Abstract

Background

University students often face mental health challenges, exacerbated by stigmas that hinder seeking support and treatment. We introduce a participatory arts programme, Movin鈥� and Groovin鈥� for Wellness (MGW), that features facilitated drumming and dancing sessions. This study aimed to investigate the impact of the MGW programme on students鈥� mental health, social connections, and creativity.

Methods

A 10-week pilot parallel Randomised Controlled Trial (RCT) was conducted with 76 participants randomly assigned into an Experimental (MGW) group (N= 38) or a Control group (N= 38). Data were collected at baseline, midway, and post-intervention. Mental health was evaluated using the Depression, Anxiety, and Stress Scale- 21 (DASS-21), and quality of life via the WHO Quality of Life-BREF (WHOQOL-BREF) scale. The Brief Resilient Coping Scale, Lubben Social Networking scale, Experience of Creation scale, and Brief Music in Mood Regulation scale (B-MMR) were also administered. Qualitative feedback was gathered through a bespoke survey and focus group discussion (FGD), focusing on participants鈥� subjective experiences of the programme, mood/emotion states, social connections, and creative expression.

Results

The MGW programme led to significant improvements in mental health, quality of life, and creativity, while the Control group experienced significant declines in mental health and quality of life over the same 10-week period (coinciding with term time). The Experimental group showed significant reductions in Stress scores (DASS-21) at Week 10, whereas the Control group had significantly worse anxiety, depression, and stress at Week 5, with stress scores remaining elevated at Week 10. Improvements in the Experimental group were also observed in the Psychological (at Week 5) and Physical (at Week 10) domains of the WHOQOL-BREF. In comparison, the Control group showed a significant decrease in WHOQOL-BREF Physical scores at Week 10. The Experimental group also showed enhanced creativity (Experience of Creation scale) at Week 5 and Week 10, although no significant changes were observed in the social networking or resilient coping scales. Qualitative findings highlighted the programme鈥檚 positive impacts on participants鈥� mental health, social connections, and creativity.

Conclusions

The MGW programme effectively improved mental health, quality of life, social connection and creative expression among university students. These findings suggest that arts-based interventions such as MGW can support student health and well-being in a stigma-free and culturally appropriate manner.

Trial registration

The trial was retrospectively registered at ClinicalTrials.gov under ID: NCT06542003 (08 August 2024).

Introduction

The world is struggling with a mental health crisis. According to the WHO, in the first year of the COVID- 19 pandemic alone, the global prevalence of anxiety and depression increased by a staggering 25%.¹ In addition to limitations regarding the ability to work and receive support from loved ones, WHO suggests that another primary explanation for this massive surge in mental health issues is due to social isolation and loneliness. Meanwhile, Southeast Asia has not been immune to this rise in mental health conditions [1], and students have been identified as an at-risk population. Even before the pandemic, the highest incidence of mental illness in Singapore was found in the population between the ages of 18 and 24 years old [2].

Indeed, universities around the world have been rolling out new mental health initiatives to address the rising levels of stress and anxiety among students. While these efforts aim to increase access to mental health resources and encourage help-seeking behaviors, students are often reluctant to seek help due to the stigma associated with mental health issues [3,4,5]. This reluctance mirrors a broader trend observed in the current study鈥檚 location, where an alarming 78.6% of adults aged 18 and older were found to refrain from seeking treatment for at least 12 months despite being diagnosed with a mental illness [6]. This is where creative arts-based programmes to support mental health can play a crucial role: an important facet of music and dance-based interventions is that there is no mental health stigma attached to participating in such programmes [7].

The recent pandemic solidified the crucial role of the arts and music in helping individuals and communities reconnect and regain a sense of wellness. Even during the first waves of the pandemic, quarantined Italians leaned out of their windows to bellow out tunes together, which served to decrease their sense of loneliness, increase social cohesion, and improve mental well-being [8]. Now that concerts and arts events are again in full swing, creative-arts initiatives can be leveraged to promote mental wellness and social connection.

Research studies in health and epidemiology have shown that participating in arts and cultural activities enhances mental health, well-being, immune response, and a variety of other health outcomes [9,10,11]. Music specifically is an extremely effective medium for supporting mental, emotional, and social wellness. Participating in music-based activities, and even passive listening to carefully selected music, has been shown to be effective for reducing stress, anxiety and depression, and elevating mood states [12, 13]. Work examining creative arts therapies has identified several mechanisms that support the therapeutic effects of these interventions, including embodiment, active engagement, creativity, group processes (e.g., group cohesion), emotion processing, and more [14]. These mechanisms highlight the value of creative arts interventions to improve health and well-being.

Drumming programmes in particular, such as the 10-week group drumming intervention by Fancourt et al. [15], have been found to decrease anxiety and depression, and shift participants from 鈥渁 pro-inflammatory towards an anti-inflammatory immune profile鈥�, thereby demonstrating both the psychological and biological benefits of group drumming on health [15]. Dancing has also been found to improve participants鈥� mental health by increasing positive mood states and self-esteem, and decreasing negative emotions and depression [16, 17].

Music, dance, and other cultural activities have also been found to increase social cohesion. For example, music-based treatments and programmes (such as group drumming) for mental health promote new social connections between participants [15, 18, 19], and support individuals鈥� sense of identity, confidence, and emotional resilience [20, 21]. Participating in a group dance class has been found to facilitate social and community connectedness among participants [17]. In addition, arts, music, and dancing activities are very effective for helping individuals communicate both within and across groups [22], which helps contribute to a sense of social connection and cohesion.

Furthermore, improvisation, which can be defined as the spontaneous creation of music or movement, has been found to have 鈥渟pecific benefits for particular populations including the amelioration of neurological damage, improvements in mental health conditions, reductions in stress and anxiety, and improved communication and joint attention behaviours鈥� in children on the autism spectrum [23]. That is, improvisation has widespread benefits for health. Dance improvisation encourages self-discovery and creativity, and has been described as a powerful tool for helping individuals alter their mental and bodily states to achieve novel forms of emotional expression [24], and to release suppressed emotions and inner thoughts [25]. Dance programmes involving movement improvisation (e.g., inventing creative movements with no pre-defined choreography) have been shown to foster creative expression in STEM students [26].

