research article

Nordic Journal of Music Therapy, 17(1) 2008, pp. 30-40.

The Day the Music Died

A Pilot Study on Music and Depression in a Nursing Home

Audun Myskja & Pl G. Nord

Abstract
Background: The nursing home Vlerengen bo- og servicesenter in Oslo, Norway, a long-term
institution with 84 residents, has continually had regular music therapy activities with a music therapist
in full-time employment since 1999. The institution was without music therapy services during the fall
of 2003. Method: At the end of the period without a music therapist, measurement of depression level
by the use of Montgomery Aasberg Depression Rating Scale (MADRS) was conducted on residents
(n=72). Two months after music therapy services had been resumed with music therapy groups twice
a week in each ward and individualized services other days, a new measurement of depression level
of all residents was conducted. Results: Depression rating show a significant fall in the music therapy
condition, compared with the no music therapy condition in a crossover design: MADRS 20.4 on an
average in the no music condition, 12.2 on an average in the music condition (p < .05). Staff at the
institution was stable, and there were no significant changes in medication. Conclusion: A significant
reduction in the average level of depression in a nursing home when music therapy services are
resumed warrants recommendation for a larger controlled follow-up study.
Keywords: Elderly, nursing homes, music therapy, singing, depression, geriatrics.

Introduction
Depression in the Elderly
The elderly segment of the population is growing
worldwide. Depression is projected to become the
leading cause of disability and the second leading
contributor to the global burden of disease by the
year 2020 (WHO, 2007). Major depressive illness
is present in about 5.7% of US residents aged 65
years, whereas clinically significant nonmajor or
subsyndromal depression affects approximately
15 % of the ambulatory elderly (VanItalie, 2005).

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Nordic Journal of Music Therapy 17(1) 2008

AUDUN MYSKJA, MD, Certified specialist in

General medicine, Fellow in Neurological music
therapy. Project leader, Red Cross Competence
Center for Palliative Care, Bergen. Correspondence
address: Idrettsv. 20, 1400 Ski, Norway.
Email info@livshjelp.no
PL G. NORD, MD, MPH, Pfizer AS, P.O. Box 3,
1324 Lysaker, Norway.
Email: paal.g.nord@pfizer.com
Conflict of Interests: Pl G. Nord has position as
medical adviser for Pfizer in Norway.

The Day the Music Died

In nursing homes, the prevalence of depressive
disorders among nursing home residents is high;
depression recognition is relatively low, with only
37%-45% of cases diagnosed by psychiatrists
recognized as depressed by staff (Teresi, 1999).
A Norwegian multicentre study of depression
and dementia in nursing home residents showed
an average prevalence of depression of around 40
% (Selbk, 2007). The coexistence of medical,
neurodegenerative, and other psychiatric disorders
are confounding factors, making diagnosis and
treatment of depression in old age a challenging
task (Weyerer, Mann & Ames, 1995).
Causes of depression are complex, compared
to depression in the younger segment of the
population. Losses and defective adaptation
to losses play a larger causative role, as do
health problems, like heart disease, cancer,
and neurological disorders, which often are
accompanied by depression. WHO reports that
depression is one of the major causes of disability
among the aged, the incidence is rising, and it is
calculated that depression will be the primary
cause of disability and one of the two largest
disease groups in the elderly by the year 2020
(WHO, 2006). Antidepressant drugs are the
major treatment strategy for depression. This
presents challenges in medical treatment of the
elderly, since drug treatment for depression is
more difficult to administer in this population
segment, side effects and interactions being
common (Mottram, Wilson & Strobl, 2006).
Another important aspect is that depression in the
elderly takes many forms and often grows as a
vicious cycle, developing in the face of multiple
losses relationships, position in society, health,
sensory function, and other important functions.
This is often compounded by sleep disturbances,
inactivity, and lack of adequate stimulation. There
is therefore a growing interest in supplementary
treatment strategies for depression in the elderly.
Music has special potential in nursing homes,
given the ability of music to function as a
language that to a certain extent can replace
verbal language in the cognitively impaired and
provide meaningful stimulation (Opie, 1999).
The clinical and precise use of music therapy can
address the different components of the vicious

