Psychiatric admissions in young people after expiration of criminal justice supervision in Australia: a retrospective data linkage study.

BACKGROUND: Mental health services are available for young people involved with the criminal justice system. However, they have unmet mental health needs after the expiration of criminal justice supervision. OBJECTIVE: To determine the incidence rate and identify predictors of psychiatric hospitalisations within 24 months after the expiration of criminal justice supervision among young people involved with the New South Wales (NSW) criminal justice system. METHODS: Retrospective data from 1556 individuals aged 14-22 years who participated in four surveys of justice-involved young people in NSW were harmonised and linked to four NSW data collections. We calculated the incidence rates of psychiatric hospitalisations within 24 months postsupervision and identified predictors of these hospitalisations using a competing risks regression analysis. RESULTS: Within 24 months postsupervision, 11.4% had a psychiatric hospitalisation compared with 3.5% during supervision. 20.7% of those admitted had a known history of mental illness and engaged with community-based and outpatient mental health services postsupervision. Predictors of psychiatric hospitalisations were: female sex (adjusted subdistribution HR (asHR) 1.84, 95% CI 1.24 to 2.73); previous incarceration (highest asHR for ≥4 episodes 1.67, 95% CI 1.01 to 2.78); head injury (asHR 1.63, 95% CI 1.20 to 2.21); personality disorder (asHR 3.66, 95% CI 2.06 to 6.48) and alcohol and substance use disorder (asHR 1.89, 95% CI 1.29 to 2.77). CONCLUSION: Justice-involved youth have higher rates of psychiatric admissions after criminal justice supervision. Engagement with mental health services postsupervision is important in addressing emerging or persisting mental health needs.

Effects of Aging on Musical Performance in Professional Orchestral Musicians.

BACKGROUND: The physical and psychological demands of playing a musical instrument are likely to be affected by age-related decline in function, including physical, cognitive, psychological, and organ-related changes. However, the complex neurophysiological demands of playing a musical instrument may delay many normal aging-related changes. AIM: This study compared professional classical musicians of different ages, using a range of physical and psychological measures, to discover how increasing age might affect work performance and to identify possible risk and protective factors for physical and psychological health as the musicians age. SUBJECTS: 377 professional orchestral musicians from eight Australian orchestras (70% response rate), ages 18 to 68 yrs (mean 42.1). Multiple standardized physical and psychological tools were used to evaluate the impact of age on a range of physical and mental health variables. RESULTS: Age was not statistically associated with frequency or severity of performance-related musculoskeletal disorders, ratings of perceived exertion, QuickDASH scores, use of beta-blockers, workplace satisfaction, and most psychological tests. Differences were observed on SPIN (social anxiety) scores, with lowest scores in the oldest age group (10.66 in 55+ yrs vs 17.83 in 18-30 yrs, p=0.016). Older musicians had higher BMIs and fewer practice sessions per day than younger musicians and also were more likely to consume alcohol on 5+ days/wk (44% vs 9%, p=0.003). CONCLUSION: Advancing age does not appear to exert undue negative impacts on physical and psychological health or performance capacity of professional orchestral musicians. However, dwindling numbers in the older age groups may suggest a "survivor" effect, whereby those who develop significant age-related decrements may cease professional performance at earlier ages. Longitudinal studies on the professional trajectories of professional orchestral musicians are needed to explore this question further.

Gender Differences in Mortality and Morbidity Patterns in Popular Musicians Across the Lifespan.

Recent studies have highlighted the disturbing morbidity and early mortality of popular musicians. Most of the studies have focused on male musicians because, until recently, there were relatively few female popular musicians on which to base a population study. With the sharp increase in female popular musicians from fewer than 2% in the 1950s to 32% in the current decade, researchers are better able to examine the health status and mortality profile of female popular musicians. To this end, this paper makes what we believe is the first detailed analysis of mortality and morbidity in female popular musicians. Mortality patterns were similar for male and female musicians, and both were highly discrepant from population curves. Examination of death rates for younger (<45 yrs) and older (>45 yrs) musicians by sex and genre showed that violent deaths continued to dominate cause of death even in older musicians, accounting for 20% of all deaths, a figure three times higher than for a comparable general population. Unlike females in the general population, female gender did not bestow any protection against early death or manner of death by suicide, homicide, or accident compared with male popular musicians.

