Music experience is associated with lower depression level and higher quality of life among family caregivers of critically ill patients

Abstract

This study aimed to investigate level of the psychological health of family caregivers of critically ill patients, considering quality of life and depression, and whether it varied depending on their individualized music use. A survey was administered in a surgical intensive care unit (ICU) of a university hospital. Adult family caregivers of ICU patients older than 18 years of age were included. Depression and quality of life were measured via self-administered scales, and emotional states were evaluated using a visual analog scale. Music use in daily life was also queried. A total of 195 caregivers (mean age, 51.2 years) participated in this study (spouses 44.6%, offspring 51.3%, and parents 4.1%). Among respondents, 44.6% were at high risk of depression, and 18.0% of these respondents reported their quality of life as poor or very poor. In terms of singing in their everyday lives, respondents who had singing experience reported higher quality of life and lower depression than those without singing experience. The results of this study support the active engagement in music as resource for caregivers of ICU patients to alleviate their emotional distress. Further investigation into diversified music use and music intervention in critical care should focus on the inclusion of family caregivers.

Keywords

intensive care family caregiver music use depression quality of life

The experience of being in an intensive care unit (ICU) can cause physical and psychological distress in both patients and their families (Fumis & Deheinzelin, 2009; Hwang et al., 2014). The stress and strain that critically ill patients experience have been well documented, but the distress experienced by these patients’ family members has been underestimated and remains relatively unexamined (Verhaeghe, Defloor, Van Zuuren, Duijnstee, & Grypdonck, 2005). During and after ICU care, substantial support (physical, emotional, and financial) tends to be provided by family caregivers of critically ill patients. As a result, these family caregivers are susceptible to the physical and psychological effects of stress over the course of the patient’s critical illness (Choi, Donahoe, & Hoffman, 2016; van Beusekom, Bakhshi-Raiez, de Keizer, Dongelmans, & van der Schaaf, 2016). Families of seriously ill patients are reported to experience severe caregiving and financial burdens (Covinsky et al., 1994) as well as serious psychological distress (Andresen, Guic, Orellana, Diaz, & Castro, 2015; Kross & Curtis, 2008). The most common symptom of emotional distress is depression (Haine, Denehy, Skinner, Warrillow, & Berney, 2015). A longitudinal descriptive study of 50 caregivers of ICU patients who received mechanical ventilation found that caregivers with significant depressive symptoms during ICU stay maintained a high level of depression, even 2 months after ICU discharge, while the caregivers with lower levels of depression during ICU stay exhibited further decreases in depression after ICU discharge of the patients (J. Choi et al., 2012).

Addressing the needs of family caregivers of critically ill patients is of increasing interest given the development of modern critical care. The contemporary model of family-centered care considers a patient’s family an important part of treatment (Mitchell, Chaboyer, Burmeister, & Foster, 2009). This is based on research showing that the psychological health and quality of life of caregivers affect not only the caregivers themselves but also the patients they care for in terms of quality of care provided to the patient and quality of the patient–caregiver relationship (Li et al., 2003; Lor, Crooks, & Tluczek, 2016). Moreover, for caregivers of ICU patients, increasing psychological morbidity, including clinical depression and even post-traumatic stress disorder, was documented to negatively affect their quality of life and that of their family (Haine et al., 2015).

As such, research on how best to address the needs of caregivers has increased in recent years (Fu, Zhao, Tong, & Chi, 2017). These efforts have focused on care-related education (Badger et al., 2011; Melnyk et al., 2006), skill-based training, and personalized interventions targeting quality of life (Garrouste-Orgeas et al., 2012). More recently, music has begun to be investigated as a means of alleviating distress in caregivers (D. I. Choi, 2017). In terms of family-centered care, music use for psychosocial health of caregivers has expanded from passive exposure to environmental music (e.g., listening to music in a hospital waiting room) to active engagement in music (e.g., individualized music use and music making–based therapeutic interventions; Baker, 2017; McDermott et al., 2018).

However, therapeutic use of music for caregivers of ICU patients remains relatively limited. A review of music interventions in family-centered care in medical settings in Korea and Western countries found only two studies that targeted caregivers of ICU patients, and most of the research on family-centered interventions grouped family and patients together in music activities (D. I. Choi, 2017). Engagement of family caregivers and patients in music experiences can lead to increased positive feelings and sense of control (Magill & Berenson, 2008), but music interventions targeting only family members of the patient are just beginning to appear in the literature (D. I. Choi, 2017).

