1. PSYCHOLOGICAL WELL-BEING IN PROFESSIONAL ORCHESTRAL MUSICIANS IN AUSTRALIA: A study of anxiety, pain, and depression
Dianna T Kenny, Bronwen Ackermann, Tim Driscoll The University of Sydney
Supporting sustainable careers in orchestral musicians through Occupational Health and Safety initiatives

2. An initiative funded by the ARC and the Australia Council for the Arts on behalf of the 8 major orchestras of Australia.

3. Introduction
Australia has eight full-time professional symphonic and pit orchestras located in each of the capital cities of Australia
Their musicians represent the country’s most elite orchestral musicians
Study motivated by the Strong Report (2005) that showed very high injury rates and escalating workers’ compensation costs for professional musicians
High frequency (60% - 90%) of self-reported musculoskeletal pain

4. Introduction
Mental health of professional musicians is not well understood; hence, their mental health needs are often poorly managed
International surveys report high rates of music performance anxiety and performance-related pain
Health behaviours such as substance and alcohol use have not been systematically studied
Strong (2005) identified a NEED for OCCUPATIONAL GUIDELINES FOR ORCHESTRAL MUSICIANS

5. Sample characteristics (n=377, 70% participation)
184 males (49%) 192 females (51%) Mean age of musicians: 42.1 years (SD=10.3; Range=18-68 years)

6. Numbers and percentages of musicians in each age group%
<30 62
16.5
31-40
103
27.4
41-50
130
34.6
51+ 81
21.5
TOTALS
376
100

7. Sample Distribution
#Seven musicians were aged between 18 and 24 years # 47 musicians were aged between 55 and 69 years #No gender differences within age groups

8. Instrument group membership%
Trumpet, French horn, trombone, bass trombone, tuba 58
15.4
Piccolo, flute, oboe, clarinet, cor anglais, bassoon, contrabassoon 67
17.8
Cello, double bass, harp 70
18.5
Violin, viola
169
44.8
Percussion, tympani 12
3.2
Total
377
100

9. Baseline assessment
K-MPAI
PRIME-ED
STAI-T
ADD
SPIN
AUDIT
CSE

10. Psychosocial Profile
33% musicians screened positive for a diagnosis of social phobia
32% screened positive for depression
30% regularly used Beta Blockers to manage their anxiety
22% answered ‘yes’ to a question screening for post-traumatic stress disorder
14% reported unsafe patterns of alcohol consumption
6% smokers

11. Inter-correlations among the psychological tests
STAI-T
K-MPAI
ADD
CSE
SPIN
.569***
.619***
.404***
-.526***
ASI
.277
.548***
.166
-.358*
.712***
.498***
-.749***
.574***
-.711***
-.496***

12. Predictors of severity of MPA (K-MPAI)
Severity of MPA is affected by the severity of other underlying anxiety conditions

13. Means, SD, minimum and maximum scores, F tests and p values for STAI-T, K-MPAI, ASI and ADD by sex
Anxiety measure
Sex 
Mean SD
Sig.
K-MPAI
male
75.95
36.30
0.001
female
91.15
43.33
Total
83.73
40.72
STAI-T
52.33
10.54
0.004
55.71
11.88
54.08
11.37
SPIN
12.92
9.67
17.17
11.45
15.09
10.81
ADD
1.84
1.30
2.33
1.37
2.09
1.35

14. Means, SD, minimum and maximum scores, F tests and p values for STAI-T, K-MPAI, ASI and ADD by age group
Anxiety measure
Age group
Mean SD
Sig.
K-MPAI
<= 30
93.5
39.1
0.037
79.0
35.9
87.0
45.1
51+
76.0
Total
83.5
40.8
STAI-T
55.6
12.5
0.056
51.6
8.9
55.2
12.7
54.2
10.7
54.1
11.4
SPIN
17.8
11.0
0.014
13.5
8.8
16.3
11.8
13.0
10.8
15.1
ADD
2.18
1.38
0.001
2.02
1.20
2.19
1.45
1.91
1.37
2.09
1.35

15. Association between alcohol frequency, K-MPAI, and age
Test
Alcohol frequency N
Mean SD
sig.
K-MPAI
every day 17
104.0
40.3
0.05
5-6 days 89
83.7
40.1
3-4 days 96
83.3
40.0
1-2 days 77
89.7
44.0
less than 1-2 days 55
73.5
35.7
Total
334
84.3
40.7
Age
49.5
10.9
0.001 88
44.1
9.2
41.7
10.5 78
37.9
9.7
41.6
10.4
41.8
10.3

16. Age, K-MPAI, STAI-T, SPIN and ASI scores by depression category
Factor
Depression category
Number
Mean SD
Sig.
Age
Yes to 2Q 63
41.3
10.1
.821
Yes to 1Q 54
41.8
11.7
No to 2Q
247
42.2
10.0
K-MPAI 64
120.4
42.3
0.001
91.8
29.1
249
74.9
36.1
STAI-T
66.5
13.2
56.8
8.9
50.3
8.6
SPIN 61
22.5
13.4 53
15.6
9.7
240
13.0
9.3

17. Self-rated causes of MPA
FNE
68%
Repertoire
61%
Bad performance experience
78%
Pressure from others
61%

18. Anxiety, depression, pain
Depressed patients with musculoskeletal pain report more psychosocial stressors and more severe anxiety than comparable non-depressed patients with musculoskeletal pain
(Poleshuck et al., 2009).
Depressed patients with pain report more severe pain than non-depressed patients with pain.
GAD + MDD = 78% pain
GAD only = 59% pain
No GAD or MDD = 28% pain
Anxiety
[MPA]
Depression
[PRMD]
Pain
Somatiz-ation
Chronic pain

19. Treatment
In depressed patients with pain, treatment that focuses on pain Mx is not effective until depression treated
Increases in pain associated with increases in depression severity
Increases in pain severity associated with increased depression (Kroenke et al., 2011).
Number pain complaints a better predictor of depression than scales of pain severity and persistence (Godfrey, 2007).

