A Systematic Review of Unpublished and Non-Refereed Music Therapy Mental Health Papers Found via Google Scholar

Search Strategies

We identified papers through the advanced search function in Google Scholar using a variety of combinations of music therapy and mental health keywords between March 1 and September 30, 2017. Keywords used included: music therapy, mental health, mental disorder, mental illness, mentally ill, psychiatric, psychosis, bipolar, depression, schizophrenia, schizoaffective, suicidal ideation, suicide, borderline personality disorder, and personality disorder.

Inclusion and Exclusion Criteria

We included papers if they met the following criteria:

We excluded papers if participants were in a forensic setting, if the population was older adults, or if they were published in languages other than English.

Data Collection and Extraction Process

We created a table for data extraction for papers meeting inclusion criteria. Data extracted and summarized for each study included: (1) Author and year; (2) Institutional Affiliation; (3) Purpose of research (i.e., thesis, dissertation, or non-required research); (4) Author credential (i.e., if the author was a music therapist); (5) clinical population and sample size; (6) type of study and design; (7) findings; and (8) the link to the unpublished paper. Throughout this process, we met frequently and discussed any discrepancies between our interpretations of the extracted data. In the case of the type of study/design, we categorized papers by the study design identified by the author in each paper.

Search and Inclusion Results

The search yielded a total of 550 possible papers. After screening the abstract and determining if the paper was published in a refereed journal, 65 unpublished papers were identified. We then read each paper to determine if it met inclusion criteria. Nine papers met most inclusion criteria but required additional login credentials for access and were therefore not included in the analysis. Eight of these nine papers were written by authors affiliated with universities within the United States. To ensure that each paper had not been published, we also emailed authors in an attempt to confirm their papers had not been published. A total of 21 papers met all inclusion criteria. Results of the search are depicted in Figure 1.

Figure 1

Flow Diagram

Author and Year

Each paper had a different author and was published since 2003.

Institutional Affiliation

The majority of the authors (n = 15) were affiliated with universities outside of the United States, with New Zealand (n = 7) and Finland (n = 3) representing the top two countries.

Purpose

Of the 21 papers that met inclusion criteria, 16 of the papers were master’s theses and five were doctoral dissertations.

Author Credential

Of the 21 papers meeting inclusion criteria, 19 were authored by music therapists. Two projects were conducted at Ball State University for Masters of Science degrees. Within these papers, we were unable to determine if the authors were Board-Certified Music Therapists. Also, both of these were prospective studies and datum was not collected.

Clinical Population, N

Almost half of the papers (n = 8) involved adolescents with mental health diagnoses. Authors conducted the research in various settings, including inpatient facilities, outpatient facilities, and transitional school settings. Concerning the number of participants in each study, studies varied considerably, and due to the diversity of paradigms and that some papers consisted of multiple studies, we decided calculating descriptive data would not be appropriate. However, we depicted these data in Table 1.

Type of Study/Design

We categorized two papers that were designed but not conducted as prospective studies. Although not all papers contained data, more papers contained qualitative data (n = 10) than quantitative data (n = 3). We categorized papers containing qualitative data as having various designs, including: exploratory (n = 3), grounded theory (n = 2), case study (n = 1), theoretical (n = 1), ethnography (n = 1), action research (n = 1) and a combination of three separate papers (n = 1). We also identified papers using quantitative data as a post-treatment only survey (n = 1), a concurrent schedule/alternating treatments single-subject design (n = 1), and a combination of three separate papers into a single paper (n = 1). Four papers contained both qualitative and quantitative data.¹ Two papers did not contain either type of data and were categorized as a descriptive analysis of published music therapy papers and a developed resource for music therapists.

Findings

Due to the assortment of types of papers and research questions, findings are mixed and we were unable to synthesize them due to their diversity. However, findings are depicted in Table 1 and summarized briefly below. We also provided links to each of the papers that met our inclusion criteria.

While outcomes of the papers varied, authors reported music therapy as having positive effects on coping with stress (Salur, 2016), emotional regulation (Salur, 2016; Young, 2010), socialization and social skills (Morgan, 2007; Salur, 2016; Travis, 2003; Young, 2010), self-expression (Young, 2010), self-esteem (Karvonen, 2015), relaxation (Travis, 2003), and attendance rates (Davis, 2008). Authors also reported that music therapy assisted in decreasing depressive symptoms (Punkanen, 2011; Salur, 2016), anxiety symptoms (Punkanen, 2011), and psychiatric symptoms (Morgan, 2007).