In terms of music use, family caregivers have reported it as beneficial to their health and well-being (Mofredj, Alaya, Tassaioust, Bahloul, & Mrabet, 2016; Perez-Cruz et al., 2012). Specifically, caregivers have reported that background music improved an unpleasant environment, stabilized physiological functions (e.g., heart rate and blood pressure), and modulated emotions and mood. In addition, caregivers’ personal use of music has been associated with greater coping skills and resilience (O’Callaghan, Hudson, McDermott, & Zalcberg, 2011). More active use of music for directly addressing the needs of caregivers in various settings demonstrated that music could be effective in helping caregivers express their emotions and develop resources for coping, which are important factors for enhancing the psychosocial health of this population (Baker, 2017; McDermott et al., 2018).

Given music’s potential to address the needs of caregivers, further investigation is warranted to identify how to use music in relation to enhancing the psychosocial health of caregivers of ICU patients. In terms of type of music activity, music listening appears in the literature more frequently than any other activity (D. I. Choi, 2017). This might be attributed to the fact that music listening is readily accessible to both caregivers and related professionals. However, the literature indicates that other music activities requiring more active engagement also show great promise. Both live and recorded music can positively impact depression and anxiety, but live music in the presence of a caring professional (i.e., a nurse) affected sleep quality and was deemed by participants as more supportive (Lai, Li, & Lee, 2011). Similarly, research that involved family caregivers of ICU patients in an active music activity (i.e., singing) resulted in the caregivers self-reporting improved mood following the activity and affirming their interest in continuing participation in that music activity (Sumathy, Bhuvaneswari, & Kala, 2016). This supports the need to investigate the effectiveness of more diverse music activities for caregivers of ICU patients and to better understand the type of music activities they are actually engaging in and their perceptions of this engagement.

Therefore, this study aimed to ascertain level of the psychosocial health of caregivers of ICU patients (i.e., quality of life, depression, and emotional states) and how the factors documented as influencing caregiving burden (e.g., relation to a patient and length of caregiving) related to their level of psychosocial health. Everyday music use of the caregivers was also investigated to examine whether their level of psychosocial health varied depending on their individualized music use.

Method

Study design and participants

A descriptive survey research design was used to investigate the perceptions of family caregivers of ICU patients in terms of the psychosocial and health effects of music. All procedures were approved by the Institutional Review Board of Severance Hospital (4-2016-1028), Seoul, Korea. Eligible participants were adults (age ⩾18 years) who had a family member admitted to the hospital’s ICU. Also, they had to identify themselves as a primary caregiver responsible for providing a majority of care for the patient. Participants were recruited through posters placed in the waiting areas of the ICU units, and informed consent was obtained from each participant before participation in the study.

Measures

A questionnaire surveying music use and perceived benefits from music involvement was developed for this study and self-administered by each participant. The questionnaire consisted of three parts. Part I included seven items related to demographic information, including the caregiver’s age, sex, relationship to the patient (e.g., spouse, child, or parent), duration of caregiving since the onset of illness (months), duration of caregiving during ICU stay (days), and the patient-related information. Part II consisted of five items related to how the participants felt in the past week. They were asked to place a line on a 100-mm visual analog scale to rate the degree to which they have experienced the presented emotion (i.e., happiness, sadness, anger, fear, and comfort) on a straight line anchored at the ends by “feeling the presented emotion not at all” and “feeling the emotion very much.” The marked distance on the scale is measured for the intensity of the felt emotion, ranging from 0 to 100. Part III consisted of nine items addressing music use and perceived benefits of music. The items included whether the participant had engaged in each of the three music activities (i.e., music listening, singing, and instrument playing) in their everyday lives over the past 6 months, how frequently they engaged in such music activities, whether and what type of musical experiences they have currently and in the past (i.e., before and after their family member became sick), whether they perceived music use as beneficial for themselves, and what benefits they believed this involvement with music would bring to their lives (e.g., physically, cognitively, emotionally, socially, and environmentally).