The above evidence supporting the efficacy of music interventions (and specifically, group drumming), dance/movement programmes, and improvisation to improve mental health and social connection warrants a programme that combines all three of these artistic elements into one creative intervention for students. To our knowledge, no such programme has been evaluated in the literature, and the anticipated benefits of such a programme are plentiful. We therefore offer the Movin鈥� & Groovin鈥� for Wellness (MGW) initiative as an innovative music-dance-improvisation programme. This iteration of the programme aims to bring translational research into the university student community, helping students navigate their emotional wellness and improve quality of life, facilitate new social connections and a sense of community, and stimulate creative expression.

The aim of the study is to test the programme鈥檚 efficacy in improving mental health, social connection, and creative expression in a Randomised Controlled Trial with university students.

Method

Trial design

A two-armed randomised parallel group design was employed to test the aims and outcome measures. Participants were randomised (1:1) into either an Experimental (MGW) group or Control (Life as Usual) group. Due to logistical reasons and room capacity, half of the students participated in group drumming for the first five weeks (鈥楪roup A鈥�), and the other half engaged in group dancing for the same period (鈥楪roup B鈥�). During the second five weeks, Group A participated in dancing activities and Group B participated in drumming activities. All activities took place at the Yong Siew Toh Conservatory of Music, at the National University of Singapore (NUS). The Control group did not participate in any music or dance activities.

Randomisation (1:1) was conducted by the Principal Investigator (PI) after participants provided informed consent to join the study. Participant numbers were first listed sequentially. A random number generator in Excel was then used to assign a random number to each participant. The list was sorted in ascending order based on the generated random numbers. The first half of participants in the sorted list were allocated to the Experimental group, and the second half were allocated to the Control group. Group allocation was communicated by the PI to participants during the information session following consent. Note that this study does not involve a blinding process due to the nature of the study (a participatory arts intervention). Both participants and researchers were aware of the group allocations.

Data collection preceded session activities on Week 1, and followed the Week 5 and Week 10 activities. Both groups completed the same questionnaires at the same time points. We also invited MGW participants to take part in a Focus Group Discussion (FGD), which was conducted within 10 days of the culmination of the programme. Students in the Control group did not participate in a FGD. Including a Control group allowed the research team to assess the benefits of the programme compared to 鈥渘ormal student life鈥�.

This study received Institutional Review Board (IRB) ethics approval under the National University of Singapore Institutional Review Board. This study adhered to CONSORT guidelines.

Recruitment

Recruitment was conducted in August and September, 2023. E-posters were sent out through social media, a participant recruitment website from the university was utilized, and physical flyers were distributed to advertise the study. Interested participants signed up for information sessions held by the PI, in which details of the study were explained and consent was obtained.

Participants

The study setting was the Yong Siew Toh Conservatory of Music (YSTCM) at the National University of Singapore (NUS), Singapore. All participants in this study were students from NUS, and they attended an information session where details of the study were provided and consent was obtained. The eligibility criteria for participating in the study are as follows.

The inclusion criteria for the study were to: (1) be currently enrolled in NUS, (2) be between the ages of 18鈥�40 years old, (3) be fluent (speaking and writing) in English, (4) be able to commit to attending the in-person sessions for the entire 10-week period, and (5) have normal or corrected-to-normal hearing and vision. Those who had been diagnosed with neurological or hearing impairment or a physical impairment that would prevent moving/dancing, or who were taking medicine to treat their mental health, were excluded from the study.

Sample size estimation is not typically required for pilot studies [27], and was not conducted prior to this intervention. We aimed for as large a sample size as we could accommodate based on the facilitated MGW activities and dedicated MGW venues.

Seventy-six participants were recruited and randomly allocated into two groups: Experimental (N= 38) and Control (N= 38). The Experimental group was further divided into two subgroups, with one drop-out occurring before the study began, resulting in 19 participants in Experimental group A, and 18 participants in Experimental group B. The remaining seventy-five participants ($63 = females$, $12 = males$; mean age = 22.6 years, $SD = 2.8$) proceeded with the study.

Intervention

In this 10-week evidence-based participatory arts programme, called Movin鈥� & Groovin鈥� for Wellness (MGW), we offered a music, dance, and improvisation-based approach to support students鈥� mental, social, and emotional health that has no stigma attached. MGW sessions took place weekly over a 10-week period (coinciding with term) in dedicated performance rooms, and each session was 1.5 hours in duration, with the exception of data collection weeks (e.g., Week 1, Week 5, and Week 10), which were 2 hours long. Students from different faculties around campus were invited to participate in facilitated music and dance sessions with trained professionals, and encouraged to cultivate their creative expression using these two artistic mediums. Its empirical evaluation will not only assess the initiative鈥檚 impact, but will inform best-practice in creative arts-based programmes for wellness, and aims to inspire new evidence-based programmes for students in the future.

Aims for the 10-week Movin鈥� & Groovin鈥� for Wellness (MGW) programme included:

• 1. Supporting mental and emotional health in NUS students by decreasing stress, anxiety, and depression; improving emotion states; and positively impacting quality of life.

• 2. Providing a dedicated space for creative expression, empowering students to interact in artistic ways (through music and dance), and stimulating creativity and non-verbal communication.

• 3. Facilitating social connection between students from different faculties to tackle loneliness and promote an increased sense of social wellness.

The Experimental group received the 10-week MGW intervention described above, while the Control participants were offered their own dedicated MGW session following the 10-week study period, as well as an open invitation to join future individual MGW sessions. All study participants, including those in the Control group, were also provided with a list of mental health resources.

Outcome measures: mental health, social connection, and creativity

To evaluate the efficacy of the programme, our research employed a mixed-methods design, utilizing both quantitative scales and bespoke surveys, as well as a Focus Group Discussion.