cycle that often accompanies depression in the

terminal stages of life (Hilliard, 2005). In this
sense, music therapy can in many situations have
an advantage over pharmaceutical treatment, since
it can address many of the components creating
the vicious cycle of depression, both restoring
a sense of community with group singing,
giving adequate sensory stimulating, furthering
movement, evoking positive and therapeutic
memory, and increasing empowerment and the
use of formally acquired skills (Brotons & Marti,
2003).
Music as a Supplementary Treatment.
Through the ages music has had a natural role
in treatment in different cultures. In Western
culture music was an integral part of treatment
of complaints in the Greek culture and the
Middle Ages, but became regarded more as a
cultural expression with little specific therapeutic
potential with the advent of modern medicine
in the 18th and 19th centuries. In the late 20th
century the role of music in treatment became
strengthened with the advent of music therapy
as a defined profession with a growing research
base after World War II. Research has found
evidence for a variety of psychophysiological
effects of music, and neuroscientific research is
building an evidence base for the use of music
(Thaut, 2005).
Effect size is a statistical tool devised specially
to evaluate therapies based on psychotherapy
and other relational methods (Cohen, 1988), and
the use of effect sizes has been found to be a
valuable tool for comparing different therapeutic
modalities (Gold, 2004).
A meta-analysis of music therapy literature
has shown active music therapy to be more
effective than prerecorded music, although there
were found only 16 studies of live music therapy
conducted by music therapists, compared to 216
studies using prerecorded music as intervention.
A comparative analysis of effect sizes showed
that live music therapy had a significantly higher
effect size than prerecorded music (Standley,
2000). These are important considerations when
deciding on whether to give priority to music
therapy in a situation with scarce funding and

Nordic Journal of Music Therapy 17(1) 2008

31

Audun Myskja & Pl G. Nord

shortage of skilled nursing staff (Dileo, Bradt,
Murphy, Keith & Zanders, 2002).
Music Therapy and Depression in the Elderly
The therapeutic use of music in the elderly does
not have less effect or higher interaction problems
than treatment with music in younger age
groups. Music is well tolerated, and experienced
positively by a majority of patients (Wigram,
2002). A large part of the elderly population has
problems with expressing emotions or expressing
through speech and language. In these cases
music may have a particular potential. Music has
shown particular promise as supportive treatment
of depression in the elderly (Hsu & Lai, 2004).
We have a general lack of studies indicating
which types of music activities are the most
effective for depressed nursing home residents,
though music therapy studies have shown
that active music therapy is more effective for
emotional variables than passive music therapy
(Montello & Coons, 1999). Music therapists
have devised tailored programs for depressed
elderly persons (Hanser, 1990). Investigations
have indicated positive effects of such strategies
(Hanser & Thompson, 1994). Literature reviews
have indicated promising results of music therapy
as supplementary treatment of depression in the
elderly (Brotons, 2000), although solid evidence
still needs to be established (Maratos & Gold,
2003).
The Reason for the Present Investigation
Vlerengen bo- og servicesenter is a nursing home
in Oslo with 84 long-term inhabitants, residing in
three wards. Ward 1 is a somatic ward with a high
degree of functional disability and a high average
number of somatic diseases and classifiable
diagnosis in the residents. Ward 2 has a mixed
population with a high incidence of dementia and
somatic diseases. Ward 3 is a dementia ward with
24 residents divided into four groups of six.
The institution has placed high emphasis on
cultural and stimulating activities, and since
1999 had employed a professional in a full time
position to provide music therapy services. The
professional in question did not have formal
music therapy education, but worked with active

