Psychobiological Responses to Choral Singing in Mentally Ill and Healthy Children and Adolescents

University of Salzburg135 enrolled

Overview

Interventional, three-armed, open, monocentric, medium-term follow-up, pre-test-post-test design, controlled, parallel group study to investigate the effects of a group singing intervention on neuroendocrine (hair cortisol, salivary cortisol, salivary alpha amylase), immune (salivary immunoglobulin A/s-IgA), and psychological (psychological stress, mood, social contacts, emotional and social competence, self-esteem, and quality of life) responses in mentally ill and healthy children and adolescents (N=135, age range 10 -18). Additionally, the child and adolescent psychiatry group (age range 13-18) takes part in three hour creative workshops every two weeks.

Background: Biopsychological responses to music-related activities (MRA) were examined in various naturalistic settings in adults. Group singing in particular seems to be associated with positive biopsychological outcomes. There is also an emerging view that MRA may play an important role for youth with mental disorders. However, longitudinal research on biopsychological responses to MRA in different clinical and healthy populations among children and adolescents is lacking. Method: Children and adolescents (age range 10-18) under psychiatric treatment at the Department of Child and Adolescents Psychiatry in Salzburg (n=45), healthy children and adolescents from a school in Salzburg (n=45), and members from the Vienna Boys Choir (n=45) in Austria will be recruited to take part in the study. Subjective measures (mood, stress experience) will be taken pre- and post singing sessions once a week throughout six months. Additionally, salivary biomarkers (cortisol, alpha amylase and IgA), social contacts, and quality of life are assessed. Emotional competence, social competence, self-esteem, and chronic stress levels are measured at the beginning, after three months, at the end, and in a follow-up of the study. The group of child and adolescent psychiatry taking part in the creative workshops will be additionally assessed via questionnaires regarding emotional regulation, self-esteem, and art experience before and after every workshop. Furthermore, some individuals of the child and adolescent psychiatry group will undergo fMRI evaluation of the brain before and after completion of all creative interventions. Conclusion: Singing and other creative activities are suggested to benefit mental and physical health in children and adolescents. However, despite the current knowledge, the researchers must better understand the biopsychological mechanisms underlying choral singing in order to determine its full potential, particularly for vulnerable populations. This is the first study to investigate this issue in this population.

Study Type

Eligibility

Sex: ALLMin age: 10 YearsMax age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria (Clinical N): * Written consent to study participation; * Gender: male, female, different; * Age: children and adolescents aged ≥ 10 and ≤ 18 years; * Diagnosis of a psychiatric disorder according to ICD-10; * Patients are admitted regardless of medication status and are allowed to the medication will continue to be used during the study; * Additional therapies and medication are recorded and are not an exclusion criterion; * Musical skills or a certain musical background are not required Inclusion Criteria (Healthy N): * Written consent to study participation; * Gender: male, female, different; * Age: children and adolescents aged ≥ 10 and ≤ 18 years; * Musical skills or a certain musical background are not required Exclusion Criteria (Clinical N): * Age: children and adolescents aged \<10 years and \> 18 years; * Criteria that prevent an application: hearing loss, states of confusion, inability to verbalize; * Patients with acute externalizing behavior or self-harm/suicidality; * Existing alcohol addiction or abuse of illegal drugs; Exclusion Criteria (Healthy N): * Age: children and adolescents aged \<10 years and \> 18 years * Criteria that prevent an application: hearing loss, states of confusion, inability to verbalize

Outcomes

Primary Outcomes

Change Short-Term Neuroendocrine Stress (Hypothalamic-Pituitary-Adrenal Axis) from pre- to post singing session over six months

Biological Stress Marker: Salivary Cortisol

Time frame: every two weeks pre- and post singing sessions for six months

Change Short-Term Immune Function from pre- to post singing session over six months

Biological Marker: Salivary Immunoglobulin A

Time frame: every two weeks pre- and post singing sessions for six months

Change from Baseline Chronic Neuroendocrine Stress (Hypothalamic-Pituitary-Adrenal Axis) at three and six months

Biological Stress Marker: Hair Cortisol

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Change Short-Term Neuroendocrine Stress (Autonomic Nervous System) from pre- to post singing session over six months

Salivary Alpha-Amylase

Time frame: every two weeks pre- and post singing sessions for six months

Secondary Outcomes

Psychological Stress

Stress and Coping Questionnaire for Children and Adolescents (SSKJ 3-8 R; Lohaus, Eschenbeck, Kohlmann, \& Klein-Heßling, 2018)

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Mood

Multidimensional Mood State Questionnaire (MDBF, short version; Steyer, Notz, Schwenkmezger, \& Eid, 1997)

Time frame: every week pre- and post singing sessions for six months

Emotional Skills

Emotional Competence Questionnaire (EKF; Rindermann, 2009)

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Self-Esteem

Selbstwertinventar für Kinder und Jugendliche (SEKJ; Schöne \& Stiensmeier-Pelster, 2016)

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Life Quality

Pediatric Quality of Life Inventory (PEDsQL; Varni, 2001)

Time frame: once a month for six months

Performance Anxiety

Das State-Trait-Angstinventar (STAI-T adapted; Laux, Glanzmann, Schaffner, \& Spielberger 1981)

Time frame: once at the beginning of the study, once after 6 months

Social Skills

Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997)

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Evaluation of the choir session

Liking of the session, liking of the songs, familiarity with the songs (5-point Likert scale; Higher scores mean a better outcome)

Time frame: every week post singing sessions for six months

Chronical Stress

Fragebogen zu chronischem Stress im Kindesalter (CSiK; Richartz, Hoffmann, \& Sallen, 2009)

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Stress Perception

Visual Analogue Scale (VAS; 0-100; higher score means a worse outcome)

Time frame: every week pre- and post singing sessions for six months

Prosocial Behavior

Social Network Map (Tracey \& Whittaker, 1990)

Time frame: every two weeks post singing sessions for six months

Psychological Stability (parents view)

Child Behavior Checklist (CBCL; Achenbach \& Arbeitsgruppe Deutsche Child Behavior Checklist, 1994)

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Psychological Stability (children view)

Youth Self-Report (YSR; Achenbach \& Arbeitsgruppe Deutsche Child Behavior Checklist, 1994)

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Emotional Control

Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen (FEEL-KJ; Grob \& Smolenski, 2005)

Time frame: at the beginning of the study, after three months, at the end of the study after six months, at a follow-up after three months, at a follow up after six months

Specific personality and character traits such as curiosity, reward dependency, cooperativity, and self-steering ability

JTCI Junior Temperament and Character Inventory in Children and Adolescents Psychiatry Group Questionnaire

Time frame: At the beginning of creative workshops, and at a follow-up after three months in the group of children and adolescents with psychiatric disorders

Current emotional state

Positive and negative affect schedule (PANAS)

Time frame: Pre and post every creative workshop in the group of children and adolescents with psychiatric disorders

Psychobiological Responses to Choral Singing in Mentally Ill and Healthy Children and Adolescents

Overview

Conditions

Interventions

Eligibility

Locations (3)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts