, as yet no population norms have been published as a reference point against which researchers can interpret their findings. This study provides preliminary population norms for this purpose. Randomly sampled community residents from two studies were pooled and used to examine the properties of the WHOQOL-Brèf by age group, gender and health status. The results showed that general norms for the WHOQOL-Brèf domains were 73.5 (SD=18.1) for the Physical health domain, 70.6 (14.0) for Psychological wellbeing, 71.5 (18.2) for Social relationships and 75.1 (13.0) for the Environment domain. In general scores declined slightly by age group. For females scores were stable across the lifespan with an accelerated decline after the age of 60years. Males exhibited a more consistent and even decline across the lifespan. There were significant differences in WHOQOL-Brèf scores when reported by health status, with those in poor health obtaining scores that were up to 50% lower than those in excellent health. Effect sizes between different health status levels are reported. These preliminary norms and effect sizes may be used as reference points for interpreting WHOQOL-Brèf scores. They provide additional information to the numerous national studies already reporting on the validity of the WHOQOL-Brèf.