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Nordic Journal of Music Therapy 17(1) 2008

music techniques under guidance from a trained

music therapist, and will therefore in this paper
be termed music therapy aide.
The music therapy aide had developed music
therapy techniques that were experienced as
highly effective by the trained staff (Myskja,
2006). There were also concerts, dances, and
individualized sessions. Measurement of wellbeing for a selected group of residents with
numerical rating scales (NRS) indicated a
significant increase in well-being in the majority
of residents participating in the music sessions,
compared to other activities not involving music.
There were thus several indications that the music
therapy intervention was beneficial, making it
natural to investigate what the benefit may be,
and for what symptoms.
A natural experiment arose when the music
therapist was absent for a period of 11 weeks. The
music therapy aide at the institution had during
the preceding year been present all year round,
having had only short absences of one week at a
time. When he had a three month leave of absence,
several nurses started reporting after a few weeks
of his absence that a large number of residents
seemed in tangibly lower spirits. They attributed
this observation to the absence of the usual
music activity. This possible effect was reported
independently in all three wards in the institution.
Even staff members with no particular affinity
to the use of music for therapeutic purposes
described that they perceived causal link between
the absence of the music groups and the increasing
depressive tendency they saw with several of the
residents. Many staff members suggested that it
would be important to look more closely at this
observation to investigate whether the observed
increase in depression also was measurable. This
led to a decision to supplement interviews with
trained staff with the use of a validated instrument
to measure depression levels.
The aim of the present study is to explore
possible changes in symptoms of depression
among the inhabitants associated with the absence
of regular music sessions. The two different
conditions are termed no music and music
conditions, not because there was an absolute
absence of music when the institution was without

The Day the Music Died

music therapy services. There were, however, no
apparent changes in other sources of music or
other stimulation to account for differences in the
no music and music conditions.

Method
Study Design
The study was designed as a pre/post measurement
of depression levels in the included residents
at the institution (n = 72). The measurement of
depression levels in the no music condition was
performed during the last week of the music
therapy aides 11-week leave of absence. After 6
weeks of resumed music activity, measurement of
depression levels in the included residents (n = 63)
was measured as the music condition parameter.
The Nature of the Intervention
Twice a week music sessions (average duration
45 minutes each) were conducted in each of the
three wards of the nursing home. The music
therapy aide led the singing of familiar and
preferred songs, accompanying the songs on the
piano. The sequences of the songs were based on
charting of music preferences both for the group
and for individuals. Music preference was found
through a method of systematic investigation
based on questionnaires and the use of preference
CDs, making the process of song selection
more precise and specific. The repertoire of the
music sessions was developed gradually from
the preference principles. The music therapy
aide sang and played the piano with a strong
chordal style songs and music pieces pooled
from results of preference charting to create a
repertoire that focused on the four sequences
outlined in the work of Danish music therapist
Hanne Ridder (2004, 2005):

Focus attention
Regulate arousal
Dialogue
Conclusion.

Each of the four main sequences charted by

Hanne Ridder for patients with dementia were

used in the planning process:

1. Focus attention. The stage setting and
creating of initial framework was normally
established by an inviting rhythmic song,
not too hard or harsh, along the lines of
welcome songs. One Norwegian song often
used had a textual theme roughly translated
as: Lift your anchor, get the motor
running, we are going together on a great
adventure.
2. Regulate arousal. Regulation of attention
and activation was attended by creating a
dialectic between brisk, danceable tunes
and slower, well-known tunes that were
instantly recognized, for instance, well
loved songs from childhood. Thus we
mainly succeeded in creating an alert
response that was able to engage each of
the individual group members, without
overstimulating or creating activation
through using solely faster songs.
3. Dialogue. In this deepening part of the
session, we used songs that had shown
the ability to communicate meaningful
memories and deep issues for the members,
evoking both awareness of the group,
mental clarity, and constructive emotional
responses. Examples of this were local
songs from the regions of different
participants, who had often moved from
rural areas into Oslo in youth or early
adulthood. We used patriotic songs for male
residents with defining memories from
World War II and well-loved hymns for
participants with strong religious beliefs.
At the same time, we tried to see to it that
as many participants as possible were
given meaningful themes individually,
in order to feel included in the group
activity. We tried to accomplish this by not
concentrating on a few categories solely,
but trying to include a broad repertoire,
which would not be offending to any
group members. For instance, some had
a history in marching bands and loved
the marching songs, but we tried not to
include too many, as this would be offputting to some other group members.

