Izvirni znanstveni članek ◆ Original Scientific Article https://doi.org/10.26493/2712-3987.20(40)125-151 © Author Choral Singing as a Means of Increasing Wellbeing in Youth and Adults: Prisma Review Zborovsko petje kot sredstvo spodbujanja blagostanja pri mladih in odraslih – PRISMA Jovana Milošević Univerza v Ljubljani, Akademija za glasbo jm78478@student.uni-lj.si Abstract: This study investigates how choral singing enhances wellbeing in adolescents and adults compared to other leisure activities. Despite extensive research on the ben- efits of choral singing for adults, its impact on adolescent wellbeing is less understood. The study examines the psychological, social, emotional, cognitive, and physical bene- fits of choir participation. A comprehensive search across various databases identified 1,377 papers, with 12 studies meeting the inclusion criteria: mixed-method (n = 5), qualitative (n = 1), and quantitative (n = 6). The studies included a diverse age range, categorized into predominantly adoles- cents (n = 4) and predominantly adults (n = 8). Psychological wellbeing was the most frequently studied dimension, highlighting en- hanced quality of life, life satisfaction, and motivation. Social wellbeing, emphasizing identity, social connectedness, and inclusion, was also prominent. Emotional wellbeing improvements included better mood and stress reduction. Cognitive benefits such as in- creased focus and improved musical skills were evident, alongside physical benefits like improved vocal health and fitness. The review highlights the unique advantages of choral singing over solo singing and oth- er activities, especially in social and psychological aspects. The scarcity of adolescent-fo- cused research suggests a need for further studies, including longitudinal research, to ex- plore the long-term effects of choir participation on youth wellbeing. Keywords: choral singing, wellbeing, adolescents, adults, stimulating musical environ- ment, PRISMA Izvleček: Pričujoča raziskava raziskuje, kako zborovsko petje izboljšuje blagostanje pri mladostnikih in odraslih v primerjavi z drugimi prostočasnimi dejavnostmi. Kljub ob- sežnim raziskavam o koristih zborovskega petja za odrasle je njegov vpliv na blagosta- nje mladostnikov manj razumljen. Raziskava preučuje psihološke, socialne, čustvene, kognitivne in fizične koristi sodelovanja v zboru. Obsežno iskanje po različnih bazah podatkov je identificiralo 1.377 člankov, od katerih je 12 raziskav izpolnjevalo merila za vključitev: mešane metode (n = 5), kvalitativne (n = 1) in kvantitativne (n = 6). Raziskave so vključevale raznolike starostne skupine, ki so bile razvrščene v pretežno mladostni- ke (n = 4) in pretežno odrasle (n = 8). Psihološko blagostanje je bila najpogosteje preu- čevana dimenzija, ki poudarja izboljšano kakovost življenja, življenjsko zadovoljstvo in g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 126 motivacijo. Socialno blagostanje, ki poudarja identiteto, socialno povezanost in vključe- nost, je bilo prav tako pomembno. Izboljšanje čustvenega blagostanja je vključevalo bolj- še razpoloženje in zmanjšanje stresa. Očitne so bile kognitivne koristi, kot so povečana osredotočenost in izboljšane glasbene veščine, poleg fizičnih koristi, kot sta izboljšano zdravje glasu in telesna pripravljenost. Pregled literature poudarja edinstvene prednosti zborovskega petja v primerjavi s solo petjem in z drugimi dejavnostmi, zlasti na področju socialnih in psiholoških vidikov. Pomanjkanje raziskav, osredotočenih na mladostnike, kaže na potrebo po nadaljnjih raziskavah, vključno z longitudinalnimi raziskavami, v ka- terih bi raziskali dolgoročne učinke sodelovanja v zboru na blagostanje mladih. Ključne besede: zborovsko petje, blagostanje, mladostniki, odrasli, stimulativno glasbeno okolje, PRISMA Introduction The significance of wellbeing, particularly in the context of choral sing-ing, has gained prominence since the development of the psycholog-ical wellbeing model by Ryff (1989). This model aimed to address the neglected aspect of positive functioning, emphasizing life satisfaction, self-ac- tualization, emotional stability and happiness for mental health. Music’s pos- itive impact on the wellbeing of individuals across different age groups is well-documented. Research conducted in the fields of mental health, psychol- ogy, arts, music and communication supports that community music activi- ties, specifically choral singing, contribute to emotional, psychological and so- cial wellbeing (Damsgaard & Jensen, 2021; Williams et al., 2018). Engagement in group singing has been shown to enhance the wellbeing of adults, including mental health, emotional-social benefits and self-efficacy (Livesey et al., 2012). Despite the findings of studies on the wellbeing of choral singing for adults, there remains a gap in research concerning the impact of choral par- ticipation on the wellbeing of adolescents. This systematic review aims to syn- thesize published literature related to the wellbeing of adolescents and adults engaged in choral singing. Specifically, it seeks to explore how choral singing contributes to psychological, social, emotional, cognitive and physical wellbe- ing in both age groups. Additionally, the unique benefits of singing in a choir compared to other leisure activities (group and individual) will be examined, as well as the long-term effects of active involvement in choral singing on the holistic wellbeing of youth. The review will also investigate the effects of active participation in choral singing on the overall wellbeing and life satisfaction of young individuals, addressing aspects that have not been explored in previous research. By identifying the characteristics and strategies employed in select- ed studies, this review aims to provide valuable insights into the significance Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 127 of being in a choir for adolescents and to encourage their participation. The re- search goal is to offer a more comprehensive understanding of the multifaceted impacts of choral singing on wellbeing across different demographics. Based on theoretical outcomes we set two research questions: – How does choral singing contribute to psychological, social, emo- tional, cognitive and physical wellbeing of adolescents and adults? – What are the unique benefits of singing in a choir compared to oth- er leisure (group and individual) activities? Method Our review followed a five-stage framework by Arksey and O’Malley (2005), complemented by the PRISMA 2020 statement: An updated