Online singing interventions for postnatal depression in times of social isolation: a feasibility study protocol for the SHAPER-PNDO single-arm trial

Rebecca H Bind, Carolina Estevao, Daisy Fancourt, Katie Hazelgrove, Kristi Sawyer, Lavinia Rebecchini, Celeste Miller, Paola Dazzan, Nick Sevdalis, Anthony Woods, Nikki Crane, Manonmani Manoharan, Alexandra Burton, Hannah Dye, Tim Osborn, Lorna Greenwood, Ioannis Bakolis, Maria Baldellou Lopez, Rachel Davis, Rosie Perkins, Carmine M Pariante, Rebecca H Bind, Carolina Estevao, Daisy Fancourt, Katie Hazelgrove, Kristi Sawyer, Lavinia Rebecchini, Celeste Miller, Paola Dazzan, Nick Sevdalis, Anthony Woods, Nikki Crane, Manonmani Manoharan, Alexandra Burton, Hannah Dye, Tim Osborn, Lorna Greenwood, Ioannis Bakolis, Maria Baldellou Lopez, Rachel Davis, Rosie Perkins, Carmine M Pariante

Abstract

Background: Postnatal depression (PND) affects 13% of new mothers, with numbers rising during the COVID-19 pandemic. Despite this prevalence, many women have difficulty with or hesitancy towards accessing pharmacological and/or psychological interventions. Group-based mother-baby activities, however, have a good uptake, with singing improving maternal mental health and the mother-infant relationship. The recent lockdowns highlight the importance of adapting activities to an online platform that is wide-reaching and accessible.

Aims: The SHAPER-PNDO study will primarily analyse the feasibility of a 6-week online singing intervention, Melodies for Mums (M4M), for mothers with PND who are experiencing barriers to treatment. The secondary aim of the SHAPER-PNDO study will be to analyse the clinical efficacy of the 6-week M4M intervention for symptoms of postnatal depression.

Methods: A total of 120 mothers and their babies will be recruited for this single-arm study. All dyads will attend 6 weekly online singing sessions, facilitated by Breathe Arts Health Research. Assessments will be conducted on Zoom at baseline and week 6, with follow-ups at weeks 16 and 32, and will contain interviews for demographics, mental health, and social circumstances, and biological samples will be taken for stress markers. Qualitative interviews will be undertaken to understand the experiences of women attending the sessions and the facilitators delivering them. Finally, data will be collected on recruitment, study uptake and attendance of the programme, participant retention, and acceptability of the intervention.

Discussion: The SHAPER-PNDO study will focus on the feasibility, alongside the clinical efficacy, of an online delivery of M4M, available to all mothers with PND. We hope to provide a more accessible, effective treatment option for mothers with PND that can be available both during and outside of the pandemic for mothers who would otherwise struggle to attend in-person sessions, as well as to prepare for a subsequent hybrid RCT.

Trial registration: ClinicalTrials.gov Identifier: NCT04857593 . Registered retrospectively on 22 April 2021. The first participants were recruited on 27 January 2021, and the trial is ongoing.

Keywords: Arts intervention; COVID-19; Mental health; Online delivery; Postnatal depression; Singing.

Conflict of interest statement

NS is the director of the London Safety and Training Solutions Ltd., which offers training in patient safety, implementation solutions, and human factors to healthcare organisations. DF is a non-executive board director for Breathe Arts Health Research, but she receives no financial compensation for her involvement. CMP has received research and consultation funding from Boehringer Ingelheim and Johnson & Johnson for research on depression and inflammation and by a Wellcome Trust strategy award to the Neuroimmunology of Mood Disorders and Alzheimer’s Disease (NIMA) Consortium (104025), which is also funded by Janssen, GlaxoSmithKline, Lundbeck, and Pfizer; the work presented in this paper is unrelated to this funding. The other authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Schedule of enrolment, interventions, and assessments
Fig. 2
Fig. 2
Recruitment strategy