In order to examine psychosocial health of caregivers of ICU patients, along with the investigator-constructed questionnaire asking the participants to self-rate their emotional states, the abbreviated form of the World Health Organization’s Quality of Life (WHOQOL) Scale was administered, which was developed to assess how individuals subjectively perceive and evaluate their lives and general health (WHOQOL Group, 1998). The WHOQOL-BREF, an abbreviated version of the WHOQOL-100, consists of 26 items related to four domains: physical health, psychological health, social relationships, and environment. Respondents were asked to rate themselves on a 5-point Likert scale (from 1 = not at all to 5 = extremely). Each participant’s total raw score could range from 26 to 130, and the average score for each domain could range from 5 to 20, with a higher score indicating a higher quality of life. The WHOQOL-BREF was translated into Korean and previously validated by Min et al. (2002). Cronbach’s alpha for the Korean version of the WHOQOL-BREF was calculated to be .90 (Min et al., 2002), and for this study, it was calculated to be .92, indicating high internal consistency of the instrument.

The third instrument administered measured each participant’s level of depression. The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1991) consists of 20 items addressing depressed affect, positive affect, somatic activity, and interpersonal relationships and was self-administered. Respondents were asked to rate how often during the past week they felt the way presented in each item using a 4-point Likert-type scale (from 1 = rarely to 4 = most or all of the time). In this study, the Korean version of the CES-D was used (Bae & Cho, 2004). Cronbach’s alpha for the translated version of the CES-D was calculated to be .92, and for this study, it was calculated to be .88.

Procedures

The present study was performed in a quiet, independent consultation room within the hospital’s ICU units. After eligibility for participation was confirmed and consent was obtained, each participant completed the three questionnaires individually. The investigator provided assistance when necessary.

Data analysis

Descriptive data were collected for each item on the investigator-developed questionnaire related to music use and the perceived benefits of music as well as for the items on the WHOQOL-BREF and the CES-D. To examine how the participants’ perceived quality of life and self-reported depression correlated with their demographic factors (e.g., duration of caregiving), a Pearson’s correlation analysis was conducted. To examine whether a participant’s relationship to a patient affected the participant’s psychosocial health as measured by their level of quality of life and depression, an independent t test was used to compare the measures between subgroups. Furthermore, linear regression was performed to examine whether a participant’s music experiences (yes/no) served as a predictor for his or her quality of life and level of depression, with the effect of sex controlled for by including it as a covariate. For each subgroup depending on the relation of a participant to a patient (e.g., spouse or child), linear regression was also conducted to determine whether music experience was a predictor of quality of life or level of depression.

Results

A total of 195 caregivers with a mean age of 51.2 years participated in this study. Among the respondents, 87 (44.6%) were spouses, 100 (51.3%) were children, and 8 (4.1%) were parents of ICU patients. Given that the proportion of parents of ICU patients was small, subgroup analyses were conducted only with the spouse and child groups. The participants’ family members (patients) were in the ICU from 1 to 10 days (1–9 days for the spouse group and 1–10 days for the child group). Demographic information of the participants and each subgroup (i.e., the spouse and child group) is summarized in Table 1. In comparing the spouse and child groups, there were significant differences in age. In terms of the severity of illness, no significant differences in the Acute Physiology and Chronic Health Evaluation (APACHE) II score (index of illness severity) and length of mechanical ventilation were observed between groups. There were no significant differences in age, duration since onset, or length of ICU stay between the patients to whom the participants gave care.

Table 1.

Participants’ demographic information.

Characteristic	Total (N = 195)	Spouse (n = 87)	Child (n = 100)	t
Sex (male: female)	69: 126	26: 61	41: 59	–
Age, years	51.2 ± 13.9	59.4 ± 12.1	43.0 ± 10.2	2.454*
Patient information
Age of patient, years	65.3 ± 13.2	65.3 ± 13.2	62.0 ± 12.5	−0.239
Diagnosis at ICU admission, n (%)
Elective surgery	170 (87.2)	79 (90.8)	84 (84.0)	–
Emergent surgery	15 (7.7)	5 (5.7)	9 (9.0)	–
Respiratory failure	4 (2.1)	1 (1.1)	9 (3.0)	–
Sepsis	3 (1.5)	2 (2.3)	1 (1.0)	–
Cardiac failure	2 (1.0)	0 (0.0)	2 (2.0)	–
Acute kidney injury	1 (0.5)	0 (0.0)	1 (1.0)	–
Length of mechanical ventilation, days	1.0 ± 2.3	0.9 ± 1.6	1.0 ± 2.0	−0.145
APACHE II score (0–75)	17.5 ± 7.0	17.3 ± 7.3	18.2 ± 6.3	−0.893
Duration since onset, months	39.0 ± 79.9	39.0 ± 79.9	46.4 ± 88.2	0.320
Length of ICU stay, days	2.2 ± 1.1	2.2 ± 1.1	2.2 ± 1.1	0.974

