Erin Bailey is a professor of Music Education at Brigham Young University. Her research, which is grounded in self-determination theory, focuses on the benefits of music participation on psychological wellbeing and mental health. The following is a revised summary of her remarks at the April and July Windsor Dialogue conferences.
Research on Music Participation and Refugees
Music participation is a broad umbrella term for purposeful interactions with music. Research on refugee participation in music generally falls into three main categories: (1) music therapy, (2) group music-making, and (3) music education. Therapeutic interactions include songwriting, group improvisation, or drum circles run by a professional music therapist. Music participation also includes community music-making, like community choirs or songwriting groups. Music education, such as programs in school environments, has been shown to nurture physical, intellectual, social, and emotional development.
Self-determination theory suggests that all humans have three basic universal needs: autonomy, competence, and relatedness, or a sense of belonging within a group. [1] Those in refugee camps lose all three of these areas. They are uprooted from homes and families; they are taken from jobs and education; and in refugee camps, especially, their autonomy is severely limited. When any of these basic needs is unsupported, wellbeing decreases and optimal functioning cannot be achieved. Research has shown that music participation can support all three of these needs. [2]
Individuals who participate in community music, especially those from disadvantaged groups, report many physical and psychological benefits, including reduced depression, anxiety, and mental distress; improved quality of life and wellbeing; greater feelings of social connectedness; and improved sense of self-concept and identity. [3] Adolescents and young adults who participate in music ensembles have even referred to their music groups as their “family” or their “home away from home.”
Choral singing specifically has been shown to unite individuals and provide physical and psychological benefits. Studies have been conducted on the therapeutic benefits of choirs organized specifically for various groups of people, including those with Parkinson’s disease, dementia, chronic pain, cancer or mental health diagnoses, and even homeless individuals. Participants reported increased belonging, self-efficacy, purpose, and positive feelings that then transferred to environments outside of the choir.
The Link Between Music Participation and Displaced Children
The American Psychological Association has reported that about one in three asylum seekers or refugees experiences high rates of depression, anxiety, and post-traumatic stress disorder. In addition to the social, cultural, and family supports in place to help refugee families with housing, employment, health care, and education, mental health care needs to be a priority, especially for children and adolescents.
In 2022, UNICEF reported that 36.5 million of those forcibly displaced from their homes are children. These traumatic experiences for children can affect not only their current wellbeing, but the impact of trauma can actually continue throughout their lifespan. The effect trauma has on social, emotional, and cognitive development may lead to a regression or loss of previously acquired skills for these children.
Refugee children can benefit from interventions to help them process what they have been through and build resilience and hope for their future. Researchers have found that music therapy provides a safe and supportive environment, creating spaces for those who have experienced trauma to open up and be vulnerable. Children are able to recount experiences through songs that would be more difficult to talk about. Researchers have also observed that children feel a sense of belonging in their music therapy groups, specifically if the groups have been organized around a common experience. [4] Groups of refugees experiencing similar feelings and trauma can create a bond and a feeling of collective understanding that benefit participants. Music therapy should be considered a valuable intervention for those who have experienced trauma and continue to suffer from mental health issues.
Scaling Music Participation for Refugee Camps: Unique Benefits of Group Music-Making
Findings from many studies demonstrate that community music programs do not need to be facilitated by a mental health professional to produce certain benefits. In fact, nonclinical groups potentially can provide a non-stigmatizing solution that provides social support. Ideally, music therapists and music directors can work together to provide optimal experiences, but it is reassuring that benefits can exist from either option if resources are limited.
One of the benefits of group music-making is that, although it is not therapy, it is therapeutic. Based on my research in the United States, many people who experience trauma or mental disorders enjoy joining a choir because they don’t feel that they are in therapy. Research shows that there are benefits to music participation, no matter the experience (such as going to a music therapist, joining a choir, or learning to play the piano). These include reduced depression and anxiety, improved self-confidence, improved social connectedness, and increased resilience and hope. Some studies show increased benefits when the frequency of participation is increased; once a week is good, and twice a week is better!
We recently gathered open-ended response data from some U.S. university students. As COVID protocols were lifted, they could come back to music-making. We did a quick survey study to find out how this return was impacting them. We never mentioned anything about therapy. That word was not used. But the words they used were all therapeutic: mental escape, processing, coping, healing, etc. One student said, “Music brought me out of a very dark place, and it continues to heal my soul every day.” Of course, these students are not refugees, but the power of music participation was present in many of their statements.
Stakeholders’ Need for Other Forms of Quantitative Data
As we strive to conduct rigorous studies on the impact of music participation on underserved populations, we can expand our data collection methods and tools. Certain stakeholders want to see the return on their investment of time and funds. We use the GAD-7 (Generalized Anxiety Disorder) and the PHQ-9 (Patient Health Questionnaire) frequently in our research to measure depression and anxiety. While self-report data are useful and prevalent in the field, other forms of quantitative data should be sought to add validity and clarity to the findings. Bringing in an external psychiatrist to do a quick assessment of participants before and after music intervention, in addition to self-report data, would be wise.
We know that mental health impacts physical health. The World Health Organization (WHO) has a health index that could potentially be used as quantitative data alongside mental health self-report questionnaires. In addition, the number of visits to the health clinic or the number of mental health referrals in the camps could be yet another measure of the success of the music programs. We can expand our studies to comparison group studies or dosage studies. Most beneficial would be studies that looked specifically at longitudinal impacts of participating in music experiences in refugee camps and after resettlement.
