Health education for classical musicians

Could compulsory health education at UK conservatoires improve the health and wellbeing of classical musicians? Dr Raluca Matei of Birkbeck’s Centre for Sustainable Working Life shares the findings of a recent study conducted with Jane Ginsborg, Juliet Goldbart, and Stephen Broad.

Picture of classical musicians

Despite rating job satisfaction very highly, many classical musicians also suffer for their art. In the largest survey to date (Fishbein et al., 1988), 76% of players reported a medical problem severe enough to impair performance. The most prevalent were musculoskeletal, affecting the shoulder, neck and back, however, they also reported acute anxiety, depression, and sleep disturbances.

More recent research shows that musicians experience hearing loss (O’Brien et al., 2014), visual problems (Beckers et al., 2016), and eating disorders (Kapsetaki and Easmon, 2017). There is a higher prevalence of insomnia and psychological distress among musicians than in the general population and they may be more likely to use psychotherapy and psychotropic drugs such as sedatives, antidepressants, hypnotics and/or medication for attention deficit hyperactivity disorder (ADHD) (Vaag et al., 2016a,b,c).

Compulsory health education for music students

Our study sought to find out if we could empower musicians to improve their health through a conservatoire-based health education course. The course was delivered to first-year undergraduate music students at a UK music conservatoire. The aims of the study were:

  • To explore students’ hearing and use of hearing protection
  • To design an evidence-based health education course
  • To assess the effects of the course on primary outcomes (perceived knowledge of course content and knowledge and awareness of potential risks to health) and secondary outcomes (including general health, health-related quality of life, health-promoting behaviors, self-efficacy, emotional state, perceived stress, frequency and severity of playing related musculoskeletal disorders (PRMDs), and perceived exertion)
  • To identify the topics within the course that were most salient to students

Unlike previous studies, which provide little information as to how curricula were designed and whether formative methodologies were used, the course curriculum was informed by findings of research on music performance anxiety (MPA) and PRMDs; the findings of evaluations of other courses designed to improve musicians’ health; theories and models deriving from health psychology (Taylor, 2012); discussions with the Acting Head of Undergraduate Studies at the institution where some of the authors are based; and members of the Healthy Conservatoires Network.

The course formed the major component of a module entitled Artist Development 1, compulsory for all first-year students at a tertiary-level music conservatoire in the UK. The module took place over the first and second terms of the academic year and consisted of ten weekly 1-hour lectures delivered to the whole cohort (104 students) and eight weekly 1-hour seminars delivered to ten small groups of 10–15 students. The course covered not only physical and mental health, but also effective strategies for practicing, memorizing and rehearsing, and life skills and behavior-change tools inspired by health psychology.

Students were required to submit a portfolio of assessments including a 1,000-word essay in response to both the following questions: (1) Looking back on the Health and Wellbeing component of Artist Development 1, what new information, useful for your own music-making, have you learned from one lecture or one workshop/seminar?; (2) How have you been able to put this information into practice when making music (e.g., practicing, rehearsing, performing or studying more generally)?

Course evaluation

A mixed-methods approach to evaluation was adopted: quantitative analyses of data gathered at baseline and post-intervention, and between-group data (intervention vs. controls); and qualitative, semi-structured interviews (unpublished).

In terms of hearing, tinnitus and hyperacusis were reported by both groups of respondents, with a higher incidence in the (third-year) control group than in the (first-year) intervention group. Ten percent of the intervention group had been diagnosed with hearing loss, although minorities of respondents in both groups reported having had hearing tests in the previous ten years.

Although respondents were more likely to use hearing protection when rehearsing with others and attending concerts, comparatively few members of either group used hearing protection, or, if appropriate, the mute on their instrument, while practicing alone. This could affect hearing, since private practice can cause over-exposure to risky levels of sound.

Reassuringly, respondents reported increased knowledge of the topics covered in the course, including the sound intensity levels associated with hearing loss and how to deal with the health and safety issues associated with learning and playing a musical instrument. They also reported increased awareness of performance factors related to potential musculoskeletal injuries. The ratings of students who had taken the course and those who had not did not differ significantly, perhaps because the control group had had informal exposure to the other topics covered in the course, with the possible exception of life skills and behavior change techniques.

