Effects of choral singing on depression and anxiety in older adults: A randomized controlled trial

Introduction: Few randomized controlled trials (RCTs) have investigated the effects of choral singing (CS) on older adults at-risk of cognitive decline and dementia. Extant RCTs on CS also lack an active control arm controlling for non-intervention-specific active components. Methods: In this parallel-arm, open-label RCT, 200 community-dwelling older adults at-risk of cognitive decline were randomized to the treatment arm, i.e., CS, or the active control arm (i.e., health education program, i.e., HEP, matched with non-intervention-specific components). Both arms involved weekly 1-h group sessions held continuously for two years. We examined the a priori registered secondary outcomes, positive screens for depressive and anxiety disorders, at baseline, 1-year, and 2-year time-points, using linear-mixed models with intention-to-treat. Results: Compared to the HEP, CS participants experienced similar decreased odds of positive screens for depressive and anxiety disorders throughout all the time-points, though different trajectories. Discussion: In contrary to previous studies using passive controls reporting positive outcomes, compared to HEP as an active comparator, CS is as effective as HEP in delaying progression to clinically significant depressive and anxiety disorders in at-risk community-dwelling older adults. Our findings highlight the critical importance of incorporating an intervention-components-matched comparison arm in non-pharmacological interventions. Trial registration: Choral Singing For the Prevention of Dementia, https://clinicaltrials.gov/study/NCT02919748; Trial Registration: NCT02919748.