ICU: intensive care unit; APACHE II: Acute Physiology and Chronic Health Evaluation.

Data presented as M ± SD unless otherwise indicated.

p < .05.

Psychosocial needs of caregivers of critically ill patients

The results for the participants’ self-reported quality of life, level of depression, and emotional states are presented in Table 2. The maximum score possible on the WHOQOL-BREF is 130, and the average score for the participants was 88.1, with highest score evidenced for the physical domain and the lowest score for the environment domain. When participants rated their overall quality of life on Item 1, 18.0% rated it as poor or very poor, which corresponded to a 1 or 2 on the 5-point Likert-type scale (M = 3.2, SD = 1.0). When they rated their overall perception of their health on Item 2, 21.0% rated it as poor or very poor (M = 3.1, SD = 1.0). The mean value of depression measured by the CES-D was 16.8. Given that individuals who score > 16 on the CES-D are at risk of clinical depression, a total of 87 participants (44.6%) scored 17–51 points, which is indicative of a high level of depressive symptoms. For perceived emotional state on a 100-mm visual analog scale, the highest intensity was perceived for happiness and the lowest for anger.

Table 2.

Quality of life and depression of caregivers of critically ill patients.

Parameter	Total (N = 195)	Spouse (n = 87)	Child (n = 100)	t	p
Parameter	M ± SD	M ± SD	M ± SD	t	p
WHOQOL-BREF
Total, raw score	88.1 ± 15.1	84.7 ± 13.0	91.8 ± 15.6	−3.372	.001**
Physical (5–20)	14.2 ± 2.6	13.6 ± 2.5	14.7 ± 2.5	−3.139	.002**
Psychological (5–20)	13.9 ± 2.7	13.4 ± 2.6	14.4 ± 2.6	−2.710	.007**
Social (5–20)	13.3 ± 2.9	12.6 ± 2.9	14.0 ± 2.8	−3.560	<.001***
Environmental (5–20)	13.2 ± 2.7	12.8 ± 2.5	13.6 ± 2.8	−2.006	.046*
CES-D	16.7 ± 10.6	19.1 ± 11.8	14.3 ± 9.1	3.146	.002**
Emotional state
Happiness	51.7 ± 25.4	51.2 ± 25.0	52.3 ± 24.9	−0.298	.766
Sadness	44.6 ± 29.6	44.7 ± 29.2	43.7 ± 28.9	0.228	.820
Anger	37.1 ± 26.4	37.0 ± 27.6	37.3 ± 24.8	−0.081	.935
Fear	42.2 ± 29.2	43.5 ± 30.4	41.5 ± 27.3	0.472	.638
Comfort	46.8 ± 26.2	46.9 ± 26.0	47.1 ± 25.1	−0.031	.975

WHOQOL-BREF: World Health Organization’s Quality of Life scale abbreviated version; CES-D: Center for Epidemiologic Studies Depression Scale.

p < .05. **p < .01. ***p < .001.

Perceived quality of life and level of depression between the spouse and child groups were compared using an independent t test. Analysis demonstrated that spouses reported a significantly lower quality of life. Also, spouses reported a significantly higher level of depression, compared with adult children of ICU patients, which indicates that spouses exhibited increased risk of depression. In terms of emotional state, while the spouse group reported higher intensity for negative emotions (e.g., sadness and fear) and lower intensity for positive emotions (e.g., happiness and comfort) than the child group, such differences did not reach statistical significance.

In order to investigate the association of quality of life and depression with other personal factors (e.g., duration of caregiving), a Pearson’s correlation analysis was conducted. There was a significant but small positive correlation for duration since the onset of illness with quality of life and depression, indicating that longer caregiving may decrease perceived quality of life and increase level of perceived depression. The correlation of duration of caregiving during ICU stay with both psychological variables (i.e., quality of life and depression) did not reach statistical significance (see Table 3).