Students who had taken the course also rated their ability to deal with relevant health and safety issues significantly higher than controls.

In contrast, the only desired secondary outcome to increase significantly from baseline to post-intervention was self-efficacy, which may or may not have been the result of the course. Other significant increases were in the wrong direction: sleep problems, distress and lack of vitality all increased significantly from baseline to post-intervention, and controls experienced more severe depression, distress and lack of vitality.

We attribute these negative findings to the cumulative pressure on students over time. The first time the intervention group completed the questionnaire, they were in their second week at the conservatoire; post-intervention, they were facing deadlines for assignments to be submitted and recitals to be given. They may, however, have fared better than the control group simply by virtue of being a year younger. What we cannot know is the extent to which the health education course may have mitigated the demands perceived by the students in the intervention group.

Finally, from the topics covered in student assignments, it appears that managing MPA and behavior change techniques are of most interest or relevance to them at this point in their studies.

Conclusions

In the absence of a national curriculum for health, all institutions of higher education must develop their own approaches to health education, as do many university music departments and music conservatoires. The questions posed by Ralph Manchester in 2006 remain pertinent: “Who will develop this course? What topics will be included in the syllabus? Who will teach it? Will it be offered to freshmen or seniors, or can it be taken during any year? Can one course meet the needs of performance majors, music education majors, and others? Should we develop some minimal national requirements?” (Manchester, 2006, pp. 95–96).

Further questions could be asked, such as: When can a course be considered successful? What are its desired outcomes? How should they be measured? Once the content and delivery of a course have been evaluated, how should they be adjusted, if necessary? To what extent should students’ requirements and feedback be taken into consideration, given the available evidence and the need, on occasion, to challenge their beliefs? Very few health courses have been formally evaluated to date, and reports of those that have been evaluated do not say how the course was improved as a result.

Although it has been argued for the last 25 years that health education for musicians should be evidence-based (Zaza, 1993), the declarations and recommendations fail to mention the importance of evidence-based teaching. There is now a wealth of research on musicians’ playing-related health problems, and their management, but unless this is disseminated effectively to senior managers and educators, instrumental and vocal tutors, and students, there is a risk that conservatoires will maintain traditional practices rather than responding systematically to the best evidence available.

The topic of how music students, too, can be convinced that health education is a vital part of their training remains largely unexplored. Framing the objectives of health education courses as “performance-enhancing” rather than “preventative” is likely to be more attractive to students.

Although the course described in the present study did not have the hoped-for impact on secondary outcomes including reported health-related behaviors, reduced PRMDs and stress, it was associated with improvements in primary outcomes relevant to health education, namely the perceived knowledge of topics covered in the course and awareness of health risks.

Furthermore, the study itself is the first evaluation of a health education course for musicians that documents the process of designing the course on the basis of a rigorous assessment of the available evidence, and its incorporation in the “real world” context of a music conservatoire.

Further Information

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Bring in Your Parents Day: an inclusive alternative to boost employee engagement

Research by Dr Alexandra Beauregard from the Department of Organizational Psychology explores the impact of LinkedIn’s employee engagement initiative.

A child walking with her parents.

Employee-sponsored family-friendly events are designed to boost engagement and encourage retention by building family members’ identification with the organization. However, longstanding traditions such as ‘Bring Your Children to Work’ days inadvertently exclude employees without caregiving responsibilities for children.

That’s where ‘Bring in Your Parents’ (BIYP) comes in. Launched by LinkedIn in 2013, the initiative targets a segment of the workforce not usually included in family-friendly initiatives: employees from the ‘Generation Y’, ‘Millennial’ or ‘Generation Z’ generations, born after 1981. After internal conversations at LinkedIn revealed that employees struggled to explain the nature of their work to parents who were not familiar with social media, LinkedIn introduced BIYP as a means of improving older parents’ understanding of their children’s jobs.

