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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 6-10

Music therapy as group singing improves Geriatric Depression Scale score and loneliness in institutionalized geriatric adults with mild depression: A randomized controlled study


1 Chennai School of Music Therapy, Chennai, Tamil Nadu, India
2 Center for Music Therapy Education and Research, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
3 Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India

Date of Web Publication16-Jan-2017

Correspondence Address:
Dr. Sumathy Sundar
Center for Music Therapy Education and Research, Mahatma Gandhi Medical College and Research Institute, Pondy-Cuddalore Road, Pillaiyarkuppam, Puducherry - 607 402
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-2296.198415

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  Abstract 

Aims: This study was conducted with an aim to evaluate the effect of group music therapy in the form of group singing, led by a music therapist, on depressive symptoms and loneliness in institutionalized geriatric individuals having mild depression. Settings and Design: The study was conducted as a randomized control trial at St. Mary's Home for the aged, Cuddalore, Tamil Nadu. The study was conducted as a randomized control trial. Subjects and Methods: The experiment group (n = 40) received daily music therapy in the form of group singing lead by a music therapist for 3 weeks. The control group (n = 40) did not receive any specific intervention. Baseline and weekly Geriatric Depression Scale-Short Form (GDS-SF) and UCLA Loneliness Scale scores were recorded in both groups. Statistical Analysis Used : Measures of Central Tendency, Mann-Whitney U-test, and Wilcoxon W value. Results: Statistically significant improvement (P < 0.05) was seen in both the scores at the end of 3 weeks in the experiment group as compared to the control group. On intragroup comparison, both scores showed statistically significant improvement (P < 0.001) in the experiment group at the end of 3 weeks as compared to baseline but not in the control group. No adverse event was reported. Conclusions: Group singing significantly improves GDS-SF scores and loneliness in institutionalized geriatric adults having mild depression at the end of 3 weeks. Further research in this area is desirable which could contribute to the well-being of the aged population.

Keywords: Complementary therapies, depression, depressive disorder, geriatric psychiatry, music therapy


How to cite this article:
Mathew D, Sundar S, Subramaniam E, Parmar PN. Music therapy as group singing improves Geriatric Depression Scale score and loneliness in institutionalized geriatric adults with mild depression: A randomized controlled study. Int J Educ Psychol Res 2017;3:6-10

How to cite this URL:
Mathew D, Sundar S, Subramaniam E, Parmar PN. Music therapy as group singing improves Geriatric Depression Scale score and loneliness in institutionalized geriatric adults with mild depression: A randomized controlled study. Int J Educ Psychol Res [serial online] 2017 [cited 2017 Dec 16];3:6-10. Available from: http://www.ijeprjournal.org/text.asp?2017/3/1/6/198415


  Introduction Top


Depression is a common geriatric problem. The prevalence of depression in the elderly population is estimated to be as high as 20% by some researchers.[1]

Clinical spectrum of geriatric depression is broad as it includes many subtypes of depression.[2] Characteristic symptoms of depression include feelings of worthlessness or guilt, changes in sleep (insomnia or hypersomnolence), changes in appetite (anorexia or hyperphagia), psychomotor retardation or irritability, low self-esteem, and suicidal thoughts. In addition to symptoms of depression, comorbidities such as heart diseases, diabetes mellitus, stroke, Alzheimer's dementia, cancer,  Parkinsonism More Details, and bone fractures are also common in geriatric depression.[2],[3] The severity of depression can vary from mild to severe.

Music therapy has wide applications in geriatrics including but not limited to depression, dementia, Parkinsonism, etc.[4],[5],[6] Conventional management of geriatric depression consists of antidepressant drugs, psychotherapy, or combination of both. However, the side effects of antidepressant medications, multiple drug interactions (which are more common in elderly population), and economic burden are important concerns with conventional management. Various techniques of music therapy such as receptive music therapy, singing, instrument playing, songwriting, and group music therapy have been explored for elderly persons with depression. However, there are only a few studies evaluating the effect of group music therapy in institutionalized geriatric patients.

