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BMJ Open. 2019 Aug 10;9(8):e026995. doi: 10.1136/bmjopen-2018-026995.

Psychosocial singing interventions for the mental health and well-being of family carers of patients with cancer: results from a longitudinal controlled study.

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Department of Behavioural Science and Health, University College London Research Department of Epidemiology and Public Health, London, UK
Centre for Performance Science, Royal College of Music, London, UK.
Applied Health Research, The Royal Marsden NHS Foundation Trust, London, UK.
Faculty of Health Sciences, University of Southampton, Southampton, UK.



The mental health challenges facing people who care for somebody with cancer are well documented. While many support interventions focus on provision of information or cognitive behavioural therapy, the literature suggests that psychosocial interventions could also be of value, especially given the low social support frequently reported by carers. Singing is a psychosocial activity shown to improve social support, increase positive emotions, and reduce fatigue and stress. This study explored whether weekly group singing can reduce anxiety, depression and well-being in cancer carers over a 6-month period.


A multisite non-randomised longitudinal controlled study.


The Royal Marsden National Health Service Trust in Greater London.


62 adults who currently care for a spouse, relative or close friend with cancer who had not recently started any psychological therapy or medication.


On enrolment, participants selected to join a weekly community choir for 12 weeks (n=33) or continue with life as usual (n=29).


The primary outcome was mental health using the Hospital Anxiety and Depression Scale. The secondary outcome was well-being using the Warwick Edinburgh Mental Wellbeing Scale. Using linear mixed effects models, we compared the change in mental health and well-being over time between the two groups while adjusting for confounding variables including demographics, health-related variables, musical engagement and length of time caring.


Participants in the choir group showed a significantly greater decrease in anxiety over time than participants in the control group (B=-0.94, SE=0.38, p=0.013) and a significantly greater increase in well-being (B=1.25, SE=0.49, p=0.011). No changes were found for depression. Sub-group analyses showed carers with anxiety or below-average well-being were most likely to benefit.


This study builds on previous research showing the mental health benefits of singing for people with cancer by showing that weekly singing can also support anxiety and well-being in cancer carers.


anxiety; cancer; carers; depression; oncology; psychosocial; singing; social support; well-being

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Conflict of interest statement

Competing interests: The funding for this study was provided by Tenovus Cancer Care who run the choirs used as the intervention in this study. However, no member of staff from Tenovus Cancer Care was involved in the specifics of the study design or in the data collection, analysis or interpretation of the data, the writing of the report, or the decision to submit the paper for publication.

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