Table 3.

Correlation between years of caregiving and psychological parameters.

Parameter	Years of caregiving
Parameter	Duration since onset	Stay at ICU
WHOQOL-BREF	−.189*	−.024
CES-D	.187**	−.110

ICU: intensive care unit; WHOQOL-BREF: World Health Organization’s Quality of Life Scale abbreviated version; CES-D: Center for Epidemiologic Studies Depression Scale.

Duration since onset and stay at ICU were measured in months and days, respectively.

p < .05; **p <.01.

Music use and its benefits

In terms of how family caregivers of ICU patients regularly experienced three types of music activity (i.e., music listening, singing, and instrument playing) in their everyday lives over the past 6 months, 89.2% of the respondents reported listening to music, 63.1% reported singing, and 15.4% reported playing an instrument. The percentage of respondents who used to engage in music activities but stopped participating after their family member became sick was 27.2% for music listening, 25.6% for attending live music performances, 14.4% for singing in a group (e.g., a choir), 7.8% for receiving music-related training (e.g., a private lesson), and 7.2% for playing an instrument in a group (e.g., an orchestra or a band). Meanwhile, the percentage of respondents who began to engage in music activities after their family member became sick was 4.1% for music listening, 2.1% for singing in a group, 2.1% for receiving music training, 1.0% for attending live music performances, and 0.5% for playing an instrument in a group.

For participants who were currently engaging in music activities, they were asked how frequently they participated in these activities. The results are displayed in Table 4. More than half of the respondents reported that they listened to music more than 4 hr per week. Among the respondents who were currently engaging in singing or instrument playing, more than 50% reported that they engaged in singing for less than or equal to 1 hr and over a third of the subgroup engaged in instrument playing for no more than an hour a week.

Table 4.

Music use and perceived benefits of music.

Variable	n (%)
Frequency of music listening, per week (n = 174)
⩽1 hr	35 (20.1)
2–3 hr	45 (25.9)
4–6 hr	47 (27.0)
⩾7 hr	47 (27.0)
Frequency of singing, per week (n = 123)
⩽1 hr	65 (52.8)
2–3 hr	33 (26.8)
4–6 hr	16 (13.0)
⩾7 hr	9 (7.3)
Frequency of instrument playing, per week (n = 30)
⩽1 hr	11 (36.7)
2–3 hr	13 (43.3)
4–6 hr	4 (13.3)
⩾7 hr	2 (6.7)
Perceived benefit of music
Yes:No	172 (88.2):23 (11.8)
Domain in which music is beneficial (n = 172)
Physical	16 (9.3)
Emotional	135 (78.5)
Cognitive	6 (3.5)
Social	8 (4.6)
Environmental	7 (4.1)

When asked whether music use would be beneficial to their health, 88.2% of the respondents reported yes (see Table 4). In terms of the specific area in which music would be reported to have a beneficial impact, the most frequent response (78.5%) was emotions, followed by physical health (9.3%), social benefits (4.7%), and environment (4.1%). The least frequent response was that music would be beneficial to cognitive health (3.5%).

Furthermore, it was investigated whether music experiences were a predictor of self-reported quality of life and level of depression in caregivers of ICU patients. Table 5 showed the measured quality of life and level of depression of the participants depending on whether or not they engaged in one of the three music experiences.

Table 5.

Quality of life and level of depression depending on music experiences.

Parameter	Listening		Singing		Playing an instrument
Parameter	Yes(n = 174)	No(n = 21)	Yes(n = 123)	No(n = 72)	Yes(n = 30)	No(n = 165)
WHOQOL-BREF	87.6 (14.7)	92.4 (17.5)	89.9 (15.0)	85.1 (14.9)	90.7 (11.9)	87.7 (15.6)
CES-D	16.9 (10.5)	14.8 (11.7)	15.7 (10.4)	18.4 (10.9)	15.4 (9.5)	16.9 (10.8)

WHOQOL-BREF: World Health Organization’s Quality of Life Scale abbreviated version; CES-D: Center for Epidemiologic Studies Depression Scale.

Data presented as M (SD).