Nordic Journal of Music Therapy 17(1) 2008

33

Audun Myskja & Pl G. Nord

Gender
Mean age

Female
51 (71 %)
87.5 (68.2-95.8)

Male
21 (29 %)
80.9 (57.7-93.2)

All
86.6

Alzheimers
Dementia (AD)

Multi-infarction
Dementia (MID)

FrontoTemporal
Dementia (FTD)

Other

Of all
53 of 72
(74%)

33 of 72 (46 %)

15 of 72 (21 %)

2 of 72 (3 %)

3 of 72 (4 %)

Of those
diagnosed
with
Dementia

33 of 53 (62 %)

15 of 53 (28 %)

2 of 53 (4 %)

3 of 53 (6 %)

Dementia

Table 1: Distribution of age, gender, and prevalence and types of dementia at the institution.
4. Conclusion. We tried, through trial and
error, to find songs that could define the
groups time together and create a feeling
of completion. When the group needed to
strengthen a sense of fellowship, we often
used the Norwegian translation of Auld
Lang Syne, whereas Anchors Aweigh
was used at times where we wished to let
the sessions end on a brisk and encouraging
note.
Song programmes were developed gradually
through observation of responses of the
participants, especially through staff, who were
present in every session and observed reactions
of the participants according to observational
guidelines taken from the validated observational
method Dementia care mapping (Brooker,
2004). The initial choice of repertoire focused on
familiar songs, encouraging participation in song
and dance to facilitate expression and mobilize
resources in the form of previous skills and
positive memories (Small & Gutman, 2001).
All residents were encouraged to participate,
and 72 of 84 residents participated regularly
at the time of the study. The non-participants
were analyzed for possible reasons for nonparticipation through observation and interviews.
Three main reasons were found: Physical
infirmity (6 persons), alcoholic dementia (4
persons), personality factors (3 persons).

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Nordic Journal of Music Therapy 17(1) 2008

Inclusion Criteria
The following criteria of inclusion were chosen:

All long-term residents at Vlerengen boog servicesenter.

Exclusion criteria were:

In hospital or in other institutions at the
time of inclusion.
Short-term placement.
In the terminal stage of life.
72 of 84 residents were thus included in the first
measurements, 5 residents were hospitalized or
in gerontopsychiatric units or other institutions,
2 residents were in short-term placement, and 5
were in terminal stages and could not participate
in the music sessions. Sixty-three could be
included in the second round of measurements,
after the same criteria. Six residents had died,
three had been discharged to hospital or other
institutions.
The distribution of mean age, gender, and
dementia diagnosis of the 72 residents who were
included is shown in Table 1.
Diagnostic data were incomplete for 13 of the
residents. The data for these residents are based
on testing for cognitive failure by the instruments
Mini Mental State Examination (MMSE), and
Clinical Dementia Rating (CDR), performed by
the occupational therapist at the institution, who

The Day the Music Died

n

Ward 1
M (SD)

Ward 2
M (SD)

Ward 3
M (SD)

Ward 1,2,3
combined

No music

27

18.6 (5.7)

12

27.5 (3.8)

24

21.7 (5.8)

63

20.4 (6.2)

Music

27

11.1 (2.7)

12

15.5 (3.6)

24

12.7 (3.2)

63

12.2 (3.3)