guideline for re- porting systematic reviews (27-item checklist) (Page et al., 2020). This strate- gic approach aimed to systematically examine and identify gaps in the exist- ing literature pertaining to the holistic wellbeing of adolescents participating in choir singing. Our objectives included: (i) comprehensive exploration of the literature on adolescent wellbeing in choir contexts, (ii) assessment of the fea- sibility and relevance of a systematic review, (iii) detailed presentation of find- ings for effective dissemination, and (iv) the identification of research gaps (Arksey & O’Malley, 2005). Through this method, we sought to facilitate a nuanced examination of various aspects of wellbeing for both adolescents and adults engaged in choir singing, ultimately contributing to a more holistic un- derstanding of the subject. Identifying Relevant Studies In order to include and identify relevant studies for the purpose of this system- atic review (PRISMA, 27-item checklist) (Page et al., 2020), the eligibility cri- teria was constructed (Table 1), considering the following items: participants, concept, context and evidence sources. Reviewed studies in this systematic re- view were collected through multiple sources, using online databases (Elsevier, MEDLINE, ERIC), as well as a manual search through other sources, includ- ing websites: Academia.edu, ResearchGate, SageJournals, PubMed, Frontiers; and journals: Musicae Scientiae, Psychology of Music, The Journal of The Roy- al Society for the Promotion of Health, Music and Health, Psychological Top- ics, Journal of Research in Music Education, Journal of Public Mental Health, Integrative Physiological and Behavioral Science, Journal of Applied Arts and Health, and Musikpsychologie. g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 128 Inclusion Criteria for the Selected Studies After gathering the studies, titles and abstracts were reviewed to determine their suitability and alignment with the eligibility criteria (Table 1). The next step in- volved excluding studies that did not meet the specified criteria for inclusion. Sub- sequently, full-text papers were obtained to gather all necessary information for further systematic analysis. If certain studies did not align with the research con- cept, context, or sample criteria, they were also eliminated. This process resulted in a final selection of papers to be included in the systematic analysis (Figure 1). Charting the Data The extracted information encompassed crucial details: the primary author’s name and publication year, the study’s title, the methods employed for data col- lection (including types of questionnaires, interviews, or other forms of data gathering), the study design and methodologies utilized, the characteristics of participants or communities (size, age and whether they participated in group or solo singing), the research objectives, the specifics of singing engagement (including frequency), various aspects of wellbeing considered and the princi- pal findings derived from the studies. Table 1 Eligibility criteria Item Inclusion criteria Exclusion criteria Participants Healthy individuals Unhealthy individuals (clinical conditions) Professional and amateur musicians Sample without group of choral singers Adolescent and adult choir singers Children under 12 years old Single-group design (no comparison group) Only individual singing Studies with comparison group (including choir singers) Concept Studies that address wellbeing of healthy individuals singing in a choir Any kind of clinical context Virtual singing due to COVID-19 Context Psychological, social, emotional and physical wellbeing Evidence sources Studies published in the English language Non-English language studies Qualitative, quantitative and mixed method approaches Case studies Studies published from 2001-2023 Studies published before 2000 Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 129 In order to determine the predominant wellbeing aspects that were fre- quently assessed, a comprehensive examination of the benefits associated with choir participation was conducted. These benefits were categorized into five distinct domains: psychological, social, cognitive, physical/physiological and emo- tional wellbeing (Table 2). This categorization aimed to explore the most fre- quently measured dimensions of wellbeing, providing valuable insights into the multifaceted impact of choir engagement on individuals’ holistic wellbeing. Considering our challenge in identifying a substantial number of stud- ies solely encompassing adolescents and the fact that many studies involve both adolescents and adults, we categorized them into two semi-homogenous groups. The first category includes studies predominantly focusing on adoles- cents as their primary sample, while the second category centres around studies Figure 1: Flow diagram for study selection g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 130 Table 2: Summary of studies regarding wellbeing aspects Wellbeing aspect Description Studies Psychological wellbeing Enhanced quality of life Life satisfaction Sense of purpose Sense of accomplishment Personality Motivation 1. Acquah (2016) 2. Clift and Hancox (2001) 3. Clift et al. (2010) 4. Fernández-Herranz et al. (2022) 5. Good and Russo (2021) 6. Jozić and Butković (2023) 7. Linnemann et al. (2017) 8. Livesey et al. (2012) 9. Lonsdale and Day (2020) 10. Maltschweiger and Sattmann (2016) 11. Parker (2014) 12. Stewart and Londsdale (2016) Cognitive wellbeing Increased focus Musical skills Improves concentration and memory Competence 1. Acquah (2016) 2. Clift et al. (2010) 3. Fernández-Herranz et al. (2022) 4. Livesey et al. (2012) 5. Lonsdale and Day (2020) 6. Maltschweiger and Sattmann (2016) 7. Stewart and Londsdale (2016) Social well- being Sense of belonging Social inclusion Social identity Positive relationships SDT 1. Acquah (2016) 2. Clift and Hancox (2001) 3. Clift et al. (2010) 4. Fernández-Herranz et al. (2022) 5. Good and Russo (2021) 6. Jozić and Butković (2023) 7. Linnemann et al. (2017) 8. Livesey et al. (2012) 9. Lonsdale and Day (2020) 10. Parker (2014) 11. Stewart and Londsdale (2016) Physical/ physiological wellbeing Controlled breathing Improved posture Mobility benefits Vocal health Benefits for heart and immune system 1. Acquah (2016) 2. Clift and Hancox (2001) 3. Clift et al. (2010) 4. Fernández-Herranz et al. (2022) 5. Livesey et al. (2012) Emotional wellbeing Enhanced positive emotion (Improved mood) Reduced negative emoti- on (less stressed, relieved tension) Energized