Daisy Fancourt

Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers

There is growing evidence that psychosocial interventions can have psychological benefits for people affected by cancer, including improved symptoms of mental health and wellbeing and optimised immune responses. However, despite growing numbers of music interventions, particularly singing, in cancer care, there is less research into their impact. We carried out a multicentre single-arm preliminary study to assess the impact of singing on mood, stress and immune response in three populations affected by cancer: carers (n = 72), bereaved carers (n = 66) and patients (n = 55). Participants were excluded if pregnant or if they were currently being treated with chemotherapy, radiotherapy or oral immunosuppressive drugs. Participants were regular participants in five choirs across South Wales and took part in one hour of group singing. Before and after singing, visual analogue mood scales, stress scales and saliva samples testing for cortisol, beta-endorphin, oxytocin and ten cytokines were taken. Across all five centres and in all four participant groups, singing was associated with significant reductions in negative affect and increases in positive affect (p < .01) alongside significant increases in cytokines including GM-CSF, IL17, IL2, IL4 and sIL-2rα (all p < .01). In addition, singing was associated with reductions in cortisol, beta-endorphin and oxytocin levels. This study provides preliminary evidence that singing improves mood state and modulates components of the immune system. Further work is needed to ascertain how this differs for more specific patient groups and whether repeat exposure could lead to meaningful, longitudinal effects.

Low-stress and high-stress singing have contrasting effects on glucocorticoid response

Performing music in public is widely recognized as a potentially stress-inducing activity. However, despite the interest in music performance as an acute psychosocial stressor, there has been relatively little research on the effects of public performance on the endocrine system. This study examined the impact of singing in a low-stress performance situation and a high-stress live concert on levels of glucocorticoids (cortisol and cortisone) in 15 professional singers. The results showed a significant decrease in both cortisol and cortisone across the low-stress condition, suggesting that singing in itself is a stress-reducing (and possibly health-promoting) activity, but significant increases across the high-stress condition. This is the first study to demonstrate that singing affects cortisol as well as cortisone responses and that these responses are modulated by the conditions of performance.

Effects of Group Drumming Interventions on Anxiety, Depression, Social Resilience and Inflammatory Immune Response among Mental Health Service Users

Growing numbers of mental health organizations are developing community music-making interventions for service users; however, to date there has been little research into their efficacy or mechanisms of effect. This study was an exploratory examination of whether 10 weeks of group drumming could improve depression, anxiety and social resilience among service users compared with a non-music control group (with participants allocated to group by geographical location.) Significant improvements were found in the drumming group but not the control group: by week 6 there were decreases in depression (-2.14 SE 0.50 CI -3.16 to -1.11) and increases in social resilience (7.69 SE 2.00 CI 3.60 to 11.78), and by week 10 these had further improved (depression: -3.41 SE 0.62 CI -4.68 to -2.15; social resilience: 10.59 SE 1.78 CI 6.94 to 14.24) alongside significant improvements in anxiety (-2.21 SE 0.50 CI -3.24 to -1.19) and mental wellbeing (6.14 SE 0.92 CI 4.25 to 8.04). All significant changes were maintained at 3 months follow-up. Furthermore, it is now recognised that many mental health conditions are characterised by underlying inflammatory immune responses. Consequently, participants in the drumming group also provided saliva samples to test for cortisol and the cytokines interleukin (IL) 4, IL6, IL17, tumour necrosis factor alpha (TNFα), and monocyte chemoattractant protein (MCP) 1. Across the 10 weeks there was a shift away from a pro-inflammatory towards an anti-inflammatory immune profile. Consequently, this study demonstrates the psychological benefits of group drumming and also suggests underlying biological effects, supporting its therapeutic potential for mental health. Trial Registration: ClinicalTrials.gov NCT01906892

Associations between singing to babies and symptoms of postnatal depression, wellbeing, self-esteem and mother-infant bond

Introduction: There is growing research documenting the psychological benefits of singing. However, it remains unknown whether singing to new babies is associated with enhanced maternal mental health. This study had two aims: (i) to explore whether these associations exist, and (ii) to compare the effects of singing to babies with listening to music in order to explore whether the sound of music alone or the physical act of singing might be responsible for effects. Methods: Multiple linear and logistic regression models were used to analyse cross-sectional data from 391 new mothers, exploring associations between both singing to babies and listening to music, and symptoms of postnatal depression, wellbeing, self-esteem and self-rated mother-infant bond. Results: Singing to babies on a daily basis was associated with lower symptoms of postnatal depression and enhanced wellbeing, self-esteem and self-reported mother-infant bond. Listening to music was associated with lower depression and enhanced wellbeing but effects were attenuated by confounding variables involving other arts engagement. Discussion: These data suggest that the specific act of singing could support the mental health of new mothers. The correlations found in this study raise questions as to whether maternal singing to babies can causally improve maternal mental health and wellbeing and as such whether singing could be recommended to new mothers as a positive parenting practice, or whether supportive community singing interventions could be developed.