Other outcomes from the papers include identification of key factors that influence group dynamics (Beatson, 2012), a descriptive analysis of music therapy and mental health research published in the Journal of Music Therapy, Music Therapy Perspectives, and The Arts in Psychotherapy (Moore, 2015), a resource for music therapists working with individuals diagnosed with schizophrenia (Purvis, 2007), and a description of the relationship between music therapy practice and key competencies of a school curriculum (Halligan, 2012).

Author and Year

Each paper had a different author and had been uploaded since 2003. This factor was limited by our search criteria (i.e., uploaded between 2000 and 2017) and the ability to publish papers online. For example, some papers might have met most of our inclusion criteria but may have been completed before online publication was common practice. The results were also limited to the English language as that is our primary language. International research teams conducting related investigations may be able to acquire and interpret papers meeting inclusion criteria that are published in other languages.

Institutional Affiliation

As the majority of the authors were affiliated with universities outside of the United States (n = 15), perhaps open-access graduate papers are promoted and accepted more widely throughout other countries than the United States. Additionally, it may be that more graduate music therapy students outside the United States are researching mental health and thus their papers met our inclusion criteria. However, nine papers met most inclusion criteria but were not included as they were located on websites that required additional login credentials for access. As eight of these papers were written by authors affiliated with universities within the United States, perhaps universities outside the United States are more apt to publish papers on open access websites.

Purpose

Of the 21 papers that met inclusion criteria, 16 of the papers were master’s theses and five were doctoral dissertations. Reasons for these papers being unpublished are difficult to conjecture but may be resultant of authors experiencing fatigue from the research process, being rejected from a journal and not submitting the paper to another journal, or not believing their paper warrants publication due to quality, sample size, or non-significant results. From these data, however, it seems that music therapists are conducting research for the fulfillment of a graduate degree. It is interesting that no identified paper was conducted by a clinician who was not seeking a graduate degree. However, it may be that non-student or clinician researchers are publishing their research and these papers did therefore not meet our inclusion criteria and were therefore not included in our paper. These factors contribute to questions concerning incentive for conducting research as a clinician. Moreover, it should be noted that facilities tend to employ and pay music therapists to treat patients and conducting research is typically not a part of the job duties of a clinical music therapist.

Author Credential

Of the 21 papers meeting inclusion criteria, 19 were authored by music therapists. Two papers were conducted at Ball State University for Masters of Science degrees. Within these papers, we were unable to determine if the authors were Board-Certified Music Therapists. Also, both of these papers were prospective studies and datum was not collected. As Ball State University does not have a music therapy program, it may be that these authors were Board-Certified² Music Therapists seeking a graduate degree in another field after completing an undergraduate degree in music therapy. However, as music-based intervention reporting guidelines (Robb, Burns, & Carpenter, 2010, 2011) were not followed by identifying the type of clinician or training they received, one might postulate that the authors were not Board-Certified music therapists. Perhaps not being Board-Certified Music Therapists prohibited data collection, as both of these were prospective studies and no datum was collected.

Clinical Population, N

Eight papers involved adolescents with mental health diagnoses. Authors conducted their research in various settings, including inpatient facilities, outpatient facilities, and transitional school settings. Due to the numerous designs, there was considerable variation in the number of research participants in the located papers meeting inclusion criteria, ranging from one to 109 research participants. As these papers were graduate theses and dissertations and likely not funded, it seems appropriate that the sample sizes were fairly small. Certainly, larger sample sizes are warranted, but these can be difficult to attain, especially when researchers are students who may have incentive to finish their project and start a paid music therapy clinical or faculty position.

Type of Study/design

Although not all papers contained data, more papers contained qualitative data (n = 10) than quantitative data (n = 3). These papers had a wide variety of study designs and are depicted in Table 1. Four studies contained both qualitative and quantitative data. However, data within these studies did not answer the same research question and were not mixed, thus not meeting criteria to be categorized as mixed-methods (Creswell & Plano Clark, 2011). Two papers did not contain either type of data and were categorized as a descriptive analysis of published music therapy papers and a developed resource for music therapists. Two papers that were designed but not conducted were categorized as prospective studies. From the considerable variance of paper types and designs, one might conclude that the researchers’ questions appropriately impacted the type of design and paper.

Findings

Due to the assortment of types of papers and research questions, findings are mixed and we felt it would be inappropriate to integrate, synthesize, or pool the data. Readers should consult Table 1 and the current authors caution against generalizing results. While outcomes of the papers varied due to the plethora of research questions, authors did report that music therapy had positive effects concerning a number of factors, including coping with stress (Salur, 2016), emotional regulation (Salur, 2016; Young, 2010), socialization and social skills (Morgan, 2007; Salur, 2016; Travis, 2003; Young, 2010), self-expression (Young, 2010), self-esteem (Karvonen, 2015), relaxation (Travis, 2003), and attendance rates (Davis, 2008). Concerning symptoms specific to mental health, authors noted that music therapy assisted in decreasing depression (Punkanen, 2011; Salur, 2016), anxiety (Punkanen, 2011), and psychiatric symptoms (Morgan, 2007).

Link

We provided links to each of the papers that met our search criteria. We hope this access to information is useful for clinicians, scholars, service users, and information seekers.

Implications for Clinical Practice

Nine papers met inclusion criteria but required additional login credentials for access and were therefore not included in the analysis. Eight of these papers were written by authors affiliated with universities within the United States. Perhaps the lack of availability was a result of the capitalist orientation of the United States. Congruently, many journals publishing research require a subscription and people seeking information for health-related decision making often do not have access to the necessary information. In our opinion, scientific information is too frequently limited to only those who have access to the internet and expensive search engines. We believe limiting scientific results is dangerous and harmful to service users, clinicians, the public, and the music therapy profession. To us, this is a social injustice as only the privileged who have access to expensive library databases can attain relevant information. In an attempt to remedy this problematic occurrence, future researchers might consider publishing via open access journals and could include unpublished papers on open-access websites. Researchers might consider including open access fees in grant proposals to increase access to scientific information.

Reflections from the Authors

There is a plethora of reasons authors may have chosen to not publish their papers. First, and perhaps most obvious, the paper may not be of a high enough quality to warrant publication in a refereed venue. As non-significant findings are likely when conducting objectivist music therapy research with mental health service users (Silverman, 2008, 2010, 2015), publication bias may limit the number of quantitative studies published. This might also be influenced by small sample sizes in the theses and dissertations, which could impact statistical power and generalizability of results. Interpretivist research might be limited by a lack of consensus among participants, biases, or problems in the question, design, or interpretation. Moreover, authors might not even recognize that their papers are of publishable quality. Additionally, as all the identified papers were theses or dissertations, it would seem that at least some of the responsibility for encouraging publication falls upon the academic advisor. Although the submission process may seem daunting to beginning researchers, academic advisors might consider including information concerning the publication process – as well as the importance of publishing graduate work – in their coursework so students are adequately prepared to submit their manuscripts for publication consideration. However, academic advisors might encourage their advisees to publish, but the publication never comes to fruition. Rejection after an initial submission could deter researchers from integrating critical feedback and attempting another submission to a different journal.

As there is likely a dearth of additional unpublished music therapy research in existence but not necessary accessible online, perhaps posting unpublished papers online would be helpful to future researchers. However, without adequate peer review, less experienced readers and researchers risk of misinterpreting data and making false conclusions that could mislead eventual readers. Truly, these are complex and consequential issues, especially in the contemporary era of increased access to information via the internet.

Limitations

One potential limitation of our study is the use of the advanced search function and the specification that the keywords needed to occur in the title of the article. With this specification, each search yielded around 100 articles or less. Without it, each search yielded anywhere between 40,000 and 70,000 articles depending on the combination of keywords. While the high number of results is an advantage of Google Scholar, the considerable difference between the two search options allows for potential unpublished articles to go undiscovered.

Another potential limitation is the use of keywords and titles of unpublished articles. For example, a citation notification was emailed to the second author of the current study containing the title of an article that, under further scrutiny, would have met all inclusion criteria. However, this article did not appear in the initial search results. As search engines such as Google Scholar continue to become increasingly sophisticated, it will be interesting to assess how access to knowledge and keywords impact the music therapy profession in the digital age.

Suggestions for Future Research

Future researchers could find and explore other open-access sources and university research databases to identify unpublished articles. Also, as nine papers met most inclusion criteria but required additional login credentials for access, future researchers could include unpublished articles that were not available on open-access websites. Future researchers might identify how many music therapists use Google Scholar to obtain scholarly output.