The reciprocal associations between social deficits, social engagement, and inflammation: Longitudinal evidence comparing venous blood samples and dried blood spots and mapping the modifying role of phenotypic and genotypic depression.

BACKGROUND: Social psychoneuroimmunology suggests an interplay between social deficits (loneliness and isolation) and chronic inflammation, but the direction of these relationships remains unclear. We estimated the reciprocal associations of social deficits and social engagement with levels of C-reactive protein (CRP), compared the consistency of the findings depending on the biological sampling method used, and examined the modifying role of phenotypic and genotypic depression. METHODS: We used longitudinal nationally representative data from the US (Health and Retirement Study, 3 waves, 2006-16) and England (English Longitudinal Study of Ageing, 4 waves, 2004-18). Loneliness, social isolation, and social engagement were self-reported. CRP was measured using dried blood spots (US) and venous blood samples (England). Cross-lagged panel models were fitted and tested interactions with phenotypic depression (above-threshold depressive symptom scores) and genotypic depression (polygenic score for major depressive disorder). RESULTS: We included 15,066 participants (mean age = 66.1 years, SD = 9.8) in the US and 10,290 (66.9 years, SD = 10.5) in England. We found reciprocal associations between loneliness and CRP using dried blood spots and venous blood samples. Higher CRP predicted higher subsequent loneliness and higher loneliness predicted elevated CRP. Both phenotypic and genotypic depression modified this reciprocal association. There were also reciprocal associations for social engagement in venous blood samples: higher CRP predicted lower social engagement and greater social engagement predicted lower subsequent CRP. Associations between social isolation and CRP were inconsistent and unidirectional. CONCLUSIONS: Loneliness may increase chronic inflammation, whereas social engagement may reduce inflammation. As these relationships were reciprocal, there may be a loop between inflammation, loneliness, and social engagement. This loop was stronger in those with depression or at high genetic risk for major depressive disorder. This relationship for loneliness was present in both blood sampling methods despite contrasting methods of CRP measurement, indicating that the finding is not attributable to measurement bias in biomarkers.

Arts and Cultural Engagement, Reportedly Antisocial or Criminalized Behaviors, and Potential Mediators in Two Longitudinal Cohorts of Adolescents.

Arts and cultural engagement is a potential strategy for reducing or preventing reportedly antisocial or criminalized behaviors (those previously and problematically termed as "delinquent") in adolescence. However, most research to date has focused on arts-based interventions and has not tested arts and cultural engagement in large population-based longitudinal studies. This study investigated whether arts and cultural engagement reduced reportedly antisocial or criminalized behaviors in two large nationally representative cohorts, the National Longitudinal Study of Adolescent to Adult Health (n = 10,610; 50% female, 72% White, age range = 11-21 mean = 15.07) and the National Education Longitudinal Study of 1988 (n = 15,214; 50% female, 73% White, age range = 13-16 mean = 14.38). Structural equation modelling also allowed exploration of two potential mechanisms that might link arts and cultural engagement to reportedly antisocial or criminalized behaviors (self-control and attitudes towards these behaviors). More arts and cultural engagement was associated with fewer reportedly antisocial or criminalized behaviors, better self-control scores, and fewer positive perceptions of reportedly antisocial or criminalized behaviors concurrently and one to two years later. Arts and cultural engagement may provide opportunities for adolescents to realize positive developmental outcomes, reducing their risk of reportedly antisocial or criminalized behaviors.

Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial.