The following quantitative measures were included in this research:

• 1. Depression, Anxiety and Stress Scale (DASS-21) [28]: To assess mental health, across 3 subscales: Depression, Anxiety, and Stress (7 items each). Scores are summed for each subscale and multiplied by 2, with higher scores indicating worse mental health.

• 2. The WHO Quality of Life scale (WHOQOL-BREF) [29] : A validated scale to assess quality of life across four domains: Physical (7 items), Psychological (6 items), Social (3 items), and Environment (8 items). Scores are mean-centered and multiplied by 4, with higher scores indicating better well-being. Additionally, two standalone items assess overall quality of Life and general Health.

• 3. The Brief Resilient Coping Scale [30]: To assess resilience (4 items), with a summed score ranging from 4鈥�20. Higher scores reflect greater resilience.

• 4. The Experience of Creation Scale [31]: To assess the impact of creative experiences (4 items), with a summed score where higher scores indicate greater creative expression.

• 5. Short form Lubben Social Networking Scale [32]: To quantify social networks and connections via two subscales: Family (3 items) and Friends (3 items). Higher summed scores indicate greater social connectedness.

• 6. The Brief Music in Mood Regulation Scale (B-MMR) [33]: To assess the use of music for mood and emotion regulation across seven subscales: Entertainment, Revival, Strong Sensation, Diversion, Discharge, Mental Work, and Solace (3 items each). Higher scores reflect more frequent use of each regulation strategy.

All scales have demonstrated good validity and reliability, with reported Cronbach鈥檚 alpha values generally ranging from 0.70 to 0.90 [30, 32,33,34,35], with the exception of the Experience of Creation Scale for which this information is not available.

Our primary outcomes are mental health and quality of life. Among the scales, DASS-21 and WHOQOL-BREF were used to assess the primary outcomes, with further information about the impact of the intervention provided by bespoke surveys and FDG (discussed below); the other scales were used to assess the secondary outcomes, including social connection, creativity, resilience, and use of music for mood regulation. These quantitative scales were administered at baseline, Week 5, and Week 10.

In addition to the quantitative measures listed above, we also employed a bespoke survey at Week 5 and Week 10 asking about students鈥� experiences of the programme. Questions were asked to assess the participants鈥� overall feelings about the sessions. They were asked about the sessions鈥� impact on their mood and how the different sessions influenced their emotional and social states, including feelings of social connectivity, engagement, judgment, openness to new experiences, and positive attitudes. Questions also explored the social benefits of the sessions, such as increased social connectivity and new friendships. Learning outcomes were assessed, asking if participants learned new dancing or drumming techniques and had opportunities for creative self-expression. Emotional awareness was another focus, with questions on whether the sessions helped participants feel more in touch with their emotions and understand the use of creative activities to express feelings. Most questions in the bespoke survey used an ordinal rating scale. Examples of response options include, 鈥淭he sessions significantly improved my mood鈥�, and 鈥淭he sessions significantly worsened my mood鈥�.

Then, to better capture the programme鈥檚 impact through lived experience, a voluntary Focus Group Discussion was conducted after the culmination of the programme.

The WHOQOL-BREF scale, Brief Resilient Coping Scale [30], and DASS-21 scale [28] were used to assess the extent to which our programme achieves Aim 1, e.g., to support NUS students鈥� mental and emotional health and quality of life. Qualitative data from the bespoke survey and FGD were also collected to obtain a holistic account of the impacts of the programme on students mental and emotional well-being.

The bespoke surveys, Experience of Creation Scale [31], and FGD are used to evaluate Aim 2, that is, the extent to which students feel stimulated and empowered to be creative and artistically expressive.

The Lubben Social Networking Scale [32], bespoke surveys, and the FGD are used to evaluate Aim 3, the extent to which the MGW programme helped to promote new social interactions, a sense of social connection, and decrease social isolation and loneliness in this student sample, as compared to the Control group.

In addition, the Brief Music in Mood Regulation Scale (B-MMR) [33] is used to examine whether the participants鈥� use of music to regulate their moods changed due to participating the programme. For example, students who tend to use music (as identified via the B-MMR) to gain energy and uplift themselves (Revival), to distract themselves from unwanted thoughts or feelings (Diversion), or to seek strong emotional experiences (Strong Sensation) from music may find the programme to be particularly beneficial for their mental health and reduction of stress/anxiety (e.g., there may be greater reductions in DASS-21 measures).

Data analysis

To analyze the data collected from the validated scales, we followed a structured approach, including a quantitative within-group analysis, between-group analysis, and subgroup analysis. All the analyses were done using R Statistical Software (v4.3.2; R Core Team 2023) [36]. Finally, the data analysis plan for the qualitative data gathered from the bespoke survey and FGD is shared below.

Within-group analysis

The within-group analysis was conducted using the Wilcoxon Signed Rank Test for both the Experimental and Control groups. This non-parametric test was employed to evaluate changes within each group over time by comparing baseline measurements with Week 5 and Week 10 measurements for each outcome measure. This approach allowed us to determine whether there were significant changes within each group across the study period.

Between-group analysis

For the between-group analysis, we calculated difference scores to reflect changes over time, and compared differences in these scores between the Experimental and Control groups. Specifically, we computed two sets of difference scores:

• D1: The difference between the baseline and Week 5 measurements.

• D2: The difference between the baseline and Week 10 measurements.

These difference scores were analyzed using the Mann-Whitney U test (also known as the Wilcoxon Rank Sum Test). This non-parametric test was chosen to compare the distribution of difference scores between the Experimental and Control groups, allowing us to determine if there were statistically significant differences in outcomes between the two groups at these time points.

Subgroup analysis

Finally, we further conducted a subgroup analysis within the Experimental group for group A and group B. The Mann-Whitney U test was again used to compare outcomes between these two subgroups. The analysis aimed to identify any significant differences within the Experimental group, providing further insights into the programme鈥檚 effectiveness, and exploring whether the order of activities (e.g., drumming in the first five weeks before dancing in the last five weeks) influenced the outcomes.

