title: A mixed-method systematic review to investigate the effect of group singing on health related quality of life.
abstract: OBJECTIVE
  To investigate the effect of group singing on health related quality of life (HRQoL) for adult, amateur singers with chronic health conditions.
  
  
  METHODS
  A literature search for experimental and observational studies and qualitative studies published before February 2014 was undertaken using the following databases: ASSIA (Proquest), CINAHL (Ebsco), EMBASE (OVID), HMIC (OVID), MEDLINE (OVID), MEDLINE in Process (OVID), OpenGrey, PsycINFO (OVID) and PubMed for Epub ahead of print studies. Social Science searches included: Web of Science, Proquest, and Scopus (Elsevier). The records were screened independently by two reviewers. Studies were critiqued using Critical Appraisal Skills Programme tools.
  
  
  RESULTS
  The literature search identified 573 papers, from which 18 were included (5 quantitative, 5 qualitative, 8 mixed-methods studies). These included a variety of patient populations including chronic respiratory disease, neurological conditions and mental health. The quantitative studies lacked consistency: two of the seven controlled studies demonstrated additional HRQoL benefits with singing compared to controls, while three of six uncontrolled studies showed improved HRQoL. Qualitative methods were recorded in variable depth. The qualitative data presented a range of benefits of group singing including increased confidence, increased mood and social support. Few negative effects of singing were reported.
  
  
  CONCLUSIONS
  This systematic review indicates that group singing interventions may have beneficial effects on HRQoL, anxiety, depression and mood. Studies were heterogeneous with significant methodological limitations, allowing only a weak recommendation for group singing as an intervention for adults with chronic health problems. The undertaking of larger controlled and in-depth qualitative studies is warranted.
authors: School of Healthcare Sciences, Cardiff University, Cardiff, UK. Electronic address: ReagonC1@cardiff.ac.uk.
authors: Carly
authors: C
authors: Reagon
authors: School of Healthcare Sciences, Cardiff University, Cardiff, UK. Electronic address: GaleNS@cardiff.ac.uk.
authors: Nichola
authors: N
authors: Gale
authors: School of Healthcare Sciences, Cardiff University, Cardiff, UK. Electronic address: EnrightS@cardiff.ac.uk.
authors: Stephanie
authors: S
authors: Enright
authors: Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK. Electronic address: mannmk@cf.ac.uk.
authors: Mala
authors: M
authors: Mann
authors: School of Healthcare Sciences, Cardiff University, Cardiff, UK. Electronic address: vanDeursenR@cardiff.ac.uk.
authors: Robert
authors: R
authors: van Deursen
mesh_terms: D000339:Affect / Q000502:physiology; D001007:Anxiety / Q000523:psychology; D002908:Chronic Disease / Q000523:psychology*; D003863:Depression / Q000523:psychology; D006801:Humans; D008603:Mental Health; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D063346:Singing / Q000502:physiology*; D012944:Social Support
keywords: Anxiety; Choirs; Depression; Group singing; Mood; Quality of life