20. Why study pain and depression in musicians?
Female
Why study pain and depression in musicians?
High PRMD
Role of other factors?
Frequency and severity of PRMD in professional musicians
Complex relationships between psychological factors and pain in other populations
Biomechanical factors but not job stress factors predicted PRMD
(Kaufman-Cohen & Ratzon, 2011)
High somatizing scores increased the odds of reporting regional pain bw 2.5 (wrist/ hand) and 5.5 (shoulder) times (Leaver, Harris & Palmer, 2011)
Depression

21. Rationale and Additional Measures
PRMD studies use pain perception, not physical measures
Need objective measure of pain cf. TRIGGER POINTS (TP)
TP show increased EMG activity during psychological stress; adjacent muscles remain non-responsive
Psychological factors may be associated with TP pain in musicians
PRMD pain, depression, MPA and SAD in professional musicians has not been previously investigated
Pain perception and pain measurement

22. Categories of pain severity and frequency of pain
Pain frequency
Frequency
Percent
0, never
100
26.7
1 - 2
117
31.2
3 - 4 67
17.9
5+, constantly 91
24.3
Total
375
Pain severity
<= 1, no pain
101
28.3
2 - 3 79
22.1
4 - 6
102
28.6
7+, Worst imaginable 75
21.0
357

23. Effects of age and sex on PRMD frequency and severityF
Sig.
Sex
PRMD frequency
7.27
.007
PRMD pain severity
4.19
.041
Age group
5.38
.001
3.20
.024
Sex by age group
0.25
.863
0.55
.651
Females had higher means for both PRMD frequency and severity
Age group years had higher pain reports

24. Cluster analyses (1)
A two-step cluster analyses: K-MPAI with severity ratings of PRMD pain as inputs. The cluster quality was good (Average silhouette=0.7) and four distinct clusters were obtained.
Cluster 1
Cluster 2
Cluster 3
Cluster 4
PRMD<=1
PRMD=2-3
PRMD =4-6
PRMD=7+
N=98 (27.9%)
N=79 (22.5%)
N=102 (29.1%)
N=72 (20.5%)
Mean KMPAI=78.2
Mean KMPAI=81.4
Mean KMPAI=84.6
Mean KMPAI=94.5
Linear relationship between MPA severity and PRMD severity

25. Cluster analyses (2)
A two-step cluster analyses: Depression categories with severity ratings of PRMD pain as inputs. The cluster quality was good (Average silhouette=0.6) and four distinct clusters were obtained.
Cluster 1
Cluster 2
Cluster 3
Cluster 4
DEPRESSION
No to both Q
Yes to 1 Q
Yes to both Q
N=148 (42.9%)
N=86 (24.9%)
N=51 (14.8%)
N=60 (17.4%)
PRMD Severity=1.61
PRMD Severity=6.65
PRMD Severity=4.21
PRMD Severity=4.52
No depression, no pain
No depression, severe pain
Moderate depression, moderate pain
May be clinically depressed, moderate pain

26. Conclusions
ANXIETY
Expected sex differences on STAI and K-MPAI but not SPIN
Female musicians 3x population rates for Social Phobia
Convergent validity of K-MPAI demonstrated e.g., high scores associated with problem alcohol use
Younger musicians more anxious than older musicians (cohort “survival” effect?)
First population level data on the psychological profile of elite professional musicians in Australia
Identifies significant issues regarding psychological functioning and psychosocial wellbeing
Provides guidelines for preventive programs

27. Conclusions DEPRESSION Role of depression in MPA has not been studied
Depression screening indicated that rates in orchestral musicians occurred at the higher end of general community rates
Even minor depression is associated with generalized psychological suffering, health concerns, impairment in daily living activities and overall quality of life
DEPRESSION
Role of depression in MPA has not been studied
22% musicians reported having a PTSD experience within the past three months
Kenny (2011) noted in an in depth interview study that the descriptions of some musicians’ worst music performance experiences resembled accounts by people who were suffering PTSD

28. Conclusions - Depression
Cluster analyses of PRMD severity and MPA severity showed that increasing PRMD severity ratings mapped linearly onto increasing mean K-MPAI scores.
Cluster analysis assessing relationship between PRMD severity and depression indicated that Cluster 2 members reported no depression + highest ratings for PRMD pain severity.

29. Conclusions
Previous studies have shown this relationship with respect to anxiety and physiological arousal but not between pain and depression.
Notion of “repressors” (i.e., denial of negative affect) – defensive and self-presentation bias
Self-report measures unreliable because people cannot report on “unconscious” experience
SOMATIZATION - emotional pain is expressed as physical pain
Trigger points were sensitive to psychological phenomena (the higher MPA, the worse TP reported in females

30. FIN