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Or Is It? Depression in Students Who Perform Or Study Music As Compared to Students Who Do Not

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Or Is It? Depression in Students Who Perform Or Study Music As Compared to Students Who Do Not “Unhappiness is my lot”. Or is it? Depression in students who perform or study music as compared to students who do not. Michaela Korte1, Deniz Cerci2, Roman Wehry2, Renee Timmers1, Victoria J. Williamson1 1Department of Music, The University of Sheffield, United Kingdom, 2Vivantes Wenckebach-Klinikum, Berlin, Germany, 3Helios Klinikum, Klinik für Schmerzmedizin, Hildesheim, Germany Abstract Professional musicians are more at risk of developing mental health problems, such as depression, compared to the general population. The level of mental health problems experienced by musicians is comparable to that found in professions with high stress levels such as physicians or air-craft engineers. Despite this fact, it remains unknown whether contributory and standardized factors have the potential to identify whether early career musicians are at risk of depression. This study examines known depression predictors such as anxiety, pain processing, depersonalization and coping strategies, and compares how they affect a music and non-music student population. Moreover, it investigates the extent to which professional identification has an effect on musicians’ levels of depression, and if this factor could be used as a depression predictor for student musicians. 102 under- and postgraduate students (75% UK, 16% other EU countries, 9% USA; age mean = 23.6 years) from various institutions and with different primary subjects (62% music, 38% medicine, psychology, biology) participated in an online survey featuring standardized scales for the above- mentioned depression predictors. Music college students had a significantly higher depression prevalence (31.2%) compared to musicians at university (9.3%), but not compared to university non-musicians (19.4%). The depression factors of anxiety and pain processing were lower in both musicians’ groups compared to non-music students, despite the latter group perceiving pain for shorter periods of time than all musicians. A hierarchical multiple linear regression and a regression tree analysis indicated that professional identification was not a significant predictor for depression. While anxiety accounted for the highest variance (58%), a combination of factors best predicted depression: high anxiety combined with a low-level of burnout with teaching staff. Taken together these results suggest that the culture of teaching institutions may play a vital role in the experience of depression in student musicians. Furthermore, standardized instruments such as anxiety scales, rather than profiling within the profession, offer a differentiated and therefore more promising depression risk analysis for training musicians. Introduction While research into depression and musicians is a relatively recent phenomenon, descriptions of mental health problems within the field have been frequent across the centuries (Cordingly, 2001; Kluge, 1818; Lorusso & Porro, 2020; Rahm, 1994) , as exemplified by Mozart’s heroine from “The Abduction from the Seraglio”, who is quoted in the title of this article. In fact, descriptions of mental health are so realistic within music, that medical papers have often discussed them as if they were case studies (Chest, 2018). These include, for instance, vision madness (e.g. apparitions) and schizophrenia (Dura-Vila & Bentley, 2009; Erfurth & Hoff, 2000; Ropert, 2003), suicide (Pridmore, Auchincloss, Soh, & Walter, 2013) or (bipolar) depression (Boutolleau, 2017; Lorusso, Franchini, & Porro, 2015). This familiarity with, and realism, in portraying mental health problems within 1 compositions have led many to speculate that composers themselves might have been affected by these conditions. Indeed, people have argued that successful musicians with no history of mental health difficulties were the exception (la Motte-Haber, 2006). Reflecting on this issue, Sigmund Freud wrote that a happy individual imagines or creates nothing (Freud, 1918). But is this historical stereotype linking musicianship and mental health reflected by evidence relating to depression nowadays? On the one hand the answer appears to be ‘yes’. Research has established that musicians – composers and performers alike – suffer more from mental health issues generally, and depression specifically, compared to the general public (Constant, 2011; Johnson et al., 2012; Kenny & Ackermann, 2015a; Lederman, 2015; Steinberg, 2016; Vitale, 2009). On this basis, musical, and thus creative, accomplishment has been predicted (Burch, Pavelis, Hemsley, & Corr, 2010; Carson, 2014; Dietrich, 2014; Janka, 2004) . The idea that musicians, creativity and depression are intertwined is so entrenched that