Effect sizes calculation and interpretation

For our non-parametric analyses, (i.e., the Wilcoxon Rank Sum and Wilcoxon Signed Rank Tests), we estimated the effect size using the formula:

$$\begin{aligned} r = \frac{Z}{\sqrt{N}} \end{aligned}$$

(1)

where

• $Z$ is the standardized test statistic from the Wilcoxon tests, and

• $N$ is the number of paired observations (for within-group tests) or the total sample size (for between-group comparisons)

This method of reporting effect sizes is commonly used in non-parametric analyses [37, 38]. For within-group comparisons, effect sizes in the Experimental group represent the magnitude of change due to the intervention. However, for the Control group, the effect sizes reflect natural variation or external influences over time (e.g., academic stress over the course of the term) rather than an intervention effect. For between-group comparisons, effect sizes indicate the difference in change between the Experimental and Control groups, which reflects the relative impact of the intervention.

Bespoke survey analysis

For the data collected from the bespoke surveys, R Statistical Software was used to calculate response percentages.

FGD analysis

The focus group discussion (FGD) was conducted over Zoom 10 days after the programme ended. It was facilitated by a member听of the study team, and lasted approximately one hour. All MGW participants were invited, but the session was voluntary (with $5 SGD in reimbursement for their time). In the FGD, the participants were asked about their experience and thoughts about the programme鈥檚 impact on their mental health, social connection and creativity, along with their suggestions for programme development. To ensure the privacy and confidentiality of the participants, the session was recorded and subsequently transcribed in a de-identified format. Following transcription, two members of the study team independently engaged in a detailed review of the data to familiarize themselves with the content. The qualitative data collected from the FGD were analyzed using a thematic analysis approach [39, 40]. Each member then independently generated initial codes from the data, which were iteratively refined and grouped into themes. Then, the two members held one session for discussion and consensus building to establish the final set of themes. Regarding the quotes presented in this article, only filler words (such as 鈥渦m鈥�, 鈥渓ike鈥�, etc.) and repeated words were omitted for clarity and readability. Any words added, or redacted due to privacy, are indicated in square brackets.

Results

Baseline characteristics

The flow chart below (Figure 1) illustrates participants鈥� recruitment and retention throughout the study. All participants across both Experimental and Control groups completed the baseline quantitative assessments before the intervention began. Throughout the study, participant attrition occurred. The primary reasons for dropout were typically related to scheduling conflicts and the time commitment required for participation.

Fig. 1

CONSORT diagram showing participants flow in each group through the study

The baseline characteristics of participants in the MGW programme were analyzed to ensure comparability across the Experimental and Control groups (see Table 1). Fisher鈥檚 exact test was used for gender, Pearson鈥檚 Chi-squared test was used for ethnicity and Wilcoxon rank sum tests were used for the remaining variables. The average age of participants in the Experimental group was 22.3 years ($SD=2.3$ years) and 22.8 years ($SD=3.1$ years) in the Control group. There was no significant difference in age across groups ($U=742$, $p = 0.68$).

Table 1 Descriptive statistics (Mean 卤 SD) for participants in each group at baseline

The gender distribution was similar across the groups, with 18% males and 82% females in the Control group, compared to 14% males and 86% females in the Experimental group (Fisher鈥檚 exact test, $p = 0.562$). There was no significant difference in ethnicity between the Control and Experimental groups ($X^2= 5.2$, $p = 0.07$).

In the B-MMR scale, significant differences were observed in the Strong Sensation subscale ($U=896$, $p < 0.05$) and Diversion subscale ($U=991$, $p < 0.01$), with the Control group showing slightly higher mean scores compared to the Experimental group. Other subscales, including Entertainment, Revival, Discharge, Mental Work, and Solace, did not show significant differences ($p> 0.05$).

No significant differences were found in other scales (see Table 1) at baseline, indicating that participants began the programme with similar mental health and psychosocial states.

Within-group comparisons

Table 2 presents the results of the within-group analyses using Wilcoxon signed rank tests for the Control and Experimental groups at Week 5 and Week 10 compared to baseline. We discuss the results for the Control and Experimental groups below.

Table 2 Within-group analyses using Wilcoxon signed rank tests for the Control and Experimental groups at Week 5 and Week 10 compared to baseline

Control group results

In the control group, significant declines in quality of life and mental health were observed over time. The Physical domain of the WHOQOL-BREF showed a significant decline at Week 10 ($mean = 14.2$, $SD = 2.5$, $U=328.5$, $p < 0.05$) compared to baseline ($mean = 14.8$, $SD = 2.3$), indicating a moderate decline, $r=0.34$. No significant changes were observed at Week 5 ($mean = 14.3$, $SD = 2.1$, $U=384.5$, $p = 0.255$). The Psychological, Social, Environment, Quality of Life, and General Health domains did not show significant changes at both time points ($p> 0.05$).

For the DASS-21, significantly worse Anxiety ($mean = 26.4$, $SD = 9.4$, $U=101$, $p < 0.05$), Depression ($mean = 26.0$, $SD = 9.0$, $U=84$, $p < 0.01$), and Stress ($mean = 29.2$, $SD = 8.4$, $U=110.5$, $p < 0.05$) scores were observed at Week 5 compared to baseline (Anxiety: $mean = 23.2$, $SD = 6.2$; Depression: $mean = 22.6$, $SD = 6.4$; Stress: $mean = 26.2$, $SD = 6.8$). The effect sizes reflect a moderate increase in Anxiety scores ($r=0.38$), a large increase in Depression scores ($r=0.51$), and a moderate increase in Stress scores ($r=0.38$). By Week 10, significantly worse Depression scores were observed ($mean = 25.4$, $SD = 9.2$, $U=90.5$, $p < 0.05$) compared to baseline, with a moderate increase in scores, $r=0.37$. No significant changes were found in Anxiety and Stress ($p> 0.05$). This indicates a significant worsening of mental health during term for Control participants, with Depression shown to be significantly worse at the end of term (at Week 10 of the programme) compared to early in the term.