Identifying attachment ruptures underlying severe music performance anxiety in a professional musician undertaking an assessment and trial therapy of Intensive Short-Term Dynamic Psychotherapy (ISTDP).

INTRODUCTION: Kenny has proposed that severe music performance anxiety that is unresponsive to usual treatments such as cognitive-behaviour therapy may be one manifestation of unresolved attachment ruptures in early life. Intensive Short-Term Dynamic Psychotherapy specifically targets early relationship trauma. Accordingly, a trial of Intensive Short-Term Dynamic Psychotherapy with severely anxious musicians was implemented to assess whether resolution of attachment ruptures resulted in clinically significant relief from music performance anxiety. METHODS: Volunteer musicians participating in a nationally funded study were screened for MPA severity. Those meeting the critical cut-off score on the Kenny Music Performance Anxiety Inventory were offered a trial of Intensive Short-Term Dynamic Psychotherapy. In this paper, we present the theoretical foundations and rationale for the treatment approach, followed by sections of a verbatim transcript and process analysis of the assessment phase of treatment that comprised a 3-h trial therapy session. CASE DESCRIPTION: The 'case' was a professional orchestral musician (male, aged 55) who had suffered severe music performance anxiety over the course of his entire career, which spanned more than 30 years at the time he presented for treatment following his failure to secure a position at audition. DISCUSSION AND EVALUATION: The participant was able to access the pain, rage and grief associated with unresolved attachment ruptures with both parents that demonstrated the likely nexus between early attachment trauma and severe music performance anxiety. CONCLUSION: Intensive Short-Term Dynamic Psychotherapy is a potentially cost-effective treatment for severe music performance anxiety. Further research using designs with higher levels of evidence are required before clinical recommendations can be made for the use of this therapy with this population.

Is Playing in the Pit Really the Pits?: Pain, Strength, Music Performance Anxiety, and Workplace Satisfaction in Professional Musicians in Stage, Pit, and Combined Stage/Pit Orchestras.

INTRODUCTION: Typically, Australian orchestral musicians perform on stage, in an orchestra pit, or in a combination of both workplaces. This study explored a range of physical and mental health indicators in musicians who played in these different orchestra types to ascertain whether orchestra environment was a risk factor affecting musician wellbeing. METHODS: Participants comprised 380 full-time orchestral musicians from the eight major state orchestras in Australia comprised of two dedicated pit orchestras, three stage-only symphonic orchestras, and three mixed stage/pit orchestras. Participants completed a physical assessment and a range of self-report measures assessing performance-related musculoskeletal disorders (PRMD), physical characteristics including strength and perceived exertion, and psychological health, including music performance anxiety (MPA), workplace satisfaction, and bullying. RESULTS: Physical characteristics and performance-related musculoskeletal profiles were similar for most factors on the detailed survey completed by orchestra members. The exceptions were that pit musicians demonstrated greater shoulder and elbow strength, while mixed-workload orchestra musicians had greater flexibility Significantly more exertion was reported by pit musicians when rehearsing and performing. Stage/pit musicians reported less physical exertion when performing in the pit compared with performing on stage. Severity of MPA was significantly greater in pit musicians than mixed orchestra musicians. Pit musicians also reported more frequent bullying and lower job satisfaction compared with stage musicians. DISCUSSION: There were few differences in the objective physical measures between musicians in the different orchestra types. However, pit musicians appear more psychologically vulnerable and less satisfied with their work than musicians from the other two orchestra types. The physical and psychological characteristics of musicians who perform in different orchestra types have not been adequately theorized or studied. We offer some preliminary thoughts that may account for the observed differences.