Making music for mental health: how group drumming mediates recovery

BackgroundWhile music-making interventions are increasingly recognised as enhancing mental health, little is known of why music may engender such benefit. The objective of this article is to elucidate the features of a programme of group drumming known to enable mental health recovery.MethodsQualitative research was conducted with 39 mental health patients and carers who had demonstrated recovery following engagement with a programme of group djembe drumming in the UK. Data were collected through semi-structured individual interviews and focus group interviews designed to understand the connection between drumming and recovery and analysed using Interpretative Phenomenological Analysis (IPA).ResultsResults revealed three overarching features of the drumming intervention: (1) the specific features of drumming, including drumming as a form of non-verbal communication, as a connection with life through rhythm, and as a grounding experience that both generates and liberates energy; (2) the specific features of the group, including the group as a space of connection in and through the rhythmic features of the drumming, as well as facilitating feelings of belonging, acceptance, safety and care, and new social interactions; (3) the specific features of the learning, including learning as an inclusive activity in which the concept of mistakes is dissolved and in which there is musical freedom, supported by an embodied learning process expedited by the musical facilitator.ConclusionThe findings provide support for the conceptual notion of ‘creative practice as mutual recovery’, demonstrating that group drumming provides a creative and mutual learning space in which mental health recovery can take place.

Attending a concert reduces glucocorticoids, progesterone and the cortisol/DHEA ratio.

We examined the impact of attending a live, public concert on steroid hormone response in 117 participants. Participants provided saliva samples for hormone analysis prior to the concert and again at the interval 60 min later. There were significant changes in cortisol, cortisone, progesterone, cortisol/DHEA ratio and cortisol/cortisone ratio. This is the first evidence that attending a cultural event can have an impact on endocrine activity and down-regulate stress.

Maternal engagement with music up to nine months post-birth:Findings from a cross-sectional study in England

There is significant evidence of the benefits of music for babies and emerging evidence that music may also benefit mothers’ wellbeing. However, there is a lack of current data documenting maternal engagement with music in England. This cross-sectional survey study used descriptive and inferential statistics to examine how 473 mothers living in England engaged with music between 1–9 months post-birth, and regression models to examine demographic and musical predictors of this engagement. Findings indicate that the most frequently reported musical activities were daily listening to music (71%) and daily singing to babies (59%). Patterns of musical engagement differ by infant age, with mothers of 4–9 month-old babies reporting more frequent singing and music class attendance compared with mothers of 1–3 month-old babies. Mothers with previous or recent experience of music were more likely to engage in other musical activities, but musical engagement did not appear to be explained by socio-economic factors including years in education, marital status or household income. Findings could support practitioners in designing music activities for mothers, in particular highlighting the need for supporting mothers with very young infants, with little or no previous musical experience or with more than one child.

The effects of mother–infant singing on emotional closeness, affect, anxiety, and stress hormones:

Among mammals who invest in the production of a relatively small number of offspring, bonding is a critical strategy for survival. Mother–infant bonding among humans is not only linked with the infant’s survival but also with a range of protective psychological, biological, and behavioral responses in both mothers and infants in the post-birth period and across the life span. Anthropological theories suggest that one behavior that may have evolved with the aim of enhancing mother–infant bonding is infant-directed singing. However, to date, despite mother–infant singing being practiced across cultures, there remains little quantitative demonstration of any effects on mothers or their perceived closeness to their infants. This within-subjects study, comparing the effects of mother–infant singing with other mother–infant interactions among 43 mothers and their infants, shows that singing is associated with greater increases in maternal perceptions of emotional closeness in comparison to social interactions. Mother–infant singing is also associated with greater increases in positive affect and greater decreases in negative affect as well as greater decreases in both psychological and biological markers of anxiety. This supports previous findings about the effects of singing on closeness and social bonding in other populations. Furthermore, associations between changes in closeness and both affect and anxiety support previous research suggesting associations between closeness, bonding, and wider mental health.

Effect of singing interventions on symptoms of postnatal depression: three-arm randomised controlled trial

This study assessed whether a novel psychosocial intervention could reduce symptoms of postnatal depression (PND) in the first 40 weeks post-birth. Analyses were carried out of 134 mothers with symptoms of PND randomised into 10 weeks of group singing workshops or group play workshops for them and their babies, or usual care (trial registration: NCT02526407). Overall, among all mothers with symptoms of PND, there was a non-significant faster improvement in symptoms in the singing group (F 4,262 = 1.66, P = 0.16, η 2 = 0.012). When isolating mothers with moderate-severe symptoms of PND, this result became significant, with a faster improvement in symptoms in the singing group (F 3.9,139.8 = 2.74, P = 0.033, η 2 = 0.028). Declaration of interest None.

The razor’s edge: Australian rock music impairs men’s performance when pretending to be a surgeon

Objective: Over the past few decades there has been interest in the role of music in the operating theatre. However, despite many reported benefits, a number of potentially harmful effects of music have been identified. This study aimed to explore the effects of rock and classical music on surgical speed, accuracy and perceived distraction when performing multiorgan resection in the board game Operation.