Calming/relaxation 1. Acquah (2016) 2. Clift and Hancox (2001) 3. Clift et al. (2010) 4. Fernández-Herranz et al. (2022) 5. Good and Russo (2021) 6. Jozić and Butković (2023) 7. Linnemann et al. (2017) 8. Livesey et al. (2012) 9. Lonsdale and Day (2020) 10. Maltschweiger and Sattmann (2016) Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 131 predominantly involving adult participants. This differentiation allows for a comprehensive examination of the distinct wellbeing outcomes associated with choral singing within these groups. Collating, Summarizing and Reporting the Results The study selection process involved an initial search across databases/online platforms and found 1,377 studies. After systematic screening and elimination of irrelevant studies, 773 articles were refined. Subsequent detailed reviews and exclusion based on incompatible research contexts and criteria led to a final se- lection of 12 studies for the systematic review. RESULTS Publication Characteristics The initial search process generated 1,377 papers (using key words) from differ- ent online sources: (i) databases (n = 79), including Elsevier, ERIC and MED- LINE; (ii) other online sources (n = 1298), including ResearchGate, Academ- ia.edu, SageJournals, Frontiers and PubMed. Through screening involving title and abstract assessment, elimination of duplicates and exclusion of non-Eng- lish publications, the list was refined to 773 articles. Subsequent review of these 773 articles led to the exclusion of 709 due to the incompatible context of the research (i.e. COVID-19, virtual singing), no access to full text, studies that focus only on older adults or young children as participants and missing the choir group in the research. Analysis of the full text was conducted on the remaining 64 studies that, so far, met all methodological criteria. After the review of the full text of the studies, 52 were excluded due to clinical context (e.g. interventions, unhealthy individuals, choir singing activity as a treatment for various health issues). The remaining 12 studies were subjected to rigorous examination and their detailed characteristics, methodologies and findings are systematically outlined (Fig- ure 1). All reviewed studies include 3 methodological approaches: mixed-meth- od (n = 5), qualitative (n = 1) and quantitative (n = 6). Participants’ Characteristics In the 12 studies examined, the number of participants varied from 9 to 1,124. Out of the total 12 studies, 5 employed mixed methods (with participants rang- ing from 84 to 1,124), 1 qualitative (with 39 participants) and 6 quantitative ap- proaches (ranging from 9 to 375 participants). The age of participants ranged from 12 to 95 years old. For three studies, exact age data were not available, although the participants were predominant- g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 132 ly adolescents and members of university choirs. Most studies encompassed a wide age range, indicating heterogeneous groups. Consequently, we catego- rized the samples into predominantly adolescents (n = 4) and predominantly adults (n = 8). It is essential to highlight that all 12 studies included choral singers as a fo- cal group in their research, regardless of other comparison groups mentioned in the studies. In studies involving adolescents, there was no specific control group and the participants were mainly university choir members. In stud- ies involving mainly adults, three studies included a comparison group to as- sess wellbeing outcomes. The first study (Londsdale & Day, 2020) compared: (a) choir singers with other leisure activities, (b) solo singers, (c) band mem- bers, (d) solo instrumentalists, (e) team athletes, and (f) individual athletes. In the second study (Stewart & Lonsdale, 2016) comparisons were made be- tween (a) choral singers, (b) solo singers, and (c) team athletes. The third study (Maltschweiger & Sattmann, 2016) assessed differences between: (a) choirs, (b) theatre groups, (c) brass band members, and (d) concert listening groups. Some studies explored gender differences and distinctions between group and indi- vidual singing, providing a comprehensive examination of choral singing’s im- pact on wellbeing, depending on the context provided. Singing Characteristics The characteristics of singing, specifically frequency (how often individuals en- gaged in singing), were measured in the selected studies. However, out of the 12 studies, 6 (50%) of them did not provide data regarding the singing frequency. The remaining 6 studies included individual responses and reported the frequ- ency of singing engagement: three studies (25%) reported singing once a week for 2 hours (Clift & Hancox, 2001); one study (8.3%) reported singing three ti- mes per week for one hour (Acquah, 2016); one study (8.3%) had a randomized sample and provided various answers: less than an hour per day/several hours per day (Parker, 2014). Also, one study (Jozić & Butković, 2023) that was in- cluded in this systematic review gathered data from 221 participants (randomi- zed sample) and provided data regarding singing frequency: once in two weeks was the most frequent answer – 104 (47.1%); once a month – 56 (25.3%); once a week – 41 (18.6%); every day – 14 (6.3%); 2-3 times a week – 6 (2.7%). Implementation, Characteristics and Strategies Contextual Components Analysing the variables measured in the 12 chosen studies, we identified five distinct dimensions of wellbeing linked to choral singing, as illustrated in Ta- Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 133 ble 2. In each of the 5 wellbeing aspects, various components were taken into account to provide more detailed descriptions of wellbeing dimensions that were explored in the reviewed studies. In terms of study goals, results show that each study covered more than one aspect of wellbeing. Psychological wellbeing was one of the dominant areas in all (100%) of the reviewed studies, encompassing facets such as enhanced quality of life/life sat- isfaction (Acquah, 2016; Clift & Hancox, 2001; Clift et al., 2010; Good & Rus- so, 2021; Jozić & Butković, 2023; Livesey et al., 2012; Londsdale & Day, 2020; Maltschweiger & Sattmann, 2016; Stewart & Londsdale, 2016), sense of pur- pose (Clift & Hancox, 2001; Livesey et al., 2012), sense of accomplishment (Fernández-Herranz et al., 2022; Londsdale & Day, 2020; Parker, 2014), per- sonality (Londsdale & Day, 2020), and motivation (Jozić & Butković, 2023; Linnemann et al., 2017; Stewart & Londsdale, 2016). Cognitive wellbeing was explored in seven (58.3%) of the reviewed studies, including the aspects: increased focus/concentration (Clift et al., 2010; Linne- mann et al., 2017; Livesey et al., 2012), improved musical skills (Acquah, 2016; Fernández-Herranz et al., 2022; Livesey et al., 2012; Maltschweiger & Satt- mann, 2016), and a greater sense of competence (Livesey et al., 2012; Londsdale & Day, 2020; Maltschweiger & Sattmann, 2016; Stewart & Londsdale, 2016). Social wellbeing was one of the focus areas in eleven (91%) of the reviewed studies, including: a sense of belonging/feel like a part of a group/social inclu- sion (Acquah, 2016; Clift & Hancox, 2001; Clift et al., 2010; Fernández-Her- ranz et al., 2022; Good & Russo, 2021; Linnemann et al., 2017; Livesey et al., 2012; Londsdale & Day, 2020; Parker, 2014; Stewart & Londsdale, 2016), identi- ty (Livesey et al., 2012; Londsdale & Day, 2020; Parker, 2014), positive relation- ships (Acquah, 2016; Londsdale & Day, 2020), and elements from Self-Determi- nation Theory – SDT (Londsdale & Day, 2020; Stewart & Londsdale, 2016). Physical/physiological wellbeing was explored in five (41.6%) of the re- viewed studies, addressing controlled breathing (Acquah, 2016; Clift & Han- cox, 2001; Linnemann et al., 2017; Livesey et al., 2012), improved posture/ mobility benefits/in shape (Clift & Hancox, 2001; Fernández-Herranz et al., 2022; Livesey et al., 2012), vocal health (Livesey et al., 2012), and advantages for the immune system (Clift & Hancox, 2001; Livesey et al., 2012). Emotional wellbeing was explored in ten (83.3%) of the reviewed studies reflecting improved mood/reduced stress/feelings of calmness and relaxation/ energized (Acquah, 2016; Clift & Hancox, 2001; Clift et al., 2010; Fernán- dez-Herranz et al., 2022; Good & Russo, 2021; Linnemann et al., 2017; Livesey et al., 2012; Maltschweiger & Sattmann, 2016). Psychological, social and emotional wellbeing were the primary areas of fo- cus across the majority of the reviewed studies, showcasing the multifaceted impact of choral singing on participants’ holistic wellbeing. g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 134 Study Outcomes Summary of outcomes (Page 143), including: author and year, study design, data collection and key findings – shows outcome of each study. Outcomes were summarized in 6 quantitative studies (50%), 5 mixed method studies (41.6%) and 1 qualitative study (8.3%). Aspects of the outcomes included: life satisfaction (SWL), quality of life (QoL), and physical, emotion- al, cognitive, psychological and social benefits. Instruments Instruments that were used for assessing wellbeing and collecting the data varied in all of the 12 reviewed studies. Three (25%) studies did not explicit- ly provide information on which type of questionnaires and scales were used. The remaining 9 studies used various instruments to measure wellbeing. Most studies used multiple research instruments to measure specific wellbeing. Out- comes and data collection are presented in Table 3. The Positive and Negative Affect Schedule (PANAS, n = 3) was employed in three studies (Good & Russo, 2021; Jozić & Butković, 2023; Maltschweiger & Sattmann, 2016) to assess emotional wellbeing. One of them additionally in- cluded saliva samples (Good & Russo, 2021). The Satisfaction With Life Scale (SWLS, n = 2) was measured in two studies (Jozić & Butković, 2023; Lons- dale & Day, 2020) to assess cognitive wellbeing. The World Health Organiza- tion Quality of Life Brief Version (WHOQOL-BREF, n = 2) was employed in two studies (Clift et al., 2010; Livesey et al., 2012), measuring physical, psycho- logical and social wellbeing. Hedonic wellbeing (ExWB, n = 2) and the Multi- dimensional Mood Questionnaire (MDMQ, n = 2) were used in two studies (Londsdale & Day, 2020; Stewart & Londsdale, 2016) to assess emotional well- being. Subjective stress assessed using a single-item approach (SLS-1, n = 1) and subscale Perceived Available Support (PAS) from the Berlin Social Support Scale (BSSS, n = 1) were used in one study (Linnemann et al., 2017) to measure emotional, psychological and social wellbeing. The Mental Health Continuum– Short Form (MHC-SF), Need Satisfaction at Work Scale (NSa-WS), the Ox- ford Happiness Questionnaire–Short Form (OHQ-SF), the four-item Patient Health Questionnaire (PHQ-4), the Rosenberg Self-Esteem Scale (RSES), and 10-Item Personality Inventory (TIPI) were measured in one study (Londs- dale & Day, 2020) to assess emotional and psychological wellbeing. The Brief Emotional Experiences Scale (BEES) was employed in one study (Clift et al., 2010), providing insights into the emotional wellbeing related to choral singing. The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), Self-regula- tion scale (SRQ-E), and Subjective Vitality Scale (SVS) were used in one study (Stewart & Lonsdale, 2016) to measure emotional and psychological wellbeing. The Perceived Stress Questionnaire (PSQ) and the State-Trait Anxiety Inven- Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 135 tory (STAI) were utilized in one study (Maltschweiger & Sattmann, 2016), fo- cusing on the assessment of stress and anxiety levels as indicators of emotional wellbeing. The Choral Activity Perceived Benefits Scale (CAPBES) was used in one study (Fernández-Herranz et al., 2022) to measure overall wellbeing, spe- cifically capturing perceived benefits related to choral activity. Five dimensions emerged from 22 items in the CAPBES scale: satisfaction, ability, group engage- ment, belonging and optimism. Studies including adolescents and adults Analysing studies mainly focused on adolescents (n = 4) that are examin- ing various benefits from their involvement in choral singing reveals a variety of positive effects on their overall wellbeing. In terms of physical benefits, two studies (Acquah, 2016; Clift & Hancox, 2001) pointed out improvements in posture, controlled/deep breathing and fitness, contributing to adolescents’ overall health. Emotional wellbeing was a common thread in three studies (Acquah, 2016; Clift & Hancox, 2001; Park- er, 2014), showcasing benefits such as boosted mood, stress reduction and in- creased self-confidence. Two studies (Acquah, 2016; Parker, 2014) examined cognitive benefits, emphasizing enhancements in musical skills and focused at- tention fostered by choir participation. Social benefits emerged as a common theme across all studies, highlighting the positive impact on social identity, friendships and teamwork, while the spiritual benefits were explicitly addressed in two studies (Acquah, 2016; Clift & Hancox, 2001), indicating