Life Expectancy and Cause of Death in Popular Musicians: Is the Popular Musician Lifestyle the Road to Ruin?

Does a combination of lifestyle pressures and personality, as reflected in genre, lead to the early death of popular musicians? We explored overall mortality, cause of death, and changes in patterns of death over time and by music genre membership in popular musicians who died between 1950 and 2014. The death records of 13,195 popular musicians were coded for age and year of death, cause of death, gender, and music genre. Musician death statistics were compared with age-matched deaths in the US population using actuarial methods. Although the common perception is of a glamorous, free-wheeling lifestyle for this occupational group, the figures tell a very different story. Results showed that popular musicians have shortened life expectancy compared with comparable general populations. Results showed excess mortality from violent deaths (suicide, homicide, accidental death, including vehicular deaths and drug overdoses) and liver disease for each age group studied compared with population mortality patterns. These excess deaths were highest for the under-25-year age group and reduced chronologically thereafter. Overall mortality rates were twice as high compared with the population when averaged over the whole age range. Mortality impacts differed by music genre. In particular, excess suicides and liver-related disease were observed in country, metal, and rock musicians; excess homicides were observed in 6 of the 14 genres, in particular hip hop and rap musicians. For accidental death, actual deaths significantly exceeded expected deaths for country, folk, jazz, metal, pop, punk, and rock.

Minimization of Childhood Maltreatment Is Common and Consequential: Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire.

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale-originally designed to assess a positive response bias-are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ's MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ's discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias-as detected by the MD subscale-has a small but significant moderating effect on the CTQ's discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

Assessing Linearity in the Loudness Envelope of the Messa di Voce Singing Exercise Through Acoustic Signal Analysis.

Messa di voce (MDV) is a singing exercise that involves sustaining a single pitch with a linear change in loudness from silence to maximum intensity (the crescendo part) and back to silence again (the decrescendo part), with time symmetry between the two parts. Previous studies have used the sound pressure level (SPL, in decibels) of a singer's voice to measure loudness, so as to assess the linearity of each part-an approach that has limitations due to loudness and SPL not being linearly related. This article studies the loudness envelope shapes of MDVs, comparing the SPL approach with approaches that are more closely related to human loudness perception. The MDVs were performed by a cohort of tertiary singing students, recorded six times (once per semester) over a period of 3 years. The loudness envelopes were derived for a typical audience listening position, and for listening to one's own singing, using three models: SPL, Stevens' power law-based model, and a computational loudness model. The effects on the envelope shape due to room acoustics (an important effect) and vibrato (minimal effect) were also considered. The results showed that the SPL model yielded a lower proportion of linear crescendi and decrescendi, compared with other models. The Stevens' power law-based model provided results similar to the more complicated computational loudness model. Longitudinally, there was no consistent trend in the shape of the MDV loudness envelope for the cohort although there were some individual singers who exhibited improvements in linearity.

Vibrato changes following imagery.

OBJECTIVES: This study investigated acoustic change in singers' vibrato following imagery and non-imagery tasks. STUDY DESIGN: The study used a fully randomized cross-over (six conditions × two times) block design, in which each singer received each intervention in random order. Data were analyzed using the general linear model (GLM). Main effects for time and condition and interaction effects (time × condition) were calculated for each dependent measure. METHODS: Six classically trained female singers recorded an 8-bar solo before and after three nonvocal, 25 minute tasks. Each singer performed the tasks in a different randomized order in a single sitting. Task 1 involved imagery of the breath directed up and down as far from the larynx as possible; Task 2 used Braille music code, enabling the singer to engage in tactile, kinesthetic and visual imagery related to music but unrelated to breath function; Task 3 was a nonimagery activity requiring the completion of a cloze passage about breath function. From the 11 longest notes in each solo, spectrograms of the partials were produced and assessed for pre- to post-test changes in vibrato rate, vibrato extent, and sound pressure level (SPL). RESULTS: Only the breathing imagery task produced significantly more moderate and regular vibrato rates. Vibrato extent was not responsive to any intervention. CONCLUSIONS: Findings indicate that breathing imagery regulates singers' vibrato in a manner consistent with that of a more proficient, warmed-up voice.