Experimental group results

In the Experimental group, significant improvements were observed in several measures. The Psychological domain of the WHOQOL-BREF showed significant improvement at Week 5 ($mean = 14.0$, $SD = 2.6$, $U=53.5$, $p < 0.05$) compared to baseline ($mean = 13.3$, $SD = 2.3$), while the Physical domain showed significant improvement at Week 10 ($mean = 15.3$, $SD = 2.5$, $U=55$, $p < 0.05$) compared to baseline ($mean = 14.3$, $SD = 2.2$). The Social, Environment, Quality of Life, and General Health domains did not show significant changes at either time point ($p> 0.05$). Both the Psychological and Physical domains showed moderate effect sizes ($r=0.45$), which suggest improvements in well-being.

For the DASS-21, significant reductions in Stress were observed at Week 10 ($mean = 25.2$, $SD = 7.8$, $U=206$, $p < 0.05$) compared to baseline ($mean = 26.2$, $SD = 7.8$), while no significant changes were observed in Anxiety and Depression at both time points ($p> 0.05$). This result indicates that, unlike the Control group, participants in the MGW group did not show worse mental health during term, and in fact showed improved Stress scores at the end of term compared with early in the term. The reduction in Stress was of moderate magnitude ($r=0.41$) and indicates a significant decrease in participants鈥� stress levels by the end of the study.

The MGW participants also displayed significantly higher Experience of Creation scores at both Week 5 ($mean = 15.2$, $SD = 3.6$, $U=60$, $p < 0.01$) and Week 10 ($mean = 15.4$, $SD = 3.8$, $U=39$, $p < 0.01$) compared to baseline ($mean = 13.1$, $SD = 3.4$), indicating a greater enhancement in creative experiences. Notably, the large effect ($r=0.59$) at Week 5 and $r=0.61$ at Week 10 highlights the impact of the programme on fostering participants鈥� creative expression.

Among the B-MMR subscales, the Strong Sensation subscale showed significant differences at Week 10 ($mean = 12.4$, $SD = 2.8$, $U=37$, $p < 0.05$) compared to baseline ($mean = 11.1$, $SD = 2.9$). The effect size for this increase ($r=0.41$) suggests a moderate increase in participants鈥� engagement with music for emotional experiences. Other subscales showed no significant differences ($p> 0.05$).

Takeaway messages from within-group comparisons

Overall, the within-group analyses indicate that the Control group experienced statistically significant declines in physical health (as measured via the Physical domain of the WHOQOL-BREF scale), and worse mental health (as measured via DASS-21 Anxiety, Depression, and Stress scores), indicating worsening overall well-being. This is likely due to the 10-week programme coinciding with the term period (with the programme running up until exam weeks), as there tend to be rising levels of stress and pressure on mental well-being over the course of the term, which may only subside after the final exam period. In contrast, the Experimental group showed significant improvements in physical and psychological well-being (as indicated from the Physical and Psychological domains of the WHOQOL-BREF), reductions in Stress (as indicated via DASS-21), and enhancements in creativity (as shown from the Experience of Creation scores).

Between-group comparisons

Table 3 presents the results of the between-group analyses using Wilcoxon rank sum tests to compare differences between the Control and Experimental groups at Week 5 and Week 10, relative to baseline.

Table 3 Between-group analyses using Wilcoxon Rank Sum tests to compare differences between the Control and Experimental groups at Week 5 and Week 10, relative to baseline, Mean 卤 SD

Comparison of baseline to Week 5

At Week 5, significant differences were observed between the Control and Experimental groups in the Psychological domain of the WHOQOL-BREF ($U=543$, $p < 0.05$), with the Experimental group showing improved physical health. The effect size ($r=0.31$) indicates the moderate intervention impact on Psychological well-being). Significant differences were also found in the Depression subscale of the DASS-21 ($U=231$, $p < 0.01$), where the Experimental group experienced greater reductions in depression scores compared to the Control group. The effect size for this difference ($r=0.31$) suggests a moderate intervention impact on depressive symptoms.

The Experience of Creation scores were significantly higher in the Experimental group at this time point ($U=616.5$, $p < 0.001$), indicating a greater subjective experience of creativity among MGW participants. The moderately large effect size ($r=0.46$) suggests a strong impact of the programme on students鈥� creativity.

The B-MMR Strong Sensation subscale also showed significant differences ($U=521$, $p < 0.05$), with the Experimental group reporting an increase in scores. This difference had a near moderate effect size ($r=0.27$) which indicates a meaningful shift in how participants engaged with music for emotional experiences. Other domains and subscales did not show significant differences between the groups ($p> 0.05$).

Comparison of baseline to Week 10

By Week 10, the differences between the Control and Experimental groups remained significant in several areas. The Physical domain of the WHOQOL-BREF showed significant improvement in the Experimental group compared to the Control group ($U=553.5$, $p < 0.01$). The effect size ($r=0.34$) suggests a moderate intervention-induced improvement in physical well-being.

The Stress subscale of the DASS-21 indicated that the Experimental group experienced significantly greater reductions in stress levels compared to Control participants ($U=237$, $p < 0.05$). The moderate effect size ($r=0.33$) indicates the positive impact of the programme on stress reduction.

The Experience of Creation scores continued to be significantly higher in the Experimental group ($U=552.5$, $p < 0.01$). The moderate effect size ($r=0.34$) suggests that the intervention had a strong impact on creativity by Week 10.

Further, the B-MMR subscales for Strong Sensation ($U=517$, $p < 0.05$) and Diversion ($U=561$, $p < 0.01$) indicated more substantial changes in healthy music-based self-regulatory strategies in the Experimental group. Both Strong Sensation ($r=0.27$) and Diversion ($r=0.36$) had moderate effect sizes, which highlight the increased engagement with music for emotional processing and distraction from stress or worries, respectively. No significant differences between groups were observed in other domains and subscales at Week 10 ($p> 0.05$).