INTRODUCTION: Singing for lung health (SLH) is a popular arts-in-health activity for people with long-term respiratory conditions. Participants report biopsychosocial benefits, however, research on impact is limited. The 'SLH: Improving Experiences of Lung Disease trial', a randomised controlled, single (assessor) blind, trial of 12 weeks SLH versus usual care for people with chronic obstructive pulmonary disease (COPD) (n=120) was setup to help to address this. The first group (n=18, nine singing and nine controls) started face-to-face (five sessions) before changing to online delivery (seven sessions) due to COVID-19-related physical distancing measures. As such, the experience of this group is here reported as a pilot study to inform further research in this area. METHODS: We conducted semistructured interviews and thematic analysis regarding barriers, facilitators and key considerations for transitioning from face-to-face to online delivery. Pilot quantitative outcomes include attendance, premeasures and postmeasures of quality of life and disease impact (Short Form 36 Health Survey, COPD Assessment Test score), breathlessness (Medical Research Council breathlessness scale, Dyspnoea-12), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalised Anxiety Disorder-7), balance confidence (Activity specific Balance Confidence, ABC scale) and physical activity (clinical visit PROactive physical activity in COPD tool, combining subjective rating and actigraphy). RESULTS: Attendance was 69% overall, (90% of the face-to-face sessions, 53% online sessions). Analysis of semistructured interviews identified three themes regarding participation in SLH delivered face to face and online, these where (1) perceived benefits; (2) digital barriers (online) and (3) digital facilitators (online). Findings were summarised into key considerations for optimising transitioning singing groups from face-to-face to online delivery. Pilot quantitative data suggested possible improvements in depression (treatment effect -4.78 PHQ-9 points, p<0.05, MCID 5) and balance confidence (treatment effect +17.21 ABC scale points, p=0.04, MCID 14.2). DISCUSSION: This study identifies key considerations regarding the adaptation of SLH from face-to-face to online delivery. Pilot data suggest online group singing for people with COPD may deliver benefits related to reducing depression and improved balance confidence.

Dance for people with chronic respiratory disease: a qualitative study.

OBJECTIVES: To explore the experiences and perceived impact on health and well-being related to participation in a dance group for people with chronic respiratory disease (CRD). DESIGN: An exploratory qualitative study using thematic analysis of semistructured interviews. SETTING: A community dance group in a UK health centre. PARTICIPANTS: Convenience sample of long-term dance group participants. INTERVENTION: Weekly community dance sessions designed for people with breathlessness, lasting 75 min, led by a trained community dance leader. RESULTS: Convenience sample of eight participants, six females, aged 57-87 years (mean 75), with a median 2-year attendance at weekly dance sessions. Long-term attendance was driven by strongly held beliefs regarding the health and well-being benefits of participation. Four key themes were identified: dance as (1) a holistically beneficial activity, with physical and psychosocial health benefits including improved or maintained physical fitness and psychological well-being, and reduced need for healthcare; (2) an integral part of their life; (3) an enjoyable activity; and (4) a source of deep social cohesion. CONCLUSIONS: Dance group participants perceived a broad range of health benefits of relevance to the biopsychosocial impacts of their respiratory disease. The themes identified are useful in the ongoing planning and evaluation of dance as a holistic complex intervention for people with CRD. Further research is required to assess the extent of health impacts identified, and how dance might be most effectively placed as an option in the management of CRD. TRIAL REGISTRATION NUMBER: NCT04006015.

Differential use of emotion regulation strategies when engaging in artistic creative activities amongst those with and without depression.

The ability to effectively regulate our emotions has been shown to be impaired in people with depression. Arts activities have been found to improve depression, but whether people with depression make differential use of emotion regulation strategies (ERSs) when engaging in the arts remains unclear. This study analysed data from 11,248 individuals with depression who were matched on demographics, personality and arts experience with a further 11,248 individuals without depression. We found a significantly lower overall use of self-reported ERSs when engaging in arts amongst those with depression; specifically lower use of approach strategies (e.g. reappraisal) and self-development strategies (e.g. improved self-esteem), but the same use of avoidance strategies (e.g. distraction). However, these differences were very slight (very small effect size and <1% difference). This suggests that people with depression still experience benefits for emotion regulation, which could help to explain the beneficial effects of arts interventions reducing symptoms of depression.

