More than 850 million people globally suffer from some form of kidney disease (ISN, 2020) and statistics indicate that 1.2 million people have died from chronic kidney disease in 2017 (Bikbov et al., 2020). Although kidney disease is largely preventable and treatable there are many factors that affect the process. To name a few; insufficient treatment such as dialysis and transplants, lack of financial resources such as high cost for treatments and living expenses due to the impact of the disease, and financial burden to the healthcare system such as the annual cost per patient for hemodialysis. Furthermore, findings demonstrate that kidney disease is prevalent in countries with low to middle socio-demographic index compared to countries with a high socio-demographic index due to the limited financial resources and health care facilities.

In relation to psychological health and wellbeing, kidney patients experience reduced quality of life due to depressive symptoms, complications that arise from their treatments such as repetitive infections, pain, weakness, fatigue, anaemia and oedema. Patients with chronic kidney disease are at a higher risk of developing depression due to the psychosocial and biological changes that happen due to treatment such as dialysis. Furthermore, their physical and psycho-emotional states are impacted due to not being able to maintain a job, difficulties in engaging in day-to-day physical activities, and lack of support to carry on with their everyday lives. Kidney patients are three to four times more likely to develop depression than the general population and two to three times more likely to develop depression than patients with other chronic diseases (Shirazian et al., 2017). Furthermore, there is a high risk of suicide ideation among chronic kidney disease and hemodialysis patients (Liu et al., 2017).

As a Musician and Psychologist, I have always been interested in the role of music in everyday life, whether music is pursued as a leisure activity, through study or as a profession, can contribute to our health and wellbeing. Music plays a key role in people’s everyday life. Music is used to facilitate health and wellbeing through listening to music, singing, playing an instrument, community music, and in the context of clinical interventions. Engaging in music has positive effects on emotional and social wellbeing, provides therapeutic benefits and enhances creative development. There is a growing rate of mental health issues, especially with the advancement of technology, and fewer social activities. Music is a great way of coping with these issues and bringing people together. We need to reflect on how we could use music in our lives effectively to contribute to our wellbeing.

Music therapy has been used as a psychosocial intervention in many clinical settings. Madson et al. (2010) used music therapy to reduce anxiety, pain, nausea and increase relaxation in solid organ transplant patients. Cantekin and Tan (2013) used music therapy as an independent nursing intervention to reduce anxiety and stress in hemodialysis patients where patients received music therapy sessions three times a week during dialysis treatment. Another study by Hagemann et al. (2018) found that kidney patients showed a reduction in depressive symptoms and increased quality of life after receiving regular music therapy sessions. Considering that music therapy sessions require a trained music therapist and that it could incur further costs to the health care system, it is worthwhile thinking how kidney patients could incorporate music in their day-to-day lives to benefit from the positive effects of music. Listening to music, group singing and playing/learning a musical instrument would be some activities to consider with minimal costs:

Listening to music
Listening to music is a common and highly valued leisure activity and as technology advances, the ways in which people interact with music are changing, and it is possible to listen to music on the radio, via a CD player, via a computer and on personal music listening devices, for example. Today it is common for people to listen to music while engaging in other activities such as exercising, studying, travelling and doing chores. The benefits of listening to music, not only in everyday settings but also in medical contexts such as critical care units, surgical units, dental surgeries and in mental health care situations, to control anxiety and pain and to promote relaxation is increasing. Listening to music frequently has the potential to increase positive emotions such as relaxation, enjoyment, mood regulation, reminiscence with past memories, and reduce negative effect such as lower the levels of stress and reduce loneliness. According to Lamont et al. (2016) people listen to music to distract, to feel energised, to entertain and to enhance the meaning they attribute to their lives.

Group singing
Group singing such as choral singing or community group singing creates opportunities to meet new people providing social support, a sense of regular commitment, focussed attention, positive emotions, improved breathing and posture and to feel spiritually uplifted. Singing can help to cope with issues affecting psychological wellbeing such as enduring mental health problems, family and relationship problems, physical health issues and disability, and recent bereavement. Singing has beneficial effects such as improving mood and reducing stress and anxiety. Being part of a group generates higher levels of wellbeing and group singing influences bonding more quickly than other activities such as art or creative writing.

Making music
Active participation in music making promotes health and wellbeing. Music can be an important feature in people’s identity, a form of socialisation, and to enhance feelings of wellbeing and competence. Maintaining social relationships, having a sense of personal wellbeing and a sense of accomplishment and taking part in inspiring recreational activities can help enhance quality of life. Coffman (2002) conducted a review of the literature on adult music participation and suggests three types of motivation for continuous engagement in music making throughout adulthood: 1) personal motivation, including using music as an outlet for creativity and leisure; 2) musical motivation, such as a love of music and performing; 3) social motivation, centred around seeking companionship and belonging to a group. Music learning, whether starting at a young age or in adulthood can bring many benefits for health and wellbeing, as there are numerous transferable skills, for example, to feel a sense of accomplishment, to fulfil their childhood dreams/goals/aspirations, to create a sense of purpose, to cope with day-to-day life stresses. With children, though the initial motivation might not always come from within them, they will surely realise the benefits at a later date.