The effects of office ergonomic training on musculoskeletal complaints, sickness absence, and psychological well-being: a cluster randomized control trial.

This study explored whether musculoskeletal complaints can be reduced by the provision of ergonomics education. A cluster randomized controlled trial study was conducted in which 3 units were randomized to intervention and received training and 3 units were given a leaflet. The effect of intervention on knowledge, workstation practices, musculoskeletal complaints, sickness absence, and psychological well-being were assessed at 6 and 12 months. Although there was no increment of knowledge among workers, significant improvements in workstation practices in the use of monitor, keyboard, and chair were observed. There were significant reductions in neck and upper and lower back complaints among workers but these did not translate into fewer days lost from work. Workers' stress was found to be significantly reduced across the studies. In conclusion, office ergonomics training can be beneficial in reducing musculoskeletal risks and stress among workers.

Sound Practice-improving occupational health and safety for professional orchestral musicians in Australia.

The Sound Practice Project is a 5-year study involving baseline evaluation, development, and implementation of musician-specific work health and safety initiatives. A cross-sectional population physical and psychological survey and physical assessment were conducted at the same time, with an auditory health assessment conducted later. The results were used to guide the development of a series of targeted interventions, encompassing physical, psychological, and auditory health components. This paper provides an overview of the project but focuses on the health findings arising from the cross-sectional survey. Three hundred and seventy-seven musicians from the eight professional symphony orchestras in Australia took part in the cross-sectional study (about 70% of eligible musicians). Eighty-four percent (84%) of musicians reported past performance-related musculoskeletal disorder (PRMD) episodes; 50% were suffering a current PRMD. Of the 63% who returned hearing surveys, 43% believed they had hearing loss, and 64% used earplugs at least intermittently. Noise exposure was found to be high in private practice, although awareness of risk and earplug use in this environment was lower than in orchestral settings. Improved strategic approaches, acoustic screens and recently developed active earplugs were found to provide effective new options for hearing protection. With respect to psychosocial screening, female musicians reported significantly more trait anxiety, music performance anxiety, social anxiety, and other forms of anxiety and depression than male musicians. The youngest musicians were significantly more anxious compared with the oldest musicians. Thirty-three percent (33%) of musicians may meet criteria for a diagnosis of social phobia; 32% returned a positive depression screen and 22% for post-traumatic stress disorder (PTSD). PRMDs and trigger point discomfort levels were strongly associated with increasing severity of psychological issues such as depression and music performance anxiety.

Intensive short-term dynamic psychotherapy for severe music performance anxiety: assessment, process, and outcome of psychotherapy with a professional orchestral musician.

This paper reports on the process and outcome of therapy using intensive short-term dynamic psychotherapy (ISTDP) with a professional musician who had suffered severe music performance anxiety over the course of his entire 30-year career. In this paper, we describe the nature of the therapy, the case history of the musician, the first assessment and trial therapy session, and the course and successful outcome of therapy. The patient underwent 10 sessions of ISTDP over a period of 4 months. This paper reports on the first 6 sessions, which were most relevant to the understanding and treatment of the patient's severe music performance anxiety. This case study is the first reported application of ISTDP to a professional musician. We believe that this case study provides initial support that moderate to severe performance anxiety, in at least some cases, has its origins in unresolved complex emotions and defences arising from ruptures to early attachment relationships.

Towards a method for loudness-based analysis of the sound of one's own voice.

This paper outlines the steps in objectively estimating the time-varying loudness of one's own voice in a room (i.e. autophonic loudness). Voice recordings, made with a near-mouth microphone, are converted to the sound that reaches the two eardrums of the talking (or singing)-listener by convolving them with the impulse responses from the mouth to the respective ears of an anthropomorphic head and torso. The influences of bone-conducted sound and room reflections are taken into account. These convolved recordings are then processed with a computational time-varying loudness model. The method is demonstrated by a short case study, and the results illustrate something of the benefit of loudness analysis over sound pressure level analysis for representing autophonic loudness.