a sense of connectedness and spiritual growth. One study (Linnemann et al., 2017) pro- vided limited evidence for direct social benefits as a positive effect of choral singing. Overall, the synthesis supports a multifaceted understanding of the wellbeing benefits associated with adolescent choir participation. The other eight studies (n = 8) primarily involved adults as participants who are engaged in choral singing and examined various aspects of wellbe- ing: emotional, physical, psychological, social and cognitive. Three studies (33.3%) highlight emotional wellbeing improvements such as: reduced anxiety, stress re- lief, and enhanced mood (Clift & Hancox, 2001; Livesey et al., 2012; Stewart & Lonsdale, 2016). Two studies (16.6%) emphasized physical benefits, includ- ing: improved respiratory and vocal health, enhanced physical fitness, and con- trolled breathing (Clift et al., 2010; Livesey et al., 2012). In two studies (16.6%), psychological benefits were identified, such as: oxytocin release and positive af- fect (Good & Russo, 2021; Stewart & Lonsdale, 2016). In terms of social well- being, benefits were found in three studies (33.3), including: social support, a sense of community, and enhanced social connection (Clift & Hancox, 2001; Livesey et al., 2012; Stewart & Lonsdale, 2016). Cognitive benefits are evident in two studies (16.6.%), highlighting brain stimulation, focused attention, and improved abilities (Clift et al., 2010; Jozić & Butković, 2023). g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 136 Studies with Comparison Groups In three (n = 3) out of the twelve studies reviewed (33.3%), comparison groups were included, allowing for a comparative examination of the benefits associ- ated with choir participation. These studies delved into the distinct outcomes and differences between individuals engaged in choral singing and those par- ticipating in other musical and non-musical activities. This comparative analy- sis contributes to a better understanding of the specific advantages and unique impacts of choral singing in contrast to other activities and conditions. In the study conducted by Lonsdale and Day (2020), which had six compar- ison groups – (a) choir singing, (b) solo singing, (c) orchestra/band membership, (d) solo musicianship, (e) team sports participation, and (f) individual sports engagement – no significant differences were found in psychological wellbeing (happiness, anxiety, depression, self-esteem) among these groups. This study, us- ing Self-Determination Theory, found that choir singers and team sports players reported higher levels of social connectedness, emphasizing a sense of belonging and shared goals. However, choir singers and team sports players reported lower autonomy, indicating less individual freedom compared to those engaged in solo activities or playing music in a band or orchestra. All groups, regardless of the activity, reported similar levels of competence, indicating that any activity pro- viding opportunities for mastery and improvement can contribute to wellbeing. Overall, while choir singing may involve less individual autonomy, its unique social and communal aspects contribute positively to participants’ wellbeing. Stewart and Lonsdale (2016) explored the psychological and social aspects of (a) choral singing compared to (b) solo singing and (c) team sports. Choral singers, after rehearsal, reported oxytocin release, improved mood, positive af- fect and a sense of connection, shared goals, social bonding and togetherness. The study revealed that choral singers and team sports players reported high- er subjective wellbeing than solo singers. Using also Self-Determination The- ory, they found that solo singers scored higher in autonomy, but team sports players and choral singers scored higher in identified regulation. Choral sing- ers considered their choirs more entitative than team sports players considered their teams. Perceived entitativity significantly predicted psychological well- being for both choral singers and team sports players. The study showed that choir singing offers unique benefits in terms of social connection, positive af- fect and entitativity compared to solo singing and team sports. However, au- tonomy levels were lower for choral singers, suggesting a potential trade-off be- tween individual autonomy and social connection. Maltschweiger and Sattmann (2016) investigated the psychological and so- cial benefits of (a) choir participation, (b) theatre group involvement, (c) brass band membership, and (d) concert listening. Choir and theatre group partici- pants reported greater satisfaction with rehearsals, positive affect and reduced stress compared to the brass band. Interestingly, the brass band experienced Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 137 the least benefit from rehearsals, while both the choir and theatre group bene- fitted the most. While there was not a significant positive change in emotions reported by the choir group, the theatre group had a more positive impact on mood, attributed to the physical activity involved. The study found a signifi- cant reduction in stress during rehearsals for the choir group, indicating the ef- fectiveness of choir singing in stress reduction. Choir members reported de- creased stress both before and during rehearsals. State of anxiety decreased in choir singers, but increased in the concert listening group. The likability of the rehearsed piece had a significant impact on increased wellbeing during rehears- als. In summary, choral singing, brass band participation and theatre group involvement were perceived as positive activities, with choir participants fre- quently reporting feeling better after rehearsals, which supports previous find- ings on the positive effects of choral singing on wellbeing. DISCUSSION Summary of Evidence This systematic review aimed to explore the various effects of choral singing on the psychological, social, emotional, cognitive and physical wellbeing of ado- lescents and adults. The synthesis of 12 studies, encompassing a diverse range of methodologies and participant demographics, provides valuable insights into the various dimensions of wellbeing associated with choir participation. In all studies, psychological wellbeing was a dominant focus, encompassing enhanced quality of life, life satisfaction, a sense of purpose, accomplishment, personality and motivation. Cognitive wellbeing was explored in seven stud- ies (58.3%), emphasizing increased focus, improved musical skills and a great- er