Loneliness is significantly related to geriatric depression; lonelier elderly have been reported to score higher on Geriatric Depression Scale-Short Form (GDS-SF).[7] A lower level of perceived emotional togetherness in a common feature in both loneliness and depression.[8] Group singing is a music therapy technique that improves social and emotional bonding among individuals. In a study, group singing has been shown to promote a faster bonding among a group of unrelated individuals due to "ice-breaker effect."[9] Considering the potential relationship between institutionalized elderly persons, geriatric depression, and loneliness, we conducted this study to evaluate the effect of group music therapy in the form of group singing, led by a music therapist, in institutional elderly persons having mild depression.


  Subjects and Methods Top


The study was conducted from June 10, 2015, to August 31, 2015, at St. Mary's Home for the aged, Cuddalore, Tamil Nadu, India. The design of the study was that of a randomized control trial having experimental (n = 40) and control groups (n = 40); total number of subjects being eighty. The study was approved by the Institutional Human Ethics Committee, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Puducherry, vide letter reference no. PG DISSERTATION/2015/05 dated June 5, 2015.

The study included men and women above 65 years having mild depression and staying at St. Mary's Home for the aged. Mild depression was defined as GDS-SF[10] score between 5 and 8. Individuals on antidepressive medications, medications, or any other medications affecting sleep or mood disorders, having depression with psychotic features, having depression secondary to organic disorders, and requiring cognitive behavioral therapy, with hearing problems and unable to comprehend/follow verbal instructions were excluded. Psychiatric assessment and application of GDS were done by a psychiatrist from Department of Psychiatry, MGMCRI, Puducherry.

Eighty subjects fulfilled the inclusion and exclusion criteria. They were divided into experimental (n = 40) and control (n = 40) groups by randomization by drawing lots. Written informed consent was obtained from all the subjects for participation in the study.

Subjects in the experimental group participated in group singing activity conducted by one of the researchers, who is also a music therapist. The group singing activity was performed every day for three consecutive weeks. Duration of each session was 30 min. Each session began with the theme (1) de-stressing and energizing. The other themes were (2) self-expression, (3) sharing and bonding, and (4) managing emotions. In de-stressing and energizing theme, the researcher collected the favorite songs of the group as a whole and initiated the singing sessions and encouraged all the group participants to sing the songs together, along clapping the hands and varying the tempos gradually during a single session. Most of the songs used were Tamil devotional songs and Bhajans. In self-expression, each member of the group chose their most favorite song which they sang while playing simple percussion instruments and also discussed with the group why they liked that particular song. In sharing and bonding, all the participants learned the favorite songs of others in the group and sang together in the group, and each participant shared his/her feelings while singing the favorite songs of the other participants. In managing emotions theme, the group participants sang songs with body percussion and movements using hands giving vent to their emotions. During each session, singing was initiated by the music therapist researcher and the subjects were encouraged to sing along and perform simple movements using hands depending on the theme. The control group received no specific intervention.

Baseline and weekly assessments of the subjects in both groups were done using GDS-SF[10] and UCLA Loneliness Scale (version 3)[11] for severity of depression and loneliness, respectively. The music therapist researcher was trained for 1 week by the Department of Psychiatry, MGMCRI, for application of these scales to subjects. If the deterioration in the psychological status of any subject was found during the study, provision was made for prompt referral of him/her to a psychiatrist for evaluation and management.

Statistical analysis of collected data was done by using Mann-Whitney U-test and Wilcoxon W value.


  Results Top


Total eighty subjects were included in the study. Both the experiment group and control group consisted of forty subjects each. All subjects were above 65 years. Each of the both groups comprised twenty males and twenty females.