What is the evidence on the role of the arts in improving health and well-being? A scoping review

Over the past two decades, there has been a major increase in research into the effects of the arts on health and well-being, alongside developments in practice and policy activities in different countries across the WHO European Region and further afield. This report synthesizes the global evidence on the role of the arts in improving health and well-being, with a specific focus on the WHO European Region. Results from over 3000 studies identified a major role for the arts in the prevention of ill health, promotion of health, and management and treatment of illness across the lifespan. The reviewed evidence included study designs such as uncontrolled pilot studies, case studies, small-scale cross-sectional surveys, nationally representative longitudinal cohort studies, community-wide ethnographies and randomized controlled trials from diverse disciplines. The beneficial impact of the arts could be furthered through acknowledging and acting on the growing evidence base; promoting arts engagement at the individual, local and national levels; and supporting cross-sectoral collaboration.

Could listening to music during pregnancy be protective against postnatal depression and poor wellbeing post birth? Longitudinal associations from a preliminary prospective cohort study.

OBJECTIVES: This study explored whether listening to music during pregnancy is longitudinally associated with lower symptoms of postnatal depression and higher well-being in mothers post birth. DESIGN: Prospective cohort study. PARTICIPANTS: We analysed data from 395 new mothers aged over 18 who provided data in the third trimester of pregnancy and 3 and 6 months later (0-3 and 4-6 months post birth). PRIMARY AND SECONDARY OUTCOME MEASURES: Postnatal depression was measured using the Edinburgh Postnatal Depression Scale, and well-being was measured using the Short Warwick-Edinburgh Mental Well-being Scale. Our exposure was listening to music and was categorised as 'rarely; a couple of times a week; every day <1 hour; every day 1-2 hours; every day 3-5 hours; every day 5+hrs'. Multivariable linear regression analyses were carried out to explore the effects of listening to music during pregnancy on depression and well-being post birth, adjusted for baseline mental health and potential confounding variables. RESULTS: Listening during pregnancy is associated with higher levels of well-being (ß=0.40, SE=0.15, 95% CI 0.10 to 0.70) and reduced symptoms of postnatal depression (ß=-0.39, SE=0.19, 95% CI -0.76 to -0.03) in the first 3 months post birth. However, effects disappear by 4-6 months post birth. These results appear to be particularly found among women with lower levels of well-being and high levels of depression at baseline. CONCLUSIONS: Listening to music could be recommended as a way of supporting mental health and well-being in pregnant women, in particular those who demonstrate low well-being or symptoms of postnatal depression.

The biological impact of listening to music in clinical and nonclinical settings: A systematic review.

This systematic review explored the evidence base on the impact of listening to music on biological response in both clinical and nonclinical settings. Human studies exploring the effects of listening to recorded music on biological markers were included. Studies had to involve a non-music control condition. Keyword searches were carried out of five major databases (Cochrane/Wiley, PsycINFO, PubMed, Sage, and Science Direct) and bias was assessed using the Cochrane Risk of Bias Tool for Randomized Studies (RoB 2.0). Forty-four studies assessing the biological impact of music listening were identified: 27 in clinical settings and 17 in nonclinical settings. Eighty-two percent had examined the effects of short-term listening interventions, while the remainder had looked at longitudinal interventions. Thirteen of 33 biomarkers tested were reported to change in response to listening to music. The most commonly analyzed biomarker was the stress hormone cortisol, with half of clinical studies demonstrating a stress-reducing effect of music listening. Blood glucose was also found repeatedly to reduce in response to music listening. Many of the other biomarkers analyzed are also part of biological stress pathways, which suggests that the primary way by which music listening affects us biologically is via modulations of stress response. Effects were shown irrespective of genre, self-selection of the music, or duration of listening, although a majority did use classical music. The evidence base for understanding biological responses to music is still developing, but there is support for the application of listening to music, especially within clinical settings for stress reduction.

Effects of Group Drumming Interventions on Anxiety, Depression, Social Resilience and Inflammatory Immune Response among Mental Health Service Users.

