1. Choral Singing and Quality of Life: Australian data from the “Cross-National Research on the Effects of Choral Singing” project Donald Stewart 1, Jing Sun 1 Stephen Clift 2, Grenville Hancox 2, Ian Morrison 2, Bärbel Hess 2, Gunter Kreutz 3 1. School of Public Health, Griffith University, Australia 2. Sidney De Haan Research Centre for Arts and Health, Canterbury Christ Church University, United Kingdom 3. Royal Northern College of Music, United Kingdom

2. School of Public Health Background Singing as an activity has been shown to carry benefits for health and well-being (Cohen, 2006 and 2007; Hillman, 2002, Hays and Minichiello, 2005) Such benefits reach across the whole of the lifespan and with people of diverse social backgrounds and health status (Clift and Hancox, 2001, Bailey and Davidson, 2005, Clift, Mackenzie and Bushell, 2006; Bamford, 2006). Singing has been found to be a powerful way to enhance health, particularly relating to stress reduction (Ruud, 2006). The direct links between choral singing and quality of life have not been systematically directly addressed in Australia

3. School of Public Health Study Aims To explore the music making and singing effect on quality of life and general health. Part of a larger study including choirs in the UK and Germany (Overall: 21 choirs; 1124 singers)

4. School of Public Health Methods A cross-sectional study design: 2007 A convenience sampling approach: Members of five choirs located in South-East Queensland, Australia, were voluntarily recruited into the study 166 participants (69% response rate)

5. School of Public Health Instruments The “Effects of Choral Singing” questionnaire consists of 27 items (Clift & Hancox, 2007). –A summed scale using the ten most highly loading items was used –This scale demonstrated high internal consistency with a Cronbach’s alpha of 0.93. WHOQOL-BREF instrument comprises 26 items –physical domain,  =0.82 –psychological domain,  = 0.80, –social domain,  = 0.68, –environmental domain,  = 0.80 (Murphy, Herrman, Hawthorne, Pinzone, & Evert, 2000)

6. School of Public Health Results: (1) demographic factors VariableM (SD)n (%) Age52.1 (15.9) Gender Male 55 (33.3) Female110 (66.7) Education Secondary 27 (16.6) College and Tertiary 23 (14.1) Postgraduate113 (69.3) Employment Full-time 60 (36.4) Part time56 (33.9) Retired45 (27.3) Unemployed4 (2.4) Sample Characteristics (n=166) Variablen (%) Single33 (20.0) Separated/divorced13 (7.9) Widowed14 (8.5) Married/Partnership105 (63.6) Religious participation Yes82 (49.7) No83 (50.3)

7. School of Public Health Results: (2) Difference between the study sample and Australian normative sample in quality of life, health status and choral singing effect Note. * p < 0.05, ** p < 0.01, *** p < 0.001 1 Physical health- 4.6*** 2 Psychological health - 2.5* 3 Social functioning - 2.8** 4 Environment 3.1** 5 Rating of Quality of life 1.1 6 Satisfaction of health 4.1***

8. School of Public Health Results: (3) The regression model: choral singing has significant effect on the psychological domain of quality of life for a bivariate model, F (1, 141) = 5.21, p < 0.01, and a multivariate model F (1, 141) = 2.34, p < 0.01. For the choral singing effect variable, its coefficient =.42, p < 0.05. Single marital status and religious participation were significant predictors for social functioning. Age was found to be a significant predictor for perception of environmental support. Participants who were older reported experiencing better environmental support.

9. School of Public Health Results: (4) Some qualitative comments “I had a full-on panic attack last week. Tried some swimming exercises which made it worse – then sang in the car for half an hour. By the end my heart rate and breathing had returned to normal, neck and shoulders relaxed, stomach unknotted. Generally find it unwinds and relaxes me. Always feel ‘looser’ after rehearsals.” Female, 38. “Singing improves my mood and my health. I have to be on guard constantly against my medical condition (anxiety and depression)” Female, 49 “(Choral singing is) especially valuable to people in their later years when they have time on their hands. I think choral singing is a (…) worthwhile activity to fill some of this time and give a real sense of achievement at a time when one might be feeling one’s usefulness is declining.” Female, 60

10. School of Public Health Discussion No significant effects of choral singing on physical health and social life were found – but … ‘happy as a clam because we sing’ Choral singing plays an important role in psychological health as a component of the quality of life Age is an important predictor for the perception of environment support

11. School of Public Health Limitations and Implications It was a convenience sample of people who had come together for a specific performance outcome and not randomised The major community-based choirs in Queensland participated in the study Singing as a means to promote connectedness and social and emotional well-being in the community