studies showing a deviation from this statement find the need to point this out specifically (Chávez-Eakle, 2006). However, the proportion of depression in musicians needs to be seen within context (Ellis, 2010), so at-risk populations can be identified correctly and the true scale of the problem laid bare. Depression prevalence in general has increased within the last decade and is the fourth cause for disability worldwide (WHO, 2012). In Europe, depression prevalence is the second overall highest burden of disease after substance abuse disorders. To put this into further context, cumulative weighted prevalence rates combining substance abuse, dependence and depression scores, account for 58% of the disease burden within the EU (Angst et al., 2005; Wittchen & Jacobi, 2005; Wittchen et al., 2011). The prevalence rate in an at-risk population, such as musicians’, will be higher. Another important at-risk subpopulation is younger people, since depression shows its first peak within the adolescent/young adult population (Bertha & Balázs, 2013). The distinctive mental challenges attached to being a student at this age are factors that contribute to the high depression prevalence in this group (Bacchi & Licinio, 2015; Kessler et al., 2009). A logical question is whether these strands of evidence lead to the conclusion that musicians in training, or students who play music in their spare time, are at particular risk of depression? Despite the apparent inevitability of such a conclusion, various reasons have been offered to explain an elevated depression prevalence in musicians. Some consider a higher-than-normal depression rate sufficient to indicate that the entire musical profession is more at risk for depression (Vaag, Bjørngaard, & Bjerkeset, 2016), while others have found that the depression rate among musicians, while higher than the norm, is comparable to that of other professions with high stress levels, such as aircraft engineers or medical students (Voltmer, Kötter, & Spahn, 2012; Voltmer, Schauer, Schroder, & Spahn, 2008; Woodward, Lipari, & Eaton, 2017). This latter hypothesis assumes that depression predictors, such as (chronic) stress and (high) anxiety could cause any population to be more at risk, no matter their age or profession. Following this thought, studies have investigated whether particular depression predictors are more commonly found within groups of musicians. Musicians were found to have higher scores for depression predictors such as (chronic) pain {Spahn:2004tr, Gasenzer:2011ki, Maric:2019dx} 2 , psycho-social stress (Hildebrandt, 2002; Holst, Paarup, & Baelum, 2012; Langendörfer, Hodapp, Kreutz, & Bongard, 2006), performance anxiety on its own or in context with other (clinical) conditions (Jabusch & Altenmüller, 2004; Kenny & Ackermann, 2015b; Spahn, Hildebrandt, & Seidenglanz, 2001) and dysfunctional attitude to discomfort (Spahn, Burger, Hildebrandt, & Seidenglanz, 2005; Zander, Voltmer, & Spahn, 2010). Since these predictors are specific to the musicians’ environments, there has been a tendency to assume that they carry more predictive weight compared to more general factors such as depersonalization (Michal et al., 2015), burnout (Frank, Nixdorf, & Beckmann, 2017) and dysfunctional coping strategies (Prinz, 2012). Furthermore, to date all depression predictors, whether specific to musicians or not, have only been analyzed on their own and not in larger models to consider their accumulative weight in predicting depression in a musicians’ environment. The inconsistencies in musicians’ depression research identified above are mirrored in sports psychology research, particularly in elite college athletes (Nixdorf, Frank, & Hautzinger, 2013). While some studies see college athletes as more at risk of depression due to their intensive investment into sports, others did not find such a significant difference in depression levels between college athletes and non-athletes (Armstrong & Oomen-Early, 2010; Proctor & Boan- Lenzo, 2010). These latter studies identified financial stress and change in lifestyle from high school to university/college life to be sufficient to explain higher than norm depression prevalence in both groups. While the added pressure for athletes to perform/compete at the highest level, and stress caused by their relationships with coaches/trainers, have been cited as reasons for this increase, their stress levels were not consistently found to be significantly different from those experienced by non-athletes. It is conceivable that the same reasoning could apply to music students, but research into music students’ wellbeing is still catching up with sports psychology in this regard. A prominent differentiating factor between athletes and musicians is a strand that appears to be exclusively discussed in reference to musicians and other creative professions, namely the hypothesis that depression
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