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

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.

Eligibility Criteria:
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