Together with Dr Karin King at LSE, I conducted a study to evaluate the impact of BIYP on the attitudes and behavioural intentions of employees and their parents. We surveyed participating employees and their parents in six organisations in six countries, followed by in-person interviews with participating employees and phone interviews with HR managers.

Following participation in BIYP, there were statistically significant increases in employee engagement and perceived problem-solving ability. By bringing parents to the workplace and having them learn about the nature of one’s job responsibilities, employees’ enthusiasm and sense of vitality on the job were renewed. Employees also felt that their employer appreciated them and their contribution to the organization’s goals.

BIYP also improved parental understanding of their child’s job. While the new, non-traditional jobs performed by their children seemed intangible to many parents prior to participating in BIYP, they now make more sense. Employees reported that having their parents better understand their work responsibilities and pace of work enabled parents to offer more frequent and appropriate support. This was especially important for young employees who, due to the high cost of housing in some metropolitan areas, still live with their parents and see them every day after work.

Furthermore, following parents’ participation in BIYP, there were significant increases in identification with their children’s organizations and of willingness to promote their children’s organization to outsiders. Parents became brand advocates among their own peer groups and even encouraged their children to stay with the firm for longer.

By incorporating events such as BIYP into existing family-friendly events, organizations can express their support for the work-family balance of all employees, rather than just those with caregiving responsibilities for children. Participation was shown to benefit all involved: employees, their parents or other family guests, and the organization for whom they work. The development of further initiatives that support employers in demonstrating inclusion, deepening employee engagement and widening organizational engagement with a range of stakeholders beyond the employee would be a welcome next step.

The citation for this study is: Beauregard, T. A., & King, K. A. (2019). “Bring in Your Parents Day”: Building inclusion and engagement through a cross-generational family-friendly workplace initiative. Strategic HR Review, (19)1, 15-21.

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Working conditions, exposure to trauma and the mental health of firefighters

Dr Kevin Teoh from the Department of Organizational Psychology shares the findings so far from the Firefighter Longitudinal Health Study.

Firefighters working on the Brumadinho Dam Disaster in 2019

Firefighters play a crucial role in the emergency response system, taking on a myriad of roles that range from the firefighting to responding to car crashes, delivering emergency care and raising safety awareness. They also perform rescue services and are involved in disaster relief.

The nature of this work is often physically, mentally and emotionally challenging, and firefighters can be exposed to traumatic situations such as the destruction of property, burn victims, serious injuries and death. All this can eventually take a toll on the mental health of this occupational group, and it is not surprising that firefighters report high levels of burnout, posttraumatic stress and common mental health disorders (Katsavouni et al., 2016; Lima & Assunção, 2011; Noor et al, 2019).

An international partnership

To better understand what, and how, different factors lead to the development of poor mental health in firefighters, in 2018 two psychologists from Brazil – Dr Eduardo de Paula Lima and Dr Alina Gomide Vasconcelos – visited the Birkbeck Centre for Sustainable Working Life for a six-month Fellowship. More specifically, they came from the Minas Gerais Fire Department, whose firefighters received international media coverage when the Brumadinho dam collapsed in 2019, leading to the loss of at least 256 lives.

The cornerstone of our international collaboration is the ongoing Firefighter Longitudinal Health Study (FLOHS), which aims to better understand the dynamic relationships among individual, operational (traumatic) and organisational risk factors in the development of post-traumatic symptoms and other mental health problems in firefighters. Recruits are assessed in their first week of training with follow up data collected every two years.

The role of working conditions

A simplistic take on the poor mental health of firefighters is that this is the product of the challenging work that they do. However, this ignores the fact that there is consistent research showing that psychosocial working conditions can have a beneficial and detrimental impact on our mental health (Harvey et al., 2017). Within the field of organizational psychology, psychosocial working conditions refer to how work is designed, organised and managed. Here in the Department of Organizational Psychology, we have studied this in a range of different occupations, including doctors (Teoh, Hassard, & Cox, 2018), teachers (Hassard, Teoh, & Cox, 2016) and performing artists (McDowall et al., 2019).