Leisure and wellbeing
Research in the field of leisure studies shows that leisure activities can play a key role in facilitating wellbeing. In our present-day industrialised society, mobile phones and laptop computers enable employees to work from home and employers to communicate with them at any time. As a result, people tend to spend more time doing work-related activities during their leisure time at home and on holiday, and less time engaging in leisure activities. Lack of leisure time can have negative outcomes for wellbeing such as poor mental health and impaired social functioning. Engaging in creative activities, regardless of whether they involve music, art or crafts, can make a positive contribution to subjective wellbeing. Music has been considered a popular leisure activity across time and cultures.

Patients with kidney disease undergo extensive treatment and they may spend a lot of their time travelling to and waiting in hospitals for treatment and resting at home due to not being able to continue working and engaging in physical activities. I would encourage them to use music in the capacity they are able to, whether it is listening to music while they are travelling, waiting in hospitals or resting at home; joining a community music group to regularly meet and either sing or play an instrument; or even taking up learning a musical instrument at a pace that they are comfortable with either via online or in person lessons. As outlined in this article, the beneficial effects of engaging in music to psychological health and wellbeing is immense and with the advancement in technology music can be easily accessed in many forms. Research in music, health and wellbeing demonstrates that music has the potential to reduce depressive symptoms, anxiety, stress and help to cope with pain and enhance quality of life. These factors are highly prevalent to kidney patients and can be prevented and treated at early stages. It is therefore valuable for kidney patients to engage in music in the forms suggested above to experience the benefits of music to their health and wellbeing. 

References

• Amy T. Madson, MA, MT-BC, Michael J. Silverman, PhD, MT-BC, The Effect of Music Therapy on Relaxation, Anxiety, Pain Perception, and Nausea in Adult Solid Organ Transplant Patients, Journal of Music Therapy, Volume 47, Issue 3, Fall 2010, Pages 220–232.
• Bikbov, B., Purcell, C. A., Levey, A. S., Smith, M., Abdoli, A., Abebe, M., … & Owolabi, M. O. (2020). Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The lancet, 395(10225), 709-733.
• Chao-Han Liu, Ming-Kung Yeh, Shu-Chuan Weng, Meng-Yi Bai, Jung-Chen Chang, Suicide and chronic kidney disease: a case-control study, Nephrology Dialysis Transplantation, Volume 32, Issue 9, September 2017, Pages 1524–1529.
• Coffman, D. D. (2002). Adult education. In R. Colwell and C. Richardson (eds.), The new handbook of research on music teaching and learning (pp. 199–209). Oxford University Press.
• Hagemann, P. D. M. S., Martin, L. C., & Neme, C. M. B. (2018). The effect of music therapy on hemodialysis patients’ quality of life and depression symptoms. Brazilian Journal of Nephrology, 41, 74-82.
• International Society of Nephrology (2020)
• Işin Cantekin & Mehtap Tan (2013) The Influence of Music Therapy on Perceived Stressors and Anxiety Levels of Hemodialysis Patients, Renal Failure, 35:1, 105-109, DOI: 10.3109/0886022X.2012.736294
• Lamont, A., Greasley, A., & Sloboda, J. (2016). Choosing to hear music: Motivation, process, and effect. In S. Hallam, I. Cross, & M. Thaut (eds.), The Oxford Handbook of Music Psychology (pp. 711–724). Oxford University Press
• Shirazian, S., Aina, O., Park, Y., Chowdhury, N., Leger, K., Hou, L., … & Mathur, V. S. (2017). Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges. International journal of nephrology and renovascular disease, 10, 11. 10.2147/IJNRD.S108045

Biography:

Dr Nellinne Ranaweera is a Teaching Fellow in Psychology at University of Leicester and King’s College London. Nellinne is a Chartered Psychologist, a member of the British Psychological Society (BPS) in the division of Academics, Researchers and Teachers in Psychology, and an Associate Fellow of the Higher Education Academy. She is also a member of the Early Career Researchers’ Working Group in Equality, Diversity and Inclusion in Music Studies (EDIMS) which is a cross-organisational network that aims to promote, support and share good practice in relation to EDI in Music Higher Education in the UK.

Nellinne is also a music educator based in Stoke-on-Trent, teaches piano in the conventional and Suzuki methods, as well as music theory. She is a member of the Incorporated Society of Musicians (ISM), the European Suzuki Association (ESA) and British Suzuki Music Association (BSMA). She was awarded her PhD in Applied Psychology without amendments for the thesis entitled ‘The role of leisure activities in the wellbeing of musicians’ at Manchester Metropolitan University in collaboration with the Royal Northern College of Music, Manchester.