Change in messa di voce characteristics during 3 years of classical singing training at the tertiary level.

A 3-year longitudinal study was conducted to investigate changes in vocal quality as a result of singing training at a tertiary level conservatorium in Australia. Singers performed a messa di voce (MDV) at intervals of 6 months over the 3-year period of training. The study investigated the evolving acoustic features of the singers' voices exhibited during the MDV, including sound pressure level (SPL), short-term energy ratio (STER), duration, and vibrato parameters of the fundamental frequency (F0), SPL, and STER. The maximum SPL exhibited a marginal systematic increase over the training period, but the maximum STER did not systematically change. F0 vibrato extent increased significantly, whereas the extent of SPL and STER vibrato did not change significantly.

Singer and listener perception of vocal warm-up.

OBJECTIVES: This study investigated changes perceived by singers and listeners after the singers had vocally warmed up. STUDY DESIGN: The study used a repeated measures within-subject design to assess changes in vibrato quality from pre (nonwarmed-up voice) to post (warmed-up voice) test. Intraclass correlation coefficients were calculated to assess singers' self-ratings pre- and posttest and intra- and interlistener rater reliability. METHODS: Twelve classically trained female singers recorded and self-rated their performance of an eight bar solo before and after 25 minutes of vocal warm-up exercises. Six experienced listeners assessed the vocal samples for pre- to posttest differences in tone quality and for each singer's warm-up condition. Perceptual judgements were also compared with pre- to posttest changes in vibrato. RESULTS: All singers perceived significant changes in tone quality, psychophysiological factors, proprioceptive feedback and technical command. Significant pre- to posttest differences in tone quality and correct appraisal of the singer's warm-up condition from most of the listeners were only observed for singers who moderated extremely fast or extremely slow vibrato after warming up. CONCLUSIONS: The findings reveal the divide between listeners' and singers' perceptions of the warmed-up voice and highlight the importance of enhanced vibrato quality to listener perception of an improvement in vocal quality.

Musculoskeletal pain and injury in professional orchestral musicians in Australia.

UNLABELLED: This paper reports on the major findings from the questionnaire component of a cross-sectional survey of the musicians in Australia's eight fulltime professional symphonic and pit orchestras, focusing on performance-related musculoskeletal disorders (PRMDs). METHODS: All musician members of the orchestras participating in this project were invited to complete a self-report survey. The overall response rate was about 70% (n = 377). In addition to general health and experience questions, respondents who reported a current or previous PRMD were asked to report on a range of associated factors. RESULTS: Of the participants, 84% had experienced pain or injuries that had interfered either with playing their instrument or participating in normal orchestral rehearsals and performances. Fifty percent reported having such pain or injury at the time of the survey, mostly with disorders perceived by the musicians to be work-related. Twenty-eight percent had taken at least 1 day off from work for such pain in the previous 18 months. The most common broad sites affected were the trunk (primarily the back), the right upper limb and neck, the left upper limb and neck, and the neck alone, but the relative proportions varied by instrument. Of those musicians who reported at least one episode of pain or injury in the past, less than 50% reported that they had completely recovered. The most commonly cited performance-related factors that had contributed to injury or pain all related to training and playing load (including practice and performance). CONCLUSION: This study provides strong evidence that PRMDs are a common complaint in professional orchestral musicians and identifies a range of factors suggested as contributing to the occurrence or persistence of these disorders.

Vocal warm-up produces acoustic change in singers' vibrato rate.