Among three common types of music experiences (i.e., music listening, singing, and instrument playing), 89.2% of the respondents reported having listening experience over the past 6 months, but only 15.4% of the respondents had instrument playing experience during the same time period. Therefore, a linear regression analysis was conducted only with singing experience as the factor. The results of the linear regression analysis revealed that when the effects of sex and age were controlled for, the quality of life value increased by 4.6 for caregivers with singing experience (p = .038). The R² value indicated that singing experience explained 6.7% of the variability in quality of life. The regression model predicted a statistically significant outcome variable, F(3, 194) = 4.565, p = .004. In terms of level of depression, the results revealed that when the effects of sex and age were controlled for, level of depression decreased by 2.8 for caregivers with singing experience (p = .074). The R² value indicated that singing experience explained 3.8% of the variability in depression. The regression model predicted a marginally significant outcome variable, F(3, 194) = 2.514, p = .060. In sum, caregivers who reported singing experiences exhibited a higher level of quality of life and a lower level of depression than those who did not have singing experiences (see Figure 1).

Figure 1.

Quality of life and level of depression depending on singing experience. The white box represents the data of the respondents who reported currently engaging in singing, while the gray box was for the respondents who did not. The middle line marks the median of the data.

For each group (spouse or child), linear regression was conducted to determine whether music experience was a predictor of quality of life or level of depression. In terms of quality of life in the spouse group, the results demonstrated that when the effects of sex and age were controlled for, quality of life increased by 1.6 for those with singing experience versus those without singing experience (p = .584). The R² value indicated that singing experience explained 1.0% of the variability in depression. The regression equation was not found at the p value of .05, F(3, 86) = 0.270, p = .847. In the child group, quality of life significantly increased by 6.9 with singing experience, compared to those without singing experience. The R² value indicated that singing experience explained 5.2% of the variability in depression. The regression equation was not found at the p value of .05, F(3, 99) = 1.740, p = .164.

For level of depression in the spouse group, when the effects of sex and age were controlled for, level of depression decreased by 4.8 with singing experience, compared to those without singing experience (p = .071). The R² value indicated that singing experience explained 4.9% of the variability in depression. The regression equation was not found at the p value of .05, F(3, 86) = 1.424, p = .242. In the child group, the level of depression decreased by 0.8 with singing experience, compared with those without singing experience. The R² value indicated that singing experience explained 1.0% of the variability in depression. The regression equation was not found at the p value of .05, F(3, 99) = 0.335, p = .800. In sum, the child group with singing experience showed greater depression than their respective counterparts without singing experience (see Figure 2).

Figure 2.

Quality of life and level of depression depending on singing experience.

Discussion

This study investigated level of the psychological health of family caregivers of critically ill patients. Also, this study investigated whether caregivers’ level of psychological health related to their relationship to a patient, length of caregiving, or music use. The results demonstrated that nearly 20% of the caregivers rated their quality of life as poor or very poor, and this rating was lowest in the environmental domain. This indicates that these family caregivers of patients in the ICU perceived their environment as unsafe and unsatisfactory and reported having limited resources to meet their needs. In addition, almost half of the sample had CES-D scores above the cutoff for clinical depression. This supports a previous study (van Beusekom et al., 2016) that demonstrated repeated documentations on extensive psychosocial burden in caregivers of ICU patients with high prevalence of depression and anxiety during ICU admission. It indicates the importance of considering psychosocial health of family caregivers as part of the overall treatment of critically ill patients.

Comparisons between the spouse and child groups demonstrated that the spouse group showed a significantly lower level of perceived quality of life and higher level of depression. This supports previous studies showing that spouses exhibit a higher rate of anxiety and depression (Pochard et al., 2001). This also aligns with the research documenting that spouses perceived greater psychosocial burden than adult child caregivers (Juntunen et al., 2018; Oldenkamp et al., 2016). Such research indicated that spousal caregivers were more likely to live together with patients, which led to the tendency that illness of a patient interferes with their lifestyle more directly and they feel more responsible for caregiving and the patient’s recovery. Meanwhile, there were no significant differences between spouse and child groups in terms of their rated emotional states, which may indicate that the psychosocial issues of caregivers were more related to persistent mood rather than immediate and strong emotional reactions. These results emphasized that consideration of relationship to a patient and identification of specified psychological needs due to the relationship is critical when designing interventions for caregivers.