Takeaway messages from between-group comparisons

Overall, the between-group analyses indicate that, over the 10 week intervention period, the Experimental group experienced significantly greater improvements in psychological well-being, creative experiences, and reductions in depression and stress levels compared to the Control group. The Experimental group also showed greater improvements in specific aspects of music-based mood regulation, particularly in the Strong Sensation and Diversion subscales of the B-MMR. These results indicate that participating in the MGW programme increased students鈥� use of music for eliciting strong emotional experiences, and for distracting themselves from unwanted thoughts or feelings. Both of these music listening strategies have been shown to be positively associated with higher Quality of Life.

Subgroup comparisons

The subgroup analysis indicates that there were no significant differences in outcomes between Group A and Group B at either Week 5 ($p>0.05$) or Week 10 ($p>0.05$). The results suggest that the order of interventions (drumming first as in Group A, or dancing first as in Group B) did not have a significant impact, as both led to similar effects on the participants鈥� mental health and creative experiences.

Bespoke survey results

The bespoke survey provides a more robust understanding of the impact of the intervention on students. The survey results offer insights into the impact of the MGW programme on students鈥� mental health, creative expression, and social connection at Weeks 5 and Week 10. We summarize the main findings below; for the detailed list of bespoke survey questions and participant responses for each group at Week 5 and Week 10, please see Supplementary Materials Tables 1鈥�4.

Mental health

At Week 5, 100% of students in the drumming and 92% of students in the dancing groups reported improvements in their mood. In addition, 94% of students in the drumming group and 100% of students in the dancing group indicated that the MGW sessions made them feel less stressed, tired, and/or sad. By Week 10, all students in the dancing group and 86% of students in the drumming group reported that the sessions improved their mood. Additionally, 71% of students in the drumming group reported feeling more lively/energetic, and 66% felt less stressed/worried. In the dancing group, 75% of students reported feeling more lively/energetic and 67% less stressed/worried.

Creative expression

The majority of students in both groups found that the programme provided them with new techniques and ideas and a supportive environment for creative expression. At Week 5, 93% of students in the drumming group and 75% of students in the dancing group said that the programme gave them the opportunity to express themselves creatively. By Week 10, 79% of students in the drumming group and 83% of students in the dancing group agreed that the sessions gave them the opportunity to express themselves creatively. Additionally, 92% of students in the dancing group and 79% of students in the drumming group agreed (at Week 10) that they had a better understanding of how creative activities can be used to express feelings.

Social connection

More than half of the students in both groups reported that the programme stimulated new friendships. At Week 5, 57% of students in the drumming group and 67% of students in the dancing group indicated that they made new friends through the sessions. By Week 10, 85% of students in the drumming group and 75% of students in the dancing group agreed that they made new friends through the sessions. Therefore, about 4 out of every 5 students in the programme made new friends by participating in MGW. In addition, 100% of students in the dancing group and 71% of students in the drumming group reported (at Week 10) that the sessions made them feel 鈥渕ore positive attitudes and feelings鈥� towards those around them.

Affordances and impacts of drumming and dancing activities

For both the drumming and dancing portions of the MGW intervention, we combined the results across Group A and Group B to examine differences in outcome measures across the two intervention activities (i.e., responses relating to the drumming portion alone were combined across Groups A and B, in order to examine the impact of drumming on mental health, social connection, and creativity).

Both drumming and dancing groups demonstrated mood improvement, with 93.33% of the drumming group and 96.0% of the dancing group reporting positive mood changes. The dancing group exhibited slightly higher rates of positive emotions, with 76.0% feeling more happy and lively, compared to 53.33% of the drumming group. Additionally, 66.67% of the drumming group felt more energetic after five weeks of group drumming. In terms of reducing negative emotions, 60.0% of the dancing group and 56.67% of the drumming group felt less stressed, while reductions in sadness were reported by 40.0% of the dancing group and 33.33% of the drumming group.

Social connectivity was notably higher in the dancing group, with 72.0% feeling more socially connected, compared to 46.67% of the drumming group. In terms of creativity, creative expression was slightly higher for the drumming group, where 86.67% felt the programme allowed them to express themselves creatively, compared to 76.0% in the dancing group.

The findings above suggest that drumming and dancing may have different affordances for supporting mental health, social connection, and creativity. While improvements were similar in most areas, higher rates of positive emotions and social connections were seen in the dancing group, and higher rates of creativity were reported by the drumming group.

Bespoke survey results across all participants at Week 10

In the subsections above, we focus on results from Group A and Group B (sections 3.5.1, 3.5.2., and 3.5.3), as well as the impact of drumming versus dancing activities (section 3.5.4). Here, we examine results across all students who participated in the MGW programme. At Week 10, all students in the MGW programme (across Groups A and B) were asked to reflect on their overall experience of the MGW programme, reflecting on their mood and emotional states, plans to participate in further creative arts programmes as a function of having participated in MGW, and desire to connect with others through creative arts in the future. Figure 2 below shows the results of participants鈥� attitudes towards the overall programme.

Fig. 2

Overall results from bespoke survey across all participants at Week 10

Several takeaway messages may be distilled from the bespoke survey results presented here and above:

• Mood improvements were reported by 96% of students by Week 10, with the dancing group showing slightly higher rates of improvement.

• High levels of positive emotions (61% or greater) across students, with the dancing group reporting slightly higher feelings of happiness and liveliness.

• Effective reduction of negative emotions such as stress and sadness in both the dancing and drumming groups.

• Enhanced social connectivity, with the dancing group feeling more socially connected with people around.

• Strong support for creative expression, particularly in the drumming group.

• Positive impact on future participation in creative arts activities more frequently.

These findings indicate that both drumming and dancing sessions effectively enhanced mood, fostered positive feelings, reduced negative emotions, and promoted social and creative engagement, with the dancing group showing a slight edge in emotional and social connectivity and the drumming group excelling in creative expression.

Focus group results

The Focus Group Discussion (FGD) highlighted the programme鈥檚 impact on mental health, social connection, and creativity. Four students participated (male = 1, female = 3) in the FGD discussion, as the FGD session was voluntary and occurred during the busy end of term. Below we present the key themes that emerged from our thematic analysis of the FGD data.

