Choral singing decreases the risk of developing depression and anxiety in older adults

An experimental study conducted in Singapore found that older adults who participated in weekly one-hour choral singing sessions over a two-year period experienced a reduced risk of developing depression and anxiety. However, this reduction was comparable in magnitude to the reduction observed in a matched group of peers who participated in a structured health education program of equal length and frequency. The study was published in the Journal of Psychiatric Research.

Depression and anxiety are two of the most common mental health conditions, marked by persistent sadness or worry that interfere with daily functioning. Depression involves low mood, loss of interest or pleasure, fatigue, and feelings of worthlessness, while anxiety is characterized by excessive fear, restlessness, and physical tension.

Among older adults, these conditions are frequently underdiagnosed because their symptoms can be mistaken for normal aging or attributed to physical illness. Many elderly individuals with depression report memory problems, slowed thinking, or social withdrawal, rather than overt sadness. Anxiety may manifest as constant worry about health, finances, or personal safety, sometimes leading to avoidance behaviors.

Common risk factors for depression and anxiety in later life include chronic health conditions, bereavement, social isolation, and reduced independence. These mental health conditions are also linked to cognitive decline and dementia, both as contributing factors and as consequences, complicating diagnosis and treatment. They are known to significantly reduce quality of life and are associated with higher rates of disability and mortality.

Lead author Ted K.S. Ng and colleagues aimed to investigate whether choral singing could reduce the risk of developing depression and anxiety in older adults at risk for cognitive decline. They also sought to compare its effectiveness to that of a health education program (HEP), which served as an active control. The researchers hypothesized that participants in the choral singing group would show a lower incidence of depression and anxiety compared to those in the HEP group.

A total of 200 community-dwelling adults aged 60 and above were recruited from neighborhoods in Singapore. Participants were required to be cognitively healthy at baseline, meaning they did not meet criteria for dementia or mild cognitive impairment. Individuals with terminal illness, stroke, or significant hearing impairments were excluded. Seven participants with preexisting depression or anxiety diagnoses were also excluded from the final analysis.

Participants were randomly assigned to one of two groups. One group attended weekly choral singing sessions, while the other participated in the health education program, both lasting two years.

The choral singing intervention was designed for individuals with no prior musical training. “Initially, participants were taught the mechanics of choral singing, vocal concepts and how to critique singing quality. Later, participants were educated on appropriate, healthy vocal production while utilizing effective breathing techniques and aural skills. Subsequently, participants learnt to sing in harmony,” the authors explained.

The health education sessions were also held weekly and included talks on topics relevant to aging, such as lifestyle, diet, mental health, dementia awareness, and fall prevention. Group activities that did not involve singing were included to encourage social interaction and engagement, mirroring the format of the choral singing group.

To assess outcomes, participants completed validated screening tools at baseline, 12 months, and 24 months: the 15-item Geriatric Depression Scale (GDS) and the 20-item Geriatric Anxiety Inventory (GAI). These measures were used to identify positive screens for clinically significant depression and anxiety.

The results showed that both groups experienced a significant reduction in the odds of screening positive for depression and anxiety over time. While the pattern of improvement differed—with the health education group showing earlier benefits at 12 months and the choral singing group showing more gradual improvements by 24 months—the overall reductions were statistically comparable by the end of the study.

“In contrary to previous studies using passive controls reporting positive outcomes, compared to HEP [health education program] as an active comparator, CS [choral singing] is as effective as HEP in delaying progression to clinically significant depressive and anxiety disorders in at-risk community-dwelling older adults,” study authors concluded.

The study contributes to the scientific understanding of choral singing for anxiety and depression risks in older adults. However, it should be noted that this was an open-label study, meaning that participants were fully aware which treatment they were undergoing and what the researchers’ expectations likely were. This could have produced the Hawthorne effect affecting the results. The Hawthorne effect is the phenomenon in which people change or improve their behavior simply because they know they are being observed.

The paper, “Effects of choral singing on depression and anxiety in older adults: A randomized controlled trial”, was authored by Ted K.S. Ng , Zhi Hao Lim, Michael Todd, Fei Sun, Kendra Ray, Xiang Qi, Jiuyu Guo, Kaisy Xinhong Ye, Andrea B. Maier, Rathi Mahendran, Goh Lee Gan, Maurine Tsakok, Ee Heok Kua, and Lei Feng.