The Arts in Psychotherapy 41 (2014) 120–126 Contents lists available at ScienceDirect The Arts in Psychotherapy Music therapy’s effects on levels of depression, anxiety, and social isolation in Mexican farmworkers living in the United States: A randomized controlled trial  Melody Schwantes a,b,* , Cathy McKinney a , Niels Hannibal b a Appalachian State University, Boone, NC, United States b Aalborg University, Aalborg, Denmark a r t i c l e i n f o Keywords: Music therapy Cross cultural Mexican farmworkers Anxiety Depression Social isolation a b s t r a c t The purpose of this research was to determine if group music therapy significantly affected Mexican farm- workers’ levels of depression, anxiety, and social isolation. Anxiety, depression, and social isolation have all been found in high levels in this population; however, intervention studies have not been conducted to determine which interventions could be effective in alleviating these symptoms. While significant results were not found for the music therapy group over the control group, effect sizes were promising. This research could lead the way to developing best practice interventions for Mexican farmworkers experiencing mental health issues. Limitations and suggestions for future research were also discussed. © 2013 Elsevier Ltd. All rights reserved. Introduction Depression, anxiety, and social isolation have been found to be substantial mental health problems for the Mexican farmwork- ers living and working throughout the United States. (Grzywacz et al., 2006; Hovey & Maga ˜ na, 2002a,b, 2003). However, no inter- vention studies have been published documenting best practices for addressing these mental health concerns with this population. A pilot study (Schwantes & McKinney, 2011) demonstrated the possibility of music therapy as a viable method for alleviating the symptoms of depression; however, a control group was not used. Based on this initial research, the authors determined that a ran- domized controlled trial (RCT) was needed to measure the effects of a series of group music therapy sessions on farmworkers’ lev- els of anxiety, depression, and social isolation. The following study outlines an RCT conducted with Mexican farmworkers in Western North Carolina (Fig. 1). Literature review Who is the average farmworker? According to the National Agricultural Workers Survey (1998) the average farmworker is a 29-year old married male with around 6 years of education. In North Carolina alone, there are 150,000 farmworkers who come to the  The authors would like to thank The Faculty of Humanities at Aalborg University for its financial support of this research. * Corresponding author. Tel.: +1 8287192159. E-mail address: melodyschwantes@gmail.com (M. Schwantes). state each year to participate in the harvest and care of the state’s $59 billion agricultural industry. Farmworkers earn $11,000 a year annually, making them the nation’s second lowest wage earners. Additionally, farmworkers have a life expectancy of 49 years and have little to no access to health care, let alone mental health ser- vices (North Carolina Farmworker Institute, 2007). Anxiety and depression have been thoroughly documented in migrant farm- worker (Hovey & Maga ˜ na, 2002a,b, 2003). Grzywacz et al. (2006) found that nearly 25% of the migrant farmworker population was dealing with some type of mental health issue. Stressors that cause these mental health issues include (a) separation from family, (b) work demands, (c) housing issues, (d) income, (e) language, and (f) isolation, among others (Hovey & Maga ˜ na, 2003). In addition, ineffective social support has also been shown to affect farmwork- ers’ levels of anxiety particularly in those individuals who have higher levels of education (Hovey & Maga ˜ na, 2002a). Social support was found to affect cognitive anxiety, affective anxiety, and physi- ological anxiety. Mental health issues stemming from lack of social support may affect farmworkers’ overall health negatively and can additionally lead to problem drinking further affecting their situ- ation (Finch, Frank, & Vega, 2004). However, barriers to accessing mental health services have been found to be a compounding fac- tor in ameliorating these concerns. Bechtel, Shepherd, and Rogers (1995) identified language, low income, minimal access to ade- quate health care providers, and a sense of powerlessness in the community as the most prevalent. The aforementioned studies have documented the overall men- tal health of Mexican farmworkers in the United States and also suggested ideas for addressing these mental health concerns with community services. Bechtel et al. (1995) recommended 0197-4556/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.aip.2013.12.002