Impact on mental health

Participants reported that the programme improved their mental health by boosting their mood and facilitating social connections through what they saw as engaging and well-facilitated activities. According to one participant,

P2: 鈥淚n the dancing session, it is easier to interact with others, because sometimes [the dance facilitator] will assign us as a group, like two or three people. So you have to interact or communicate with your partner. Maybe during this, a lot of interaction, then I became friends with some of them and that made me feel better. I think [I] get more energy and spiritual support from the session鈥�.

Sessions were reported to provide a much-needed break from academic stress, offering a temporary escape that participants looked forward to each week. Engagement in music and dance was regarded as a stress management tool and a coping mechanism, although one participant noted that the sessions did not completely eliminate stress. As one participant remarked,

P1: 鈥淚 guess music like kind of gave me a solution to cope with it [stress] in the moment or something. But I wouldn鈥檛 say like overall like there was no anxiousness and no problem, like I think I still felt very like all the stresses that I usually feel鈥�.

Participants also felt inspired to integrate more movement and music into their daily routines, which they believe enhanced their mental health, physical health and overall well-being. One participant stated,

P3: 鈥淎nd in fact, it [the MGW programme] did help me to relax myself, because, for example, in the dancing group through the movement, it help[ed] me in physical health. And at the same time,...I feel more relaxed about myself鈥�.

Impact on social connection

Participants agreed that the programme created a safe and supportive community atmosphere which fostered social connections. Participants were able to bond with others and share personal aspects of their lives in the sessions through structured group activities. This particularly benefited those who were naturally shy. According to one participant,

P1: 鈥淚t鈥檚 also the fact that we all make mistakes and do silly things and it鈥檚 kinda like we show each other embarrassing sides, but also very personal sides because we express days and stuff. And that鈥檚 something you don鈥檛 do outside. You don鈥檛 suddenly move and show how your day was. It鈥檚 awkward, and it is something kind of embarrassing to do. But by doing it, it creates a safe space because everyone is kind of confidently doing it. It creates a safe space where you bond with people more because they created that safe space and also this very open space with each other鈥�.

Over time, the social connection led to the formation of meaningful friendships. This enhanced participants鈥� sense of social connectedness and understanding of different perspectives and at times brought students together from different faculties who would not normally interact in classroom settings. One participant remarked that,

P2: 鈥淚 think I made a very good friend there. We share a lot about the cultural differences because we are from different countries. The cultural differences, and also what we鈥檝e learned. I鈥檓 from business school and she鈥檚 form engineering. And [we] share our opinions on different subjects鈥�.

Impact on creativity

Participants said the programme provided them with new opportunities for personal exploration through creative expression. These were said to contribute positively to their quality of life and mental health. According to one participant (P1), 鈥渃reatively expressing myself through music really makes me feel better and improves my mental well-being鈥�.

The participant further commented that the sessions not only improved their mental health, but also encouraged participants to use the arts to facilitate expression outside of the sessions,

P1: 鈥淚 started listening to music way more. Now when I鈥檓 sad, I think I definitely listen to music. I actually started playing piano as well because I just thought creating art by myself is a very like therapeutic and everything鈥�.

These reflections highlight how creative expression through the arts is connected to mental health, and how participating in the MGW programme has led to behavioral change in some participants.

Participants stated that the programme helped with removing their perceived barrier of entry to the arts, and encouraged them to engage freely in music and dance without focusing on the quality of their output. One participant (P4) remarked that the dance facilitator encouraged them, regardless of their perceptions of their own dancing abilities, to 鈥渏ust move your body to express your feelings鈥�. The participant (P4) further commented that regardless of body shape or dancing ability, 鈥淵ou can just move... You can just do whatever you like鈥�.

Although technical skills were not seen as being necessary for creative expression, the acquisition of technique was valued highly, with participants appreciating acquiring a broader skill set that allowed them to express themselves more freely and creatively. As one participant (P1) noted, 鈥淚 think technique is actually so important and it helps us express ourselves better...That鈥檚 what allows us to become creative with those kind[s] of techniques鈥�.

Programme development: strengths and limitations

When reflecting on strengths of the programme, participants valued the opportunity to enjoy the arts and have fun with fellow participants. They reported that the varied activities provided different levels of comfort for self-expression, with dancing offering a less direct focus on individuals (as everyone was moving around the room). This helped ease self-consciousness.

Despite some initial shyness, the programme鈥檚 elements and its supportive atmosphere enabled participants to overcome their initial reservations and engage more fully as the sessions progressed. However, the start of the programme was sometimes marked by awkwardness and discomfort as participants met new people, which was seen as the least favorite aspect of the experience by some participants. It took a couple of sessions for students to form a rapport with one another.

When asked whether they believe the programme should be offered to more students around campus, participants recognized the value of the programme for other students. One participant also suggested that, like the current version of the programme, it may be a good idea to not specifically recruit friends (groups of students who already know each other), as participating with friends may hinder the openness and effectiveness of self-expression. In addition to feeling the space and freedom to express without judgement, joining as an individual also helps facilitate new social connections.

Considering the suggestions above, the programme can be further refined to enhance participant comfort and engagement. For example, future versions of MGW may aim to create a more welcoming and inclusive environment from the start by including more ice-breaker activities and small group interactions.

Discussion

Our findings indicate that the MGW programme significantly improves university students鈥� mental health, creative expression, and social connections among participants. In our RCT study, the Experimental group exhibited significantly lower levels of depression at Week 5 compared to the Control group, as well as a significant reduction in stress at Week 10 (according to DASS-21 scores). In addition, unlike the Control group, the Experimental group did not demonstrate worse depression, anxiety, and stress scores at Week 5 compared to baseline. These findings indicate that the MGW programme helped students maintain better mental health over the course of the 10-week intervention. Importantly, these improvements in mental health were not only statistically significant, but showed moderate to large effect sizes, which further support the programme鈥檚 effectiveness in promoting participants鈥� mental health. MGW participants also demonstrated improvements in the Physical and Psychological domains of the WHOQOL-BREF scale, reflecting enhanced physical health and mental well-being. The programme also significantly boosted creative expression, as evidenced by higher scores on the Experience of Creation scale and positive feedback from the bespoke survey and FGD. The observed increase in creative engagement was particularly strong as evidenced by the large effect sizes. Finally, the programme effectively fostered social connections, with MGW participants reporting new friendships and a stronger sense of community.