sense of competence. Social wellbeing took centre stage in eleven studies (91%), addressing a sense of belonging, social inclusion, identity, positive rela- tionships and elements from Self-Determination Theory (relatedness, autono- my and competence). Physical/physiological wellbeing was explored in five stud- ies (41.6%), including controlled breathing, improved posture, vocal health and benefits for the immune system. Emotional wellbeing was a key area in ten studies (83.3%), reflecting improved mood, reduced stress, feelings of calmness and relaxation. The instruments used in the 12 reviewed studies to assess wellbeing and collect data varied. While three studies did not explicitly provide informa- tion on the instruments used, the remaining nine studies employed a diverse range of measures: the Positive and Negative Affect Schedule (PANAS), Satis- faction with Life Scale (SWLS), World Health Organization Quality of Life Brief Version (WHOQOL-BREF), Hedonic Wellbeing (ExWB), Multidi- mensional Mood Questionnaire (MDMQ), Singers’ Emotional Experienc- g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 138 es Scale (SEES) and instruments measuring stress and anxiety levels like the Perceived Stress Questionnaire (PSQ) and the State-Trait Anxiety Invento- ry (STAI). Each study used multiple instruments to measure specific aspects of wellbeing, contributing to a comprehensive understanding of the impacts of choral singing. Reviewing and analysing studies on choral singing benefits for adoles- cents and adults reveals a range of positive effects on overall wellbeing. Studies focused on adolescents (n = 4) revealed positive effects on physical, emotion- al, cognitive and social wellbeing. Physical benefits included improvements in posture, controlled breathing and fitness. Emotional benefits encompassed boosted mood, stress reduction and increased self-confidence. Cognitive ben- efits emphasized enhancements in musical skills and focused attention. So- cial benefits highlighted positive impacts on social identity, friendships and teamwork. Spiritual benefits, indicating a sense of connectedness and spiritual growth, were explicit in two studies. Studies primarily involving adults (n = 8) demonstrated emotional wellbeing improvements, physical, psychological, so- cial and cognitive benefits. The synthesis supports a multifaceted understanding of the wellbeing benefits associated with both adolescent and adult choir participation. Differ- ences and similarities across studies underscore the nuanced impact of choral singing on emotional, psychological, social, cognitive and physical wellbeing. Emotional benefits were consistently observed in both age groups, while physi- cal benefits were more emphasized in adolescents. Social wellbeing emerged as a universal theme, indicating positive impacts on social identity, relationships and community connection. The cognitive benefits of increased focus and im- proved musical skills were evident across age groups. Overall, the comprehen- sive analysis reveals a rich tapestry of wellbeing dimensions influenced by cho- ral singing across diverse demographic groups. For adolescents (n = 4), physical improvements in posture, controlled breathing and fitness were noted (Clift & Hancox, 2001; Acquah, 2016), along- side emotional benefits like mood enhancement and stress reduction (Clift & Hancox, 2001; Acquah, 2016). Cognitive benefits, including enhanced mu- sical skills and focused attention, were highlighted in two studies (Acquah, 2016; Parker, 2014). Socially, positive impacts on social identity, friendships and teamwork were consistent themes across all adolescent-focused studies. Spiritual benefits, indicating a sense of connectedness and growth, were ex- plicitly addressed in two studies (Clift & Hancox, 2001; Acquah, 2016). The other eight studies (n = 8) primarily involved adults as participants en- gaged in choral singing, exploring various dimensions of wellbeing: emotional, physical, psychological, social and cognitive. Three studies (n = 3) highlighted emotional wellbeing improvements, demonstrating reduced anxiety, stress relief and enhanced mood (Clift & Hancox, 2001; Livesey et al., 2012; Stewart & Lons- dale, 2016). Two studies (n = 2) emphasized physical benefits, including improved Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 139 respiratory and vocal health, enhanced physical fitness and controlled breathing (Livesey et al., 2012; Clift et al., 2010). In two studies (n = 2), psychological ben- efits were identified, such as oxytocin release and positive affect (Good & Rus- so, 2021; Stewart & Lonsdale, 2016). Regarding social wellbeing, three studies (n = 3) reported benefits, including increased social support, a sense of commu- nity and enhanced social connection (Clift & Hancox, 2001; Livesey et al., 2012; Stewart & Lonsdale, 2016). Cognitive benefits were evident in two studies (n = 2), highlighting brain stimulation, focused attention and improved abilities (Jozić & Butković, 2023; Clift et al., 2010). Research by Good and Russo (2021) highlights the psychological and emotional advantages of group singing, with increased oxy- tocin levels and reduced stress, emphasizing the unique benefits of choral singing over solo performances. One study (Fernández-Herranz et al., 2021) introduced the CAPBES (Choral Activity Perceived Benefits Scale), providing a structured instrument to define the various dimensions of choral singing benefits. Their findings underscore the psychological, cognitive, and social dimensions, empha- sizing overall satisfaction, personal growth, improved abilities, and a sense of be- longing. These consistent positive findings underscore the diverse positive im- pacts of choral singing on the overall wellbeing of adult participants. In three (33.3%) of the twelve studies reviewed, comparison groups were employed to examine the unique benefits of choir participation. The first study (Lonsdale & Day, 2020), with six comparison groups, found no significant differences in psychological wellbeing between choir singers, solo singers, or- chestra/band members, solo musicians and team or individual sports partici- pants. Choir singers and team sports players reported higher social connected- ness but lower autonomy. These findings suggest that the psychological benefits of choral singing may be more linked to its social and interpersonal aspects than its musical or individual nature. This aligns with the emphasis on group activ- ities, like choir singing, fostering social connectedness, as noted in other