The current study

As psychologists, we were not only interested in whether exposure to traumatic events had a link to firefighters’ mental health, but whether psychosocial working conditions had a similar effect. In our first published study from the FLOHS project, we examined the data from 312 firefighters that were part of the first batch of participants. Three types of psychosocial working conditions were measured: how demanding the job is (i.e. job demands), how much influence one has on their work environment (i.e. job control) and how supported one is (i.e. social support). This was in addition to measuring firefighters’ exposure to traumatic events. The findings were quite clear:

  • 13% of firefighters reported a level of poor mental health that warrants psychological intervention.
  • Higher levels of exposure to trauma and higher levels of job demands were associated with poorer mental health.
  • Higher levels of job control and social support were associated with better mental health.
  • The strength of the relationship that job demands had on poor mental health reduced when firefighters reported high levels of either job control or social support.

What does this all mean? What if I’m not a firefighter?

The findings show that to support the mental health of firefighters, fire departments should focus on reducing the levels of job demands while increasing the levels of social support and job control. Given the inherently difficult nature of firefighting that will be very difficult to remove or reduce, the very least that firefighters deserve is to work in an organisation where the psychosocial working conditions are not another contributing factor to poor mental health.

This message has direct relevance to workers in other occupations within the emergency services, including healthcare workers, the police and the armed forces. In addition, more generally, our findings emphasise that supporting the mental health of workers requires improvements to their psychosocial working conditions and needs to focus on the organisation itself – not through individual interventions such as resilience or mindfulness training (Kinman & Teoh, 2018).

The citation for the study is: Teoh, K. R. H., Lima, E., Vasconcelos, A., Nascimento, E., & Cox, T. (2019). Trauma and work factors as predictors of firefighters’ psychiatric distress. Occupational Medicine. doi: 10.1093/occmed/kqz168

Further information:

References

Harvey, S. B., Modini, M., Joyce, S., S, M.-S. J., Tan, L., Mykletun, A., … Mitchell, P. B. (2017). Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occupational and Environmental Medicine, oemed-2016-104015. https://doi.org/10.1136/oemed-2016-104015

Hassard, J., Teoh, K. R.-H., & Cox, T. (2016). Organizational uncertainty and stress among teachers in Hong Kong: work characteristics and organizational justice. Health Promotion International, daw018. https://doi.org/10.1093/heapro/daw018

Katsavouni, F., Bebetsos, E., Malliou, P., & Beneka, A. (2016). The relationship between burnout, PTSD symptoms and injuries in firefighters. Occupational Medicine, 66(1), 32–37. https://doi.org/10.1093/occmed/kqv144

Kinman, G., & Teoh, K. R.-H. (2018). What could make a difference to the mental health of UK doctors? A review of the research evidence. London, UK, UK. Retrieved from https://www.som.org.uk/sites/som.org.uk/files/What_could_make_a_difference_to_the_mental_health_of_UK_doctors_LTF_SOM.pdf

Lima, E. de P., & Assunção, A. Á. (2011). Prevalência e fatores associados ao Transtorno de Estresse Pós-Traumático (TEPT) em profissionais de emergência: uma revisão sistemática da literatura. Revista Brasileira de Epidemiologia, 14(2), 217–230. https://doi.org/10.1590/S1415-790X2011000200004

McDowall, A., Gamblin, D., Teoh, K. R.-H., Raine, C., & Ehnold-Danailov, A. (2019). Balancing Act: The Impact of Caring Responsibilities on Career Progression in the Performing Arts. London. Retrieved from http://www.pipacampaign.com/wp-content/uploads/2019/04/BA-Final.pdf

Noor, N., Pao, C., Dragomir-Davis, M., Tran, J., & Arbona, C. (2019). PTSD symptoms and suicidal ideation in US female firefighters. Occupational Medicine. https://doi.org/10.1093/occmed/kqz057

Teoh, K. R.-H., Hassard, J., & Cox, T. (2018). Individual and organizational psychosocial predictors of hospital doctors’ work-related well-being. Health Care Management Review, 1. https://doi.org/10.1097/HMR.0000000000000207

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BEI Research Year in Review

2019 was a busy year for the School of Business, Economics and Informatics. Here are some of our research highlights.