Table 2: Mean MADRS score in Ward 1, 2 and 3, in No Music and Music condition. P-value for the
paired t-test of the difference mean is <0.001
emotional and behaviour states of patients the
project leader had taken advanced education in
dementia care mapping, and had educated staff
in observational criteria to uncover depressive
reactions. Staff members involved in this
study had been trained through role plays and
discussion of cases to observe and evaluate mood
states as precisely and objectively as possible.
The measurement was conducted by interviews,
taking place in the same location at two fixed
Method of Measurement Practical Aspects
times during a 7-day period, 11 AM and 4 PM.
The measurements by Montgomery Aasberg Where there was doubt on the MADRS rating
Depression Rating Scale (MADRS) in the no we observed the resident after the observational
music condition were conducted the last week criteria outlined in the validated rating method
of October 2003, in the last week of the music Dementia Care Mapping (DCM) to find
therapists leave of absence. The second part was consensus on the rating (Beavis, Simpsons &
conducted in the last week of January 2004, two Graham, 2002).
months after the music therapist had resumed
The level of depression measured by MADRS
his work. To increase precise evaluation of the was conducted by proxy, in each case choosing
the nurse leading the group and the primary nurse
Mean MADRS Score and 95% CI in the
with the closest contact to the resident. The two
No music and in the Music condition
main nurses involved with each patient giving
their ratings independently, blinded to the rating
2 5 ,0 0
results of the other. The aim of the investigation
2 0 ,0 0
was not divulged, but presented as a general
investigation of the level of cognitive decline,
1 5 ,0 0
agitation and depression in the residents in the
(N = 63)
institutions. Where possible, the same nurses were
1 0 ,0 0
used both in evaluation of depression through
5 ,0 0
MADRS in the no-music condition and in the
music condition. Where there was consensus
0 ,0 0
within one digit the highest number was taken.
No M usic
M usic
If the diversion was two digits or more, the
patient was re-evaluated until the correct figure
arose through discussion of each question in the
Figure 1: MADRS scores in the no music condition MADRS scale, in order to make measurements
and the music condition: Average values for all as precise as possible.
included patients from the three wards combined.
The results were evaluated statistically through
MADRS Score

had special training in using these instruments.

Is this population representative of a nursing
home population? There are no special conditions
distinguishing the institution in question from
comparable institutions in other regions of Norway
(Selbk, 2007). The demographic data show little
difference from nursing home residents studied in
other investigations, and are comparable to data
from other countries (Ness, 2004).

Nordic Journal of Music Therapy 17(1) 2008

35

Audun Myskja & Pl G. Nord

Degree of
participation

No. of residents in
category

MADRS no music
condition
M (SD)

MADRS music
condition
M (SD)

Mean
change

10

14.00 (3.89)

13.80 (3.71)

-0.20

1
2
3

2
11
40

24.00 (16.97)
17.91 (4.35)
22.45 (5.37)

11.00 (1.41)
12.55 (2.07)
11.85 (3.44)

-13.00
-5.36
-10.60

Table 3: The relation between participation in the music therapy groups and MADRS values.
simple linear model descriptive analysis.

A descriptive analysis for each subgroup is shown

in Table 3.
To examine the relationship between the
degree of participation in music therapy and
the degree of symptom change statistically, we
calculated a linear model with the change in
symptom scores as the response variable, and
participation, pre-test score, and the interaction
of the two as predictor variables.
The result of this linear model, as shown in
Table 4, indicates that participation predicted
change (p < .05). The model explained 79% of
the total variance.
We thus found a tendency towards larger
improvement in the groups with high levels
of participation. We also found that the most
deeply depressed individuals had a lower level of
participation in the music therapy sessions.

Results
The initial measurements following 11 weeks of
the no music condition gave average MADRS
levels in Ward 1, 2, and 3 as shown in the No
music figures in Table 2.
The results of MADRS measurements in Ward
1, 2, and 3, conducted following the resumed
music therapy, are shown in the Music figures
in Table 2: Measurement results ranged from 6
to 46, higher values indicating higher level of
depression.
Frequency analysis including standard deviation
and confidence intervals showed p < .05, i.e., a
highly significant reduction of depression in the
music condition.
The included residents were rated
independently by the ward nurses for degree of
participation in the music therapy groups, shown
in Table 3:

Discussion
Choice of Design
We wished to look at the general impact the
music therapy session might have on the mood
state of the population of the nursing home. A
randomised controlled trial design was evaluated

3 always or nearly always present

2 usually present
1 sometimes present
0 never or almost never present
(Intercept)
Score1
Participation
Score1 x Participation

Estimate

SE

10.75
-0.79
-2.22
0.05

2.31
0.14
1.02
0.06

4.66
-5.54
-2.18
0.85

< .001 ***

< .001 ***
< .05 *
0.40

Table 4: Linear model of participation in music therapy and symptom change.