Finally, we frequently talk about the importance of quantitative data. I do, however, think that qualitative data from interviews and focus groups are also beneficial. To allow the authentic voice of refugees to speak their truth and share their reflections on their experiences illuminates aspects of those experiences that quantitative data cannot. Mixed methods research can be a highly effective way of looking at problems from two different lenses to find powerful solutions.
Speaking to “the Macro”
In 2010, it was estimated that the cost of poor mental health was $2.5 trillion U.S. dollars (USD) per year, and in 20 years, it will rise to $6 trillion USD. This projection was before COVID hit, so it is now probably even higher. According to the WHO Mental Health Atlas 2017, mental health expenditure accounted for less than 2 percent of government budgets for health. The Lancet Commission estimated that for every $1 USD for treatment of mental health, there is a $4 USD return in better health and productivity. This estimate relates to established countries and communities, but the same results could be found within refugee populations. How much money does it take to have a singing group? Very little. Music participation interventions can be financially sound ways to create large returns in the long run for mental health.
Article 39 of the United Nations Convention on the Rights of the Child says, “Children who have experienced neglect, abuse, exploitation, torture or who are victims of war must receive special support”—not basic support, but special support—“to help them recover their health, dignity, self-respect and social life.” In an earlier presentation, ICLRS Director Brett Scharffs commented on the need to create a rich tapestry. Of course, these children need food, medical care, and shelter. However, I believe that music is a perfect vehicle to create a rich tapestry with all in the refugee camps, children and adults alike. Music can help you find your voice when it has been taken from you. Music can help make a family when that has been taken from you. Music can help restore your identity and dignity when it has been taken from you. Music participation can be powerful and therapeutic and increase wellbeing for all.
[1] Richard M. Ryan & Edward L. Deci, Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness (Guilford Publications 2017).
[2] Cecil Adderley et al., A Home Away from Home: The World of the High School Music Classroom, 51(3) J. Rsch. Music Educ. 190 (2003); Robert Faulkner & Jane W. Davidson, Men in Chorus: Collaboration and Competition in Homo-Social Vocal Behaviour, 34(2) Psych. Music 219 (2006); Karin S. Hendricks, Relationships Between the Sources of Self-Efficacy and Changes in Competence Perceptions of Music Students During an All-State Orchestra Event (2009) (Ph.D. Dissertation, University of Illinois at Urbana-Champaign) (ProQuest); Adam J. Lonsdale & Evelyn R. Day, Are the Psychological Benefits of Choral Singing Unique to Choirs? A Comparison of Six Activity Groups, 49(5) Psych. Music1179 (2020); Wendy K. Matthews, “Stand by Me”: A Mixed Methods Study of a Collegiate Marching Band Members’ Intragroup Beliefs Throughout a Performance Season, 65(2) J. Rsch. Music Educ. 179 (2017); Katrina Skewes McFerranet al., A Critical Interpretive Synthesis of the Literature Linking Music and Adolescent Mental Health, 48(4) Youth & Soc’y 521 (2016); Eiluned Pearce et al., Singing Together or Apart: The Effect of Competitive and Cooperative Singing on Social Bonding Within and Between Sub-groups of a University Fraternity, 44(6) Psych. Music 1255 (2016); Nikki S. Rickard et al., Orchestrating Life Skills: The Effect of Increased School-Based Music Classes on Children’s Social Competence and Self-Esteem, 31(3) Int’l J. Music Educ. 292 (2013); Suvi Saarikallio, Music as Emotional Self-Regulation Throughout Adulthood, 39(3) Psych. Music 307 (2011); Nick Alan Joseph Stewart & Adam Jonathan Lonsdale, It’s Better Together: The Psychological Benefits of Singing in a Choir, 44(6) Psych. Music 1240 (2016); Elyse Williams et al., A Systematic Review of Mental Health and Wellbeing Outcomes of Group Singing for Adults with a Mental Health Condition, 26(6) Eur. J. Pub. Health 1035 (2018); Gloria P. Zapata & David J. Hargreaves, The Effects of Musical Activities on the Self-Esteem of Displaced Children in Colombia, 46(4) Psych. Music 540 (2018).
[3] Adderley et al.; Faulkner & Davidson; Hendricks; Matthews; Donald E. Michel & Dorothea Martin Farrell, Music and Self-Esteem: Disadvantaged Problem Boys in an All-Black Elementary School, 21(1) J. Rsch. Music Educ. 80 (1973); Pearce et al.; Rickard et al; Zapata & Hargreaves.
[4] Moshe Bensimon, Perceptions of Music Therapists Regarding Their Work with Children Living Under Continuous War Threat: Experiential Reframing of Trauma Through Songs, 29(4) Nordic J. Music Therapy 300 (2020); Benisom, Relational Needs in Music Therapy with Trauma Victims: The Perspective of Music Therapists, 29(3) Nordic J. Music Therapy 240 (2020); Rivka Felsenstein, From Uprooting to Replanting: On Post-Trauma Group Music Therapy for Pre-school Children, 22(1) Nordic J. Music Therapy 69 (2013).