Vibrato rate and vibrato extent were acoustically assessed in 12 classically trained female singers before and after 25 minutes of vocal warm-up exercises. Vocal warm-up produced three notable changes in vibrato rate: (1) more regularity in the cyclic undulations comprising the vibrato rate of a note, (2) more stability in mean vibrato rates from one sustained note to the next, and (3) a moderating of excessively fast and excessively slow mean vibrato rates. No significant change was found for vibrato extent. The findings indicate that vocal warm-up may regulate vibrato rate. Thus tone quality, which is strongly linked to vibrato characteristics, may undergo positive change as a result of vocal warm-up.

Incidence of injury and attitudes to injury management in skilled flute players.

OBJECTIVE: The flute is a highly popular instrument, yet little is known about the potential injury association with playing this instrument. PARTICIPANTS: Twenty flautists from a major music training institution volunteered to participate in this project, and had played the flute for a minimum of ten years. METHODS: A specifically designed musicians' health questionnaire was used to determine injury rates in a group of skilled collegiate flute players majoring in music to examine self-reported perceptions of performance-related musculoskeletal disorder causation and approaches to managing these conditions. RESULTS: All except one player reported suffering from a performance-related musculoskeletal disorder, with pain present for longer than 3 months in two thirds of this group. The most common approach by the flautists was to take Alexander lessons rather than seeking health professional advice. Most attributed their symptoms to long hours of practice, poor posture and the presence of performance anxiety. CONCLUSIONS: Flautists in this sample reported high rates of performance-related musculoskeletal disorders with the majority having been present for longer than 3 months. The approach to management often did not involve consultation with a health professional qualified to diagnose musculoskeletal conditions.

How can surgical training benefit from theories of skilled motor development, musical skill acquisition and performance psychology?

Trainee surgeons must acquire expert status in the context of reduced hours, reduced operating room time and the need to learn complex skills involving screen-mediated techniques, computers and robotics. Ever more sophisticated surgical simulation strategies have been helpful in providing surgeons with the opportunity to practise, but not all of these strategies are widely available. Similarities in the motor skills required in skilled musical performance and surgery suggest that models of music learning, and particularly skilled motor development, may be applicable in training surgeons. More attention should be paid to factors associated with optimal arousal and optimal performance in surgical training - lessons learned from helping anxious musicians optimise performance and manage anxiety may also be transferable to trainee surgeons. The ways in which the trainee surgeon moves from novice to expert need to be better understood so that this process can be expedited using current knowledge in other disciplines requiring the performance of complex fine motor tasks with high cognitive load under pressure.

Voice training and changing weight--are they reflected in speaking fundamental frequency, voice range, and pitch breaks of 13-year-old girls? A longitudinal study.

OBJECTIVE: Assessment of the voice-change progress of 20 girls (12-13 years) over 1 year by observing changes in speaking fundamental frequency (SFo), voice range, and register pitch breaks in the context of weight, height, voice training, and self-perception. STUDY DESIGN: One-year longitudinal collective case study. METHOD: Twenty girls were recorded at the beginning and end of a year; nine girls were recorded another three times. SFo, vocal range, and characteristics were analyzed and interactions between these data assessed against weight and height to indicate pubertal development, and to test the hypothesis that changes in weight, height, SFo, and pitch breaks were related. Effects of training and the girls' self-perception of their voice use were also assessed. RESULTS: Vocal characteristics changed as the girls passed through different weight ranges. During 47.5-52.4 kg (called band 2) and 52.4-57.5 kg (band 3), there was progressive contraction of vocal range and in some girls a slight rise in SFo between recording times 1 and 5. Both high- and low-pitch breaks were present in 45% of girls' voices. Girls in band 4 (<57.5 kg) had an increased vocal range, and pitch breaks in vocal-range areas that indicated the development of adult vocal registers. In this study, voice-trained girls were heavier, had higher SFo, used wider speech-range inflection, had a higher vocal range, and greater voice-use confidence; all girls lost confidence in their voice use over the year. CONCLUSIONS: In this longitudinal study of twenty 13-year-old girls, voice changes in SFo, vocal range, and pitch-break frequency were synchronous with certain weight ranges. Girls with training registered higher maximum phonational frequency and were more confident in their voice use than girls without training.