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Nordic Journal of Music Therapy 17(1) 2008

The Day the Music Died

to be both impracticable and debatable from an
ethical viewpoint: The residents had voted with
their feet as to whether they wished to take part
or not. To see if randomisation was still feasible,
we conducted a pilot study with a small group
(n = 8), to see whether it would be practically
possible to carry out randomisation. A resident
who was included in the trial usually became
agitated by music, ran out of the room, and could
not be contained, whereas a resident who was
excluded by randomisation but loved the music
groups, heard the music and tried to get in to the
music room during a session.
Therefore, a pilot study involving all the
residents at the institution was found to be best
suited, on a combined evaluation of practicability,
completeness, the study question, and ethical
aspects. Each resident at the institution who
could be included, served as his/her own control
and was evaluated both in the no music condition
and in the music condition.
Choice of Measuring Instrument
After deciding to measure depression levels
of the residents at the institution, the choice of
instrument was challenging. The project leader
had extensive experience with MontgomeryAasberg Depression Rating Scale (MADRS),
from clinical work and research in general
practice, psychiatry, and gerontopsychiatry,
and the project supervisors advised that this
instrument would be adequate to give answers of
value. In the literature, we found that MADRS
had been used as a tool to evaluate depression in
elderly patients suffering from dementia (Rao &
Lyketsos, 2000). MADRS as diagnostic tool has
been found to have sufficient internal consistency,
validity, and reliability in rating this patient
group in a recent study indicating that MADRS
may have reliability on a level with Cornell Scale
for Depression in Dementia, which is regarded
as state-of-the-art tool to evaluate depression in
dementia (Muller-Thomsen, Arlt, Mann, Mass &
Ganzer, 2005).
The Change in Depression Levels
The reduction in depression after the music
therapist had resumed his activity is statistically

significant, and warrants closer investigation.

There are several factors within the study situation
that need consideration:
The depression rates in the initial no music
condition were different in the three wards,
highest in ward 2, a mixed ward with both somatic
complaints and dementia. The ratings were lowest
in ward 1, a somatic ward, whereas ward 3, the
dementia ward, had ratings in between the two.
The reasons for this difference may be complex:
One may presume that the somatic ward has
patients with more somatic complaints and thus
less psychiatric complaints, like depression. This
is, however, an assumption, and we had no clear
data to indicate that this is so. We know that
dementia and depression often accompany each
other and form a vicious cycle. There was no
significant difference in the use of antidepressant
drugs in the three wards.
From observation and interviews we found
that the most likely account of the difference in
depression level between the three wards was
the working conditions of staff. Ward 2 had had
instability and discontent in staff, several different
leaders the preceding years, and was only just
beginning to enter a more stable situation. Ward
1 and 3 had more stable leadership and personnel
situations, but the dementia ward had several
challenging cases with preexisting psychiatric
illness compounding the clinical picture of
dementia.
There was also a correlation between
participation in music groups and improvement
in MADRS measurements. The lack of adequate
stimulation of elderly residents in nursing homes
does not rule out general stimulating effects. It
must, however, be noted that the music therapy
sessions were replaced with general activities
in the absence period of the music therapist,
activities like card games presumed to be both
enjoyable and stimulating to the residents. At
the present institution, the benefit of the music
therapy sessions was obvious to staff, as expressed
in semistructured interviews conducted during
the project period. The interviews particularly
emphasize the effect of the music therapy sessions
on the general mood state, both of individuals and
at the institution as a whole (Myskja, 2006).