stud- ies (Maltschweiger & Sattmann, 2016; Stewart & Lonsdale, 2016). The second study (Stewart & Lonsdale, 2016) revealed that choir singers, after rehearsal, ex- perienced improved mood, social bonding and higher subjective wellbeing than solo singers, although with lower autonomy. Additionally, choral singers demon- strate intrinsic motivation and report higher levels of wellbeing compared to solo singers and participants in team sports, emphasizing the unique advantages of group-based musical activities. Maltschweiger and Sattmann (2016) found that choir and theatre groups reported greater satisfaction and reduced stress com- pared to brass band members and concert listeners. Choir singing, particularly, proved effective in stress reduction. Participants reported feeling less stressed af- ter engaging in group activities. This study emphasizes that satisfaction with the rehearsal in group activities, including choir singing, is linked to positive affect, providing relaxation and a positive distraction from everyday life. In summary, these studies highlight the social and psychological advantages of choir singing over solo singing, team sports and other musical activities. g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 140 Limitations Our research aimed to predominantly concentrate on adolescents as the prima- ry participant group; however, the limited availability of studies meeting this criteria necessitated the inclusion of studies involving adults in the sample. The inclusion criteria of English-language studies further narrowed the selection, potentially limiting the generalizability of findings. Additionally, some studies lacked comprehensive information on singing frequency and data collection instruments, introducing challenges for objective comparisons and analyses. Moreover, the methodological diversity, participant demographic variations, and disparate outcome measures across the selected studies pose a substantial challenge for direct comparisons. Another notable limitation is that only one person reviewed the studies, which may introduce a potential bias and could benefit from additional perspectives for a more comprehensive assessment. CONCLUSION This systematic review explored the effects of choral singing on the various di- mensions, synthesizing findings from 12 selected studies, encompassing diverse methodologies and participants’ demographics. The aim was to investigate in what ways choral singing contributes to different dimensions of wellbeing: psy- chological, social, emotional, cognitive and physical. We also wanted to iden- tify differences in wellbeing level between adolescents and adults, as well as to explore predominant aspects of wellbeing frequently assessed in the literature. Across all studies, in both adolescents and adults, choral singing demon- strated a consistent positive impact on psychological, social, emotional, physi- cal and cognitive benefits. Psychological wellbeing emerged as a dominant fo- cus (n = 12), with participants reporting enhanced quality of life, increased life satisfaction, a sense of purpose, accomplishment, improved personality traits, and higher motivation. These findings underscore the comprehensive psycho- logical benefits associated with singing in a choir, which are consistent re- gardless of age group. Social wellbeing was explored in the eleven of the revi- ewed studies (n = 11) and the benefits included: a strong sense of belonging, social inclusion, identity formation, positive interpersonal relationships, and elements of Self-Determination Theory (higher competence, autonomy and re- latedness). It highlights the power of choral singing activity in fostering social connectedness, strengthening community and social support networks. Emo- tional wellbeing was highlighted in ten studies (n = 10), with participants expe- riencing improved mood, reduced stress, feelings of calmness, and relaxation, which is crucial in reducing the negative impacts of everyday life stress and en- hancing overall mental health. Cognitive benefits were documented in seven studies (n = 7), showing improvements in concentration, focus, musical skills, Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 141 memory, attention, and a greater sense of competence. These cognitive enhan- cements illustrate how engaging in choir activities can stimulate mental pro- cesses and contribute to cognitive wellbeing in individuals. Five studies (n = 5) examined physical wellbeing, identifying benefits such as controlled breathing, improved posture, lung function, heart health, mobility, respiratory and vocal health, physical fitness, and generally feeling more energized and active, as well as positive effects on the immune system. The differentiation between studies focusing on adolescents and adults re- vealed nuanced differences. For studies including mainly adolescents (n = 4), choral singing was associated with significant physical improvements: better posture, controlled breathing and overall fitness, which were not prominent in adults’ experiences. Cognitive benefits for adolescents were evident in enhan- ced musical skills, and focused attention, while these aspects were less emp- hasized in studies including adults. Adolescents reported that choral singing fosters a sense of identity, strengthens friendships and emphasizes teamwork. They have also experienced a unique sense of connectedness, spiritual growth, and a therapeutic and uplifting effect, indicating spiritual benefits from cho- ral singing. In studies including mainly adults (n = 8), participants experien- ced primarily emotional wellbeing such as reduced anxiety, stress relief, and enhanced mood, indicating a greater emphasis on emotional regulation and stress management in this demographic. While both adults and adolescents report increased social support and a sense of community, adolescents may focus more on the formation of social identity and friendships, while adults may prioritize maintaining existing social connections. Overall, both age gro- ups derive many significant benefits from choral singing, but there are specific outcomes reflecting the unique developmental stage and life contexts of ado- lescents and adults. In three studies (n = 3), researchers used comparison groups in order to explore the benefits of choir participation compared to other leisure and gro- up activities. The first study (Londsday & Day, 2020) involved six compari- son groups: choir and solo singers, orchestra/band members, solo musicians, team sports players, and individual sports