This study also found that perceived quality of life and level of depression were negatively correlated with years of caregiving since the onset of illness and not correlated with the duration of stay at ICU. This might be attributed to a lack of variability in the number of days participants had been at the ICU, ranging from 1 to 10 days with an average of 2.2 days (SD = 1.1). Although there were no significant differences across the participants in terms of days of mechanical ventilation and index for illness severity evaluated during ICU admission, this study did not control variable factors that may influence the psychosocial health of caregivers of ICU patients, including primary diagnosis of patients, caregivers’ situation, and accessibility to resources for their health (Choi et al., 2016). In addition, this study did not consider the impact of past experiences in an ICU, which has been reported as influencing the psychosocial needs of people involved in medical treatment (Mitchell et al., 2009). Future studies could investigate whether other possible variables affect the psychological health of caregivers of critically ill patients.

In terms of music use over the past 6 months, most participants had experienced music listening, followed by singing and instrument playing. Despite music listening being the most common music activity among the participants, more than 25% of the respondents reported that they discontinued this activity after the onset of their family member’s illness. This result aligns with previous findings about caregivers of critically ill patients undervaluing their own psychosocial health and prioritizing the needs of their family members. Indeed, family caregivers report their greatest need involves enhancing their ability to care for their sick family member. Repeated documentation highlights the physical and psychological strain family caregivers endure (Matt, Schwarzkopf, Reinhart, König, & Hartog, 2017; McPeake et al., 2016; Pochard et al., 2001). Meanwhile, most of the respondents perceived that music would be beneficial to their health, particularly emotional health, which supports the use of music in addressing caregivers’ psychological issues and highlights the needs for music-related programs for this population.

The results of regression analysis demonstrated that singing experience as an active form of engagement in music can be an influencing factor for quality of life and depression. The ICU caregivers who experienced singing in the past 6 months tended to report significantly increased quality of life and decreased depression, supporting the usefulness of singing when intervening in the psychological health of caregivers of ICU patients. This result supports that active engagement in music, such as singing, could attenuate stress and other emotional issues of this population (Sumathy et al., 2016). Also, it aligns with the previous studies demonstrating that emotional expression as a coping strategy (e.g., reframing thoughts and exploring identity) can be effectively facilitated by active engagement in music and lead to decreased emotional distress (Baker, 2017; McDermott et al., 2018). For example, singing has been found to help caregivers with physical and emotional regulation due to the experience of controlling their body to produce sounds and expressing themselves and their emotions (Chong, 2010; Hammer, Emami, Götell, & Engström, 2011). Lyrics of songs can also help the involved individuals (e.g., caregivers) relate to singing experiences by finding more specified meaning from the song, while musical elements of the song reflect their emotional states (Jung & Na, 2019). Given these benefits, the incorporation of singing as active utilization of music as a resource for psychosocial health into individualized use or therapeutic interventions for family caregivers should be further investigated.

However, the results of this study should be interpreted with caution. This was based on a small sample size of participants who self-reported music experience over the past 6 months and not the direct effects of each type of music experience. Therefore, the findings from this study need to be confirmed with other music activities as mediating factors. Such attempts would be able to show whether increased quality of life and decreased level of depression resulted from singing specifically or from music engagement more generally.

It is interesting to note that the child group with singing experience showed greater increases in quality of life than those without singing experience, when comparing the degree of increase between the spouse group with singing versus without singing experience. Also, the spouse group with singing experience showed greater decreases in level of depression, compared to the degree of decrease in the child group with singing experience. Although these results did not reach statistical significance, these findings may have been due to the fact that spouses of critically ill patients are more vulnerable to depression than are the adult children of critically ill patients. Moreover, this tendency implies that the focus of a music intervention for family caregivers depends on the caregiver’s relationship to the patient.

The results of this study support the potential of active engagement in music as resource for caregivers of ICU patients to alleviate their emotional distress and help them cope with their challenges. The findings related to singing in everyday life suggest that a diverse form of music use can be implemented depending on the needs of caregivers. Additional investigation is needed into developing singing-based therapeutic interventions and effective means of promoting and facilitating caregivers’ music use.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a grant from the National Research Foundation of Korea (2016R1A2B1012708).

ORCID iD

Ga Eul Yoo

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