Comparison of GDS scores and UCLA Loneliness Scale scores in both groups at the baseline and at the end of 1st , 2nd , and 3rd week are shown in [Table 1].
Table 1: Comparison of Geriatric Depression Scale-Short Form scores and UCLA Loneliness Scale scores for experiment and control groups


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In the intergroup comparison, GDS-SF scores showed continued improvement over 3 weeks in the experiment group; the improvement being statistically significant at end of 1st, 2nd, and 3rd week as compared to the control group [Table 2]. Within the experiment group, improvement in GDS-SF scores at the end of 3 weeks was also statistically significant (Chi-square 52.70491, P < 0.001). The control group showed no significant improvement at the end of 3 weeks as compared to the baseline (Chi-square 1.82, P = 0.61).
Table 2: Comparison of mean ranks of Geriatric Depression Scale-Short Form and UCLA Loneliness Scale scores at the baseline and at the end of 3 weeks in both groups


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As compared to the control group, UCLA Loneliness Scale scores showed no statistically significant improvement during initial 2 weeks in the experiment group, but the improvement at the end of 3 weeks was statistically significant at the end of the 3rd week [Table 2]. In the intragroup comparison, UCLA Loneliness Scale scores in the experiment group showed statistically significant improvement at the end of 3 weeks as compared to baseline (Chi-square 27.46, P < 0.001); while the control group showed no improvement at the end of 3 weeks (Chi-square 0.0039, P = 0.9999).


  Discussion Top


In our study, there is a significant improvement in GDS-SF scores in the experiment group as compared to control group at the end of 3 weeks. This is consistent with results of other studies that have shown that music therapy is useful in depressive disorders, including geriatric depression.[12],[13],[14],[15]

Music has multiple and complex effects on the brain, involving different areas of the brain and several neural networks, involving but not limited to frontal lobe, parietal lobe, temporal lobe, limbic system, thalami, basal ganglia, cerebellum, and other specific areas.[16] Music therapy improves mood in depression by modulating various, known and unknown, neurobiological activities in the brain. Antidepressive effects of music therapy are believed to be mediated by the influence of music on the central neural serotonergic transmission and hippocampal brain-derived neurotrophic factor levels, but other mechanisms are also possible.[16]

The spectrum of music therapy approaches toward geriatric depression is broad. Active forms of music therapy include singing including group singing, movement therapy, instrument playing, songwriting, etc., Active techniques help the patients to get connected with a therapist or other people, to articulate difficult feelings, and to enhance their own emotional awareness. In passive (receptive) techniques, music can act as a form of nonverbal communication and helps the patient to relax, to reduce stress and anxiety, to ventilate suppressed emotions, to improve sleep quality, and to improve mood and sense of well-being.

Singing as a music therapy has many beneficial effects on psychology and emotional well-being. Choir singing has been shown to improve symptoms of depression significantly in depressed elderly persons.[14] Apart from relaxation benefits, active participation in choir singing also improves many aspects of health including emotional status, immunity, well-being, social, and spiritual aspects.[17],[18] Singing has many positive effects on respiratory and cardiovascular physiology, as well as on some common geriatric neurological disorders such as Parkinson's disease and aphasia.[19] Thus, the positive effect of group singing on geriatric depression seems to be multifactorial.

Although UCLA loneliness scores for subjects in the experiment group showed the beginning of improvement from the 1st week, statistically significant improvement was seen at the end of 3 weeks. This can be partly explained by initial resistance in getting involved in group singing activity, experienced by some of the subjects. Moreover, it takes time to develop social and emotional bonding among individuals in a group explaining the delayed effect on loneliness. Although group music therapy has many positive social and psychological effects, we did not come across a study specifically exploring the effect of group singing on loneliness in geriatric depression.

There was no drop out from either of groups. No adverse event was reported due to music therapy intervention.