Nordic Journal of Music Therapy 17(1) 2008

37

Audun Myskja & Pl G. Nord

Possible Sources of Bias
In this study, we initially tried to use MADRS
to interview the residents. However, we found it
impossible to carry through the ratings, due to the
high number of residents who had dementia and
therefore were not able to comprehend and reply
adequately to the questions. We therefore used
independent evaluations by two experienced
staff members who knew the patients, in all
six staff members in each ward. This gives an
obvious weakness with possible bias in the
form of a positive pre/post evaluation. We were
aware of this bias factor, and tried to reduce this
confounding factor by:
Not informing staff about the purpose
the pre/post MADRS measurements.
These measurements were divulged as a
way to chart the level of depression in a
nursing home population, with control of
variations over time. This does not rule
out the possibility that the real motivation
of the measurements were guessed or
intuited by the interviewed staff members,
but we believe that this at least reduced
the likelihood of bias towards the music
therapy intervention.
We let two experienced staff members
who knew the residents make independent
ratings, initially blinded to the evaluation
of the other. We sought consistency
between the raters, although the figures
were too small to evaluate statistically.
Another factor that may have been able
to reduce bias was that attitudes towards
music therapy varied strongly among staff,
uncovered by depth interviews at an earlier
stage of the project. Several of the staff
members used as raters were convinced
that music therapy had effect on clinical
symptoms, whereas other staff members
used as raters looked at music therapy as a
pasttime to create diversion from boredom,
and had weak beliefs that it could work on
clinical symptoms.
We also tried to reduce bias by not
divulging results of the first test while
rating the second time.

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Nordic Journal of Music Therapy 17(1) 2008

Another obvious source of bias is the use of the

author as interviewer. We sought guidance on how
to reduce this source of bias. The interviewer tried
to use a neutral appearance and body language
during interviews, and consciously employed
low degrees of directiveness while interviewing,
as outlined in Whytes Directiveness Scale for
analysing interview technique (Britten, 1995).
The medical doctor directing treatment at the
institution was not in contact with the project. We
therefore have the opinion that changes in music
therapy activity did not lead to bias in form of
changes in regular medical treatment policies.
The Possible Interaction between Medical
Treatment and Music Therapy
We had several cases during the study that
indicated that a combination of pharmaceutical
treatment and music therapy tailored to the
clinical picture of the patient will give added
benefit. When the presentation of symptoms of
depression was mixed with anxiety and agitation,
the individualized music therapy measure would
use a calming and comforting. Patients who had
a catatonic, frozen, passive form of depression,
on the other hand, benefited from music therapy
measures that used positive energizing elements.
Patients who had difficulty coping with losses,
stuck in a grieving process, benefited from
familiar songs and music that could help work
through emotional difficulties. The choice of
pharmaceutical treatment would in several cases
be informed by this conscious use of musical
elements tailored to the patients needs. In some
cases, the music therapy sessions uncovered pain
that had not been treated adequately, for instance,
and could thus aid in shedding light on clinical
presentations that are often difficult to decipher
(Myskja, 2005). How different forms of treatment
given the same individual, e.g., drugs and music
therapy, influence each other mutually, is an
area that has so far been inadequately addressed
in the research literature, and would be another
important area for future exploration (Rajendran,
Thompson & Reich, 2001).

The Day the Music Died

Conclusion
A study with a pre-post design, involving all
the residents in a Norwegian nursing home that
were able to participate, compared a no music
condition with a music condition, instigated by
a temporary pause in music therapy services. The
measurements of depression levels by the use of
MADRS showed an overall significant reduction
in depression levels in the institution when the
music therapy services were resumed compared
to the end of an 11-week period when the music
therapy aide had a leave of absence. Measurement
of depression levels showed a similar reduction in
depression levels in all three wards in the music
condition, compared with the no music condition.
The reduction in depression showed a correlation
to the degree of participation in the music therapy
groups. High levels of participation were linked
to a large reduction in depression. Low levels of
participation in the music therapy groups were
linked to advanced disease, more than to previous
relationship to music.
The present study has methodological
limitations; however, it does address issues
inadequately dealt with in music therapy
literature. The robust effect found in the study
needs to be followed by larger controlled studies
to give stronger evidence not only of the efficacy
of music therapy, but also clearer indications of
which approaches to the use of music are the most
effective and give the best utilization of available
resources.

Acknowledgments
Oslo Church City Mission, for practical help;
Health and Rehabilitation, for project funding;
G C Rieber Foundations, for study funding;
Torgeir Bruun Wyller and Brynjulf Stige, for
helpful advice.

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