BEI Research Year in Review

Improving Diversity on Sport Boards

Improving diversity on sport boards

Dr Richard Tacon and Dr Geoff Walters from the Department of Management worked with Sport England to improve the diversity of board members in the sport and physical activity sector. The programme, unveiled in September, follows a series of studies demonstrating that sports governance lacks diversity, particularly with regards to ethnicity and disability.

Richard and Geoff have designed and implemented training materials as part of the initiative, which will identify and develop a pool of suitable candidates from under-represented groups. The intention is that sports organisations will then be able to turn to these people when recruiting for new board positions.

Diagnosing Gaming Disorder

Gaming

Researchers led by Bruno Schivinski, Lecturer in Marketing, developed the first psychological test to check for ‘gaming disorder’, a new type of mental illness now recognised by the World Health Organisation.

Now accessible online, the test provides participants with feedback on their video game habits in comparison with the rest of the population. Research is ongoing to understand the point at which gaming becomes a health problem and the factors which contribute to the development of gaming disorders to promote responsible gaming.

Sticking up for Parents in the Performing Arts

Paloma Faith is among those calling for better support for parents in the performing arts

Academics from the Department of Organizational Psychology developed a survey of workers and work-life balance in the performing arts in partnership with Parents and Carers in Performing Arts (PiPA).

Over 2500 UK workers from the performing arts, including 1000 parents and carers, took the survey. It found that 43% of performing artists who left their careers did so because they became parents. Carers pay a significant penalty in terms of well-being and remuneration in order to maintain a career in the performing arts and are far more likely to leave the industry than non-carers, leading to a drain in talent and reduced diversity in the arts. Professor Almuth McDowall, Head of Department, added her voice to the call for change alongside leading figures in the sector such as actor Cate Blanchett and singer Paloma Faith.

Understanding Text Data

Researchers from the Department of Computer Science and Information Systems developed a tool to simplify the process of understanding and using data from text. Called Samtla API, the new service can automatically annotate words and phrases from digital text documents with named entities and sentiments using machine learning and text mining technologies.

Spearheaded by Dr Mark LeveneDr Martyn Harris, and Dr Andrius Mudinus, the initiative grew in response to the growing need for easily understandable annotations on the large volumes of text data, generated by media, businesses and individuals all over the world.

A Prizewinning Contribution

Dr Alexey Pokrovskiy was awarded the European Prize in Combinatorics

In August, Dr Alexey Pokrovskiy from the Department of Economics, Mathematics and Statistics was awarded the European Prize in Combinatorics. The prestigious award is made once every two years, recognising excellent contributions in Combinatorics, Discrete Mathematics and their Applications by young European researchers aged 35 or under.

Adapting to Climate Change

Strategic management experts from the Department of Management and the Cass Business School at City, University of London found that greater collaboration between the insurance industry and state policy makers could improve society’s ability to recover from disasters linked to climate change.

Using insurance is a step away from crisis towards risk management, strengthening socio-economic resilience under a changing climate. Birkbeck’s Dr Konstantinos Chalkias, the Cass Business School’s Professor Paula Jarzabkowski and their co-authors put forward seven recommendations to the Global Commission on Adaptation to maximise the benefits of insurance for climate adaptation.

Supporting Sustainable Return to Work following Mental Ill-health Absence

Dr Jo Yarker from the Department of Organizational Psychology and Professor Karina Nielsen from the University of Sheffield have been researching how to support employees who are returning to work following mental ill-health absence.

In the UK alone, stress, anxiety or depression accounts for 57% of all working days lost to ill-health in 2017-18. Yarker and Nielsen developed a toolkit for employees, colleagues, line managers and HR professionals to support individuals to return to and stay in work.

Further information:

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