players. They wanted to explore whether the psychological wellbeing is unique to choirs, in comparison to the other mentioned activities. Results did not show any significant differences in psychological wellbeing between groups. However, distinct differences were observed in autonomy and relatedness between groups, with choir singers and team sports players reporting higher levels of relatedness compared to solo mu- sicians and individual sport players. It suggests that the psychological bene- fits of choral singing may be explained through the social and interpersonal dynamics of the activity, rather than its musical nature or individual aspects. This study emphasized that group activities (such as choir singing) foster social connectedness in participants. All groups demonstrated a similar level of com- petence, suggesting that any group activity that promotes mastery can positi- g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 142 vely affect wellbeing. The second study (Stewart & Londsdale, 2016) used three groups – choir singers, solo singers and team sports players – to explore psycho- logical and social wellbeing aspects associated with choir participation. The aim was to examine how different activities influenced participants’ mood, so- cial bonding, and their subjective wellbeing. Results indicated that the cho- ir singers group experienced notable improvements in mood, social connecte- dness and subjective (hedonic) wellbeing after the rehearsals, distinguishing them from both solo singers and team sports players. Despite these benefits, choir singers reported lower autonomy levels compared to solo singers, sug- gesting a potential compromise between individual autonomy and the com- munal aspect inherent in choral singing. Employing Self-Determination The- ory, the study revealed that choir singers had a strong intrinsic motivation and valued their own activity, although autonomy levels were low. Choir singers and team sports players showed higher levels of overall wellbeing, compared to solo singers, which underscores the positive impact of group activities. Cho- ir singers reported a higher entitavity score, indicating a strong sense of social identity and cohesion within the choir community, compared to team sports players. The third study (Maltschweiger & Sattmann, 2016) included four di- fferent comparison groups: 3 choirs, 2 brass bands, 3 theatre involvement gro- ups and 1 concert listening group. It focused on examining the effects of each group activity on participants’ psychological, emotional and social wellbeing. They found that choir and theatre group members reported higher levels of po- sitive affect and reduced stress after the activity, when compared to the brass band group. They also found that the more participants like and are familiar with the musical piece they are engaging with (playing, singing, listening to), the more they experience wellbeing. Choir singers reported reduced stress be- fore and during the rehearsals, and their anxiety levels decreased after, compa- red to the concert listening group, whose anxiety levels increased during the activity. The study showed that choir participation, brass band and theatre gro- up were perceived as positive activities, with choir singers frequently reporting improved wellbeing after rehearsals, supporting the previous research regar- ding positive effects from choral singing on overall health and wellbeing. The systematic review shows that choral singing is a valuable activity that significantly contributes to various aspects of wellbeing for both adolescents and adults. Its unique combination of psychological, social, emotional, cogni- tive and physical benefits distinguishes it from other leisure activities. It under- scores the importance of promoting choral singing as a beneficial practice for enhancing overall health and quality of life. The findings highlight the signifi- cance of choir engagement not only for individual growth but also as a means of fostering inclusion and social connections during the formative years. The scarcity of research dedicated to the wellbeing of adolescents in choirs shows a notable gap, emphasizing the need for more extensive investigations in this es- sential area. Jo va n a M ilo šević ◆ C H O RA L SIN G IN G A S A M EA N S O F IN C REA SIN G W ELLBEIN G IN YO U TH A N D A D U LTS: PRISM A REVIEW 143 Summary of Outcomes Studies that include mainly adolescents (n = 4) 1. Clift and Hancox (2001) Study design: Mixed method Data collection: – 2 surveys conducted – 1. Qualitative (open ended questions) – 2. Quantitative (statements) Key findings: – Psychological/emotional Improves mood, induces emotions, reduces stress, more relaxed, good psychologically, happiness, good for soul, achievement – Social Meeting new people, making friends, socialize, good atmosphere – Physical Improved posture, increased control over breathing/improves breat- hing, more energized, lung function, heart exercise – Spiritual More positive about life, contributes to society, connected, therapeutic – Main finding Choral singing significantly enhances psychological/emotional and physical well-being, mental health and spiritual fulfilment, with varia- tions in experiences depending on gender and age. 2. Acquah (2016) Study design: Mixed method Data collection: – 1. Questionnaire with students – 2. Interview with teachers Key findings – Psychological/emotional Reduced stress, relieving tension, positive emotions, self-confidence, dedication – Social Emotional support, fostering teamwork, building social identity, sharing – Physical Deep breathing, physically active – fitness, energized, improved posture g la sb en o pe da g o šk i z bo rn ik ◆ le tn ik /v o lu m e 20 ◆ št ev il k a /n u m be r 40 144 – Cognitive Expression during the performance, musical skills – sight reading, vo- cal technique, focused attention, brain stimulation – Spiritual Therapeutic, uplifting, spiritual growth – Main finding Generative mechanisms that were recognized: focused attention, deep breathing, dedication, physical fitness, sharing and brain stimulation. 3. Parker (2014) Study design: Qualitative Data collection: – Interviews – 3 waves of data collection: – 45 minute interviews with 15 choir members – 13 students reviewed and gave feedback regarding the temporal matrix – and propositional statements Key findings – Psychological Pride, acknowledgement and accomplishment, self-acceptance, at peace – Social Developing social identity, belonging to a group, part of a team, buil- ding friendships, social sup