UNLABELLED: Growing numbers of mental health organizations are developing community music-making interventions for service users; however, to date there has been little research into their efficacy or mechanisms of effect. This study was an exploratory examination of whether 10 weeks of group drumming could improve depression, anxiety and social resilience among service users compared with a non-music control group (with participants allocated to group by geographical location.) Significant improvements were found in the drumming group but not the control group: by week 6 there were decreases in depression (-2.14 SE 0.50 CI -3.16 to -1.11) and increases in social resilience (7.69 SE 2.00 CI 3.60 to 11.78), and by week 10 these had further improved (depression: -3.41 SE 0.62 CI -4.68 to -2.15; social resilience: 10.59 SE 1.78 CI 6.94 to 14.24) alongside significant improvements in anxiety (-2.21 SE 0.50 CI -3.24 to -1.19) and mental wellbeing (6.14 SE 0.92 CI 4.25 to 8.04). All significant changes were maintained at 3 months follow-up. Furthermore, it is now recognised that many mental health conditions are characterised by underlying inflammatory immune responses. Consequently, participants in the drumming group also provided saliva samples to test for cortisol and the cytokines interleukin (IL) 4, IL6, IL17, tumour necrosis factor alpha (TNFα), and monocyte chemoattractant protein (MCP) 1. Across the 10 weeks there was a shift away from a pro-inflammatory towards an anti-inflammatory immune profile. Consequently, this study demonstrates the psychological benefits of group drumming and also suggests underlying biological effects, supporting its therapeutic potential for mental health. TRIAL REGISTRATION: ClinicalTrials.gov NCT01906892.

A Randomized Controlled Trial of Listening to Recorded Music for Heart Failure Patients: Study Protocol.

AIMS: To describe a conceptual framework and to test the effectiveness of a recorded music-listening protocol on symptom burden and quality of life in heart failure (HF) patients. BACKGROUND: Heart failure is an important public health problem. Many HF patients experience symptoms burden and poor quality of life, even with current improvements in pharmacological treatments. Recorded music listening has been shown to improve outcomes in cardiovascular patients, but it has never been tested on HF patients and with a specific music protocol and a randomized controlled trial methodology. METHODS: This study is a multicenter blinded randomized controlled trial that will involve 150 patients. Eligible patients will have a diagnosis of HF, in New York Heart Association functional classification of I to III, and will be recruited from 3 large hospitals in Northern Italy. Patients will be randomly allocated in a 1:1 ratio to receive recorded music-listening intervention with or without standard care for 3 months. Data will be collected at baseline and at the end of the first, second, and third month during the intervention, and at 6 months for follow-up. The following variables will be collected from HF patients with validated protocols: quality of life (primary endpoint), use of emergency services, rehospitalization rates, all cause mortality, self-care, somatic symptoms, quality of sleep, anxiety and depression symptoms, and cognitive function. DISCUSSION: This study will examine the effect of recorded music listening on HF patients and will inform clinical practice. If the findings are found to be positive, the protocol could be used as a tool for evidence-based applications of recorded music in HF patients. The framework developed in this study may be helpful for future research focused on the effects of music in HF patients.

The psychoneuroimmunological effects of music: a systematic review and a new model.

There has been a growing interest over the past decade into the health benefits of music, in particular examining its psychological and neurological effects. Yet this is the first attempt to systematically review publications on the psychoneuroimmunology of music. Of the selected sixty-three studies published over the past 22 years, a range of effects of music on neurotransmitters, hormones, cytokines, lymphocytes, vital signs and immunoglobulins as well as psychological assessments are cataloged. Research so far points to the pivotal role of stress pathways in linking music to an immune response. However, several challenges to this research are noted: (1) there is very little discussion on the possible mechanisms by which music is achieving its neurological and immunological impact; (2) the studies tend to examine biomarkers in isolation, without taking into consideration the interaction of the biomarkers in question with other physiological or metabolic activities of the body, leading to an unclear understanding of the impact that music may be having; (3) terms are not being defined clearly enough, such as distinctions not being made between different kinds of stress and 'music' being used to encompass a broad spectrum of activities without determining which aspects of musical engagement are responsible for alterations in biomarkers. In light of this, a new model is presented which provides a framework for developing a taxonomy of musical and stress-related variables in research design, and tracing the broad pathways that are involved in its influence on the body.