The positive effects of the Movin鈥� & Groovin鈥� for Wellness (MGW) programme on mental health can be attributed to several interconnected mechanisms. Firstly, the music and dance activities themselves played a significant role in reducing depression and stress. Engaging in rhythmic drumming and dance can lead to physiological changes, such as lowering cortisol levels and increasing the release of endorphins [15, 41], which are known to enhance mood and reduce stress. The physical act of moving to music and participating in coordinated group activities provides an immediate and enjoyable way to alleviate the symptoms of anxiety/stress and depression [42, 43].

Secondly, the programme鈥檚 emphasis on creative expression through improvisation likely played a crucial role in fostering emotional release and reducing stress. Improvisation has been associated with improvements in mental health conditions, reductions in stress and anxiety, and improved communication [23]. When embedded within music and dance activities, improvisation allows participants to explore and process their feelings in a supportive and non-judgmental environment [23, 25]. This form of creative expression can act as a powerful outlet for suppressed emotions, and help participants gain insights into their emotional states. Further, the structured yet flexible nature of improvisation encourages spontaneity and self-discovery, which can be particularly therapeutic for individuals dealing with mental health challenges [23, 25].

We also found that the group-based nature of the sessions facilitated social interactions and bonding, which are critical for reducing feelings of loneliness and enhancing a sense of community. The social connections formed through the programme not only provided emotional support but also helped students build a network of peers who share similar experiences. This sense of belonging, contribution, and community is vital for improving mental health and well-being, as it counteracts the isolation and loneliness that many students face [44]. The focus group discussions revealed that participants valued the opportunity to interact with others, make new friends, and engage in shared activities, all of which contributed to their well-being and an overall positive experience.

Importantly, creative expression and social connection themselves may act as mediating factors for mental health improvement. In this way, the three aims of the MGW programme-mental health support, social connection, and creative expression-are deeply intertwined. Participating in creative activities in a group setting not only provides the opportunity and space for self-expression but also fosters shared experience and social bonds, which, in turn, can positively impact mental health and well-being.

Additionally, the skills learned during the MGW programme had a positive impact on participants鈥� mental health outside of the sessions. The significant increase for the Experimental group in two B-MMR subscale scores, including the 鈥淪trong Sensation鈥� and 鈥淒iversion鈥� categories, illustrates the programme鈥檚 efficacy in empowering students to use music as a tool for mood regulation. Participants reported in the FGD that the techniques and practices they learned during the sessions improved their mood and helped them manage their stress even outside the programme. The lived experiences collected from the FGD highlighted how students continued to use music and dance to find emotional relief and joy, demonstrating the enduring benefits of the skills acquired during the programme.

Finally, although the MGW programme always involves both drumming and dancing activities, we recognize that these activities have different affordances for participants. The results (especially of the bespoke survey) revealed the benefits associated with each activity. Between the two activities, drumming was more strongly associated creative expression, while dancing was reported as particularly effective for facilitating social connection among the participants. These findings highlight the different affordances of drumming and dancing within MGW programme. Incorporating both activities in the programme, addresses both the needs and preferences of participants, and allows for different aspects of health and wellness to be supported.

Novelty of the programme

This programme was innovative in several ways. First, bespoke music and dance protocols were developed for the 10-week programme in an interdisciplinary/artistic collaboration between the team members (spanning backgrounds in cognitive science and psychology, music performance, and dance). These protocols offered a new way to engage students through performing arts, and were specifically tailored to support our health and mental wellness goals. To our knowledge, no similar programme (integrating drumming, dancing, and improvisation to live music) currently exists in Singapore.

Second, it is unique to combine rhythmic drumming with tonal improvisation (provided by the musicians playing live), let alone to add a dance component - most programmes focus on a single modality, or for example dancing to music. Here we included improvisation 鈥渏sm sessions鈥� that involved students drumming and dancing along with live improvised music. We know that both music- and movement-based activities are empowering for emotional expression, and the literature confirms that both of these activities are powerful means of supporting mental health. The addition of improvisation was the proverbial icing on the cake 鈥� it allowed students to leverage the drumming and dancing skills they developed for creative expression with their peers, and provided the joy of engaging with live music.

Providing accessible, enjoyable, and culturally relevant activities is essential for promoting young adults鈥� mental health, especially when those activities are stigma-free. Future studies can explore how to sustainably integrate and sustain arts-based strategies into universities鈥� health and wellness services.

Limitations

We are mindful that like any programme or research study, we encountered certain limitations. Firstly, the dropout rate during the 10-week programme was a concern. The length of the intervention may have been too long for some participants (with the final session held the week before finals), leading to the relatively small sample size by the end of the intervention. Future programmes might benefit from a shorter duration (e.g., 6 or 8 weeks), ending more in advance of the final exam period, or integrating additional strategies (such as increasing the reimbursement) to maintain participant retention throughout the intervention period. Increasing the sample size in subsequent research studies would provide more robust evidence.

Additionally, our sample included more female participants than males, and this gender imbalance could affect the generalizability of our results, as the experiences and outcomes might differ by gender. Future studies would benefit from specifically targeting a more balanced gender distribution.

Finally, we recognize that the study was conducted within a specific sociocultural context in Singapore (e.g., a university setting in SE Asia). Cultural factors, such as local attitudes towards mental health and the arts, can always potentially influence the outcomes of such interventions.

Implications for policy

The MGW programme seeks to promote mental and social well-being through the translation of research findings into a scalable initiative that positively supports university students. The findings from this study have practical implications for mental health programmes and public health policy around campus and beyond. Arts-based initiatives like MGW demonstrate the potential to promote mental health, creativity, and social connection in university students in a culturally appropriate way with no stigma attached. Furthermore, arts-based programmes can attract participation by framing mental health support as an enjoyable and culturally enriching activity, which can be particularly effective in encouraging students who might otherwise not to seek help.