Standard and validated tools were used in our study to measure the objectives. The short version of GDS used in our study adequately substitutes the long form of GDS.[20] UCLA Loneliness Scale is also a validated tool with acceptable internal consistency reliability.[21] An important limitation is the absence of a placebo intervention in the control group which was not feasible considering methodology of our study involving a group intervention in a community setup.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Karam GE. Geriatric depression: A brief review. J Med Liban 2012;60:200-6.  Back to cited text no. 1
    
2.
Blazer DG. Depression in late life: Review and commentary. J Gerontol A Biol Sci Med Sci 2003;58:249-65.  Back to cited text no. 2
    
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Krishnan KR, Delong M, Kraemer H, Carney R, Spiegel D, Gordon C, et al. Comorbidity of depression with other medical diseases in the elderly. Biol Psychiatry 2002;52:559-88.  Back to cited text no. 3
    
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Hanser SB, Thompson LW. Effects of a music therapy strategy on depressed older adults. J Gerontol 1994;49:P265-9.  Back to cited text no. 4
    
5.
Raglio A, Bellelli G, Traficante D, Gianotti M, Ubezio MC, Villani D, et al. Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Dis Assoc Disord 2008;22:158-62.  Back to cited text no. 5
    
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Pacchetti C, Mancini F, Aglieri R, Fundarò C, Martignoni E, Nappi G. Active music therapy in Parkinson′s disease: An integrative method for motor and emotional rehabilitation. Psychosom Med 2000;62:386-93.  Back to cited text no. 6
    
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8.
Tiikkainen P, Heikkinen RL. Associations between loneliness, depressive symptoms and perceived togetherness in older people. Aging Ment Health 2005;9:526-34.  Back to cited text no. 8
    
9.
Pearce E, Launay J, Dunbar RI. The ice-breaker effect: Singing mediates fast social bonding. R Soc Open Sci 2015;2:150221.  Back to cited text no. 9
    
10.
Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clin Gerontol 1986;5:165-73.  Back to cited text no. 10
    
11.
Russell DW. UCLA loneliness scale (version 3): Reliability, validity, and factor structure. J Pers Assess 1996;66:20-40.  Back to cited text no. 11
    
12.
Hanser SB. A music therapy strategy for depressed older adults in the community. J Appl Gerontol 1990;9:283-98.  Back to cited text no. 12
    
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Chan MF, Wong ZY, Onishi H, Thayala NV. Effects of music on depression in older people: A randomised controlled trial. J Clin Nurs 2012;21:776-83.  Back to cited text no. 13
    
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Cassol M, Bos AJ. Impact of choir singing in elderly on depression symptoms and voice quality. Public Health Prev Med 2015;1:101-7.  Back to cited text no. 14
    
15.
Maratos AS, Gold C, Wang X, Crawford MJ. Music therapy for depression. Cochrane Database Syst Rev 2008;1:CD004517.  Back to cited text no. 15
    
16.
Lin ST, Yang P, Lai CY, Su YY, Yeh YC, Huang MF, et al. Mental health implications of music: Insight from neuroscientific and clinical studies. Harv Rev Psychiatry 2011;19:34-46.  Back to cited text no. 16
    
17.
Kreutz G, Bongard S, Rohrmann S, Hodapp V, Grebe D. Effects of choir singing or listening on secretory immunoglobulin A, cortisol, and emotional state. J Behav Med 2004;27:623-35.  Back to cited text no. 17
    
18.
Clift SM, Hancox G. The perceived benefits of singing: Findings from preliminary surveys of a university college choral society. J R Soc Promot Health 2001;121:248-56.  Back to cited text no. 18
    
19.
Wan CY, Rüber T, Hohmann A, Schlaug G. The therapeutic effects of singing in neurological disorders. Music Percept 2010;27:287-95.  Back to cited text no. 19
    
20.
Lesher EL, Berryhill JS. Validation of the geriatric depression scale - Short form among inpatients. J Clin Psychol 1994;50:256-60.  Back to cited text no. 20
    
21.
Hartshorne TS. Psychometric properties and confirmatory factor analysis of the UCLA loneliness scale. J Pers Assess 1993;61:182-95.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2]



 

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