References

    1. Boath E, Henshaw C. The treatment of postnatal depression: a comprehensive literature review. J Reprod Infant Psychol. 2001;19(3):215–248. doi: 10.1080/02646830120073224.
    1. Morrell CJ, Warner R, Slade P, Dixon S, Walters S, Paley G, et al. Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial Heal Technol Assess. 2009;13(30):1–153.
    1. Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016;191:62–77. doi: 10.1016/j.jad.2015.11.014.
    1. Biaggi, A., & Pariante, C. M. (2020). Risk factors for depression and anxiety during the perinatal period. In Handbook of Perinatal Clinical Psychology (pp. 239-265). Routledge.
    1. Hessami K, Romanelli C, Chiurazzi M, Cozzolino M. COVID-19 pandemic and maternal mental health: a systematic review and meta-analysis. J Maternal-Fetal Neonatal Medi. 2020:1-8.
    1. Yan H, Ding Y, Guo W. Mental health of pregnant and postpartum women during the coronavirus disease 2019 pandemic: a systematic review and meta-analysis. Front Psychol. 2020;11:3324.
    1. Bhopal SS, Bagaria J, Bhopal R. Risks to children during the covid-19 pandemic: some essential epidemiology. BMJ. 2020:369.
    1. Bind RH, Biaggi A, Bairead A, Du Preez A, Hazelgrove K, Waites F, Conroy, S, Dazzan, P, Osborne, S, Pawlby, S, Sethna, V, Pariante CM. Mother–infant interaction in women with depression in pregnancy and in women with a history of depression: the Psychiatry Research and Motherhood – Depression (PRAM-D) study. BJPsych Open 7(3). Available from:
    1. Sawyer KM, Zunszain PA, Dazzan P, Pariante CM. Intergenerational transmission of depression: clinical observations and molecular mechanisms. Mol Psychiatry. 2019;24(8):1157–77.
    1. Fancourt D, Perkins R. Creative interventions for symptoms of postnatal depression: a process evaluation of implementation. Arts Health. 2019;11(1):38–53. doi: 10.1080/17533015.2017.1413398.
    1. Bledsoe SE, Grote NK. Treating depression during pregnancy and the postpartum: a preliminary meta-analysis. Res Soc Work Pract. 2006;16(2):109–120. doi: 10.1177/1049731505282202.
    1. Cooper PJ, Murray L, Wilson A, Romaniuk H. Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression: I. Impact on maternal mood. Br J Psychiatry. 2003;182(5):412–9. doi: 10.1192/bjp.182.5.412.
    1. Milgrom J, Negri LM, Gemmill AW, McNeil M, Martin PR. A randomized controlled trial of psychological interventions for postnatal depression. Br J Clin Psychol. 2005;44(4):529–542. doi: 10.1348/014466505X34200.
    1. Smith MS, Lawrence V, Sadler E, Easter A. Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK. BMJ Open. 2019;9(1):e024803. doi: 10.1136/bmjopen-2018-024803.
    1. Feeley N, Bell L, Hayton B, Zelkowitz P, Carrier M-E. Care for postpartum depression: what do women and their partners prefer? Perspect Psychiatr Care. 2015;52(2):120–130. doi: 10.1111/ppc.12107.
    1. Clift S, Morrison I. Group singing fosters mental health and wellbeing: findings from the East Kent “singing for health” network project. Mental Health and Social Inclusion. 2011.
    1. Coulton S, Clift S, Skingley A, Rodriguez J. Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial. Br J Psychiatry. 2015;207(3):250–255. doi: 10.1192/bjp.bp.113.129908.
    1. Mualem O, Klein PS. The communicative characteristics of musical interactions compared with play interactions between mothers and their one-year-old infants. Early Child Dev Care. 2013;183(7):899–915. doi: 10.1080/03004430.2012.688824.
    1. Nakata T, Trehub SE. Infants’ responsiveness to maternal speech and singing. Infant Behav Dev. 2004;27(4):455–464. doi: 10.1016/j.infbeh.2004.03.002.
    1. Vlismas W, Malloch S, Burnham D. The effects of music and movement on mother–infant interactions. Early Child Dev Care. 2013;183(11):1669–1688. doi: 10.1080/03004430.2012.746968.
    1. Fancourt D, Perkins R. Associations between singing to babies and symptoms of postnatal depression, wellbeing, self-esteem and mother-infant bond. Public Health. 2017;145:149–152. doi: 10.1016/j.puhe.2017.01.016.
    1. Fancourt D, Perkins R. Effect of singing interventions on symptoms of postnatal depression: three-arm randomised controlled trial. Br J Psychiatry. 2018;212(2):119–121. doi: 10.1192/bjp.2017.29.
    1. Fancourt D, Perkins R. Does attending community music interventions lead to changes in wider musical behaviours? The effect of mother–infant singing classes on musical behaviours amongst mothers with symptoms of postnatal depression. Psychol Music. 2019;47(1):132–143. doi: 10.1177/0305735617742197.
    1. Fancourt D, Perkins R. The effects of mother–infant singing on emotional closeness, affect, anxiety, and stress hormones. Music Sci. 2018;1:2059204317745746. doi: 10.1177/2059204317745746.
    1. Estevao C, Fancourt D, Dazzan P, Chaudhuri KR, Sevdalis N, Woods A, et al. Scaling-up Health-Arts Programmes: the largest study in the world bringing arts-based mental health interventions into a national health service. BJPsych Bull [Internet]. 2021 Jan 19;1–8. Available from:
    1. Pariante CM. Let’s kick off the world’s largest study into arts and health! [Internet]. InspireTheMind. 2019. Available from:
    1. Estevao C, Bind R, Fancourt D, Sawyer K, Dazzan P, Sevdalis N, Woods A, Crane N, Rebecchini L, Hazelgrove K, Manoharan M, Burton A, Dye H, Osborn T, Greenwood L, Davis R, Soukup T, Arias de la Torre J, Bakolis I, Healey A, Perkins R, Pariante CM. SHAPER-PND trial: clinical effectiveness protocol of a community singing intervention for postnatal depression. BMJ Open. 2021;11(11):e052133.
    1. Soukup T, Davis RE, Lopez MB, Healey A, Estevao C, Fancourt D, Dazzan P, Pariante C, Dye H, Osborn T, Bind R, Sawyer K, Rebecchini L, Hazelgrove K, Burton A, Manoharan M, Perkins R, Podlewska A, Chaudhuri R, Derbyshire-Fox F, Hartley A, Woods A, Crane N, Bakolis I, Sevdalis N. Study protocol: randomised controlled hybrid type 2 trial evaluating the scale-up of two arts interventions for postnatal depression and Parkinson’s disease. BMJ Open. 2022;12(2):e055691.
    1. Spek V, Cuijpers PIM, Nyklícek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007;37(3):319–328. doi: 10.1017/S0033291706008944.
    1. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009;38(4):196–205. doi: 10.1080/16506070903318960.
    1. Fancourt D, Steptoe A. Present in body or just in mind: differences in social presence and emotion regulation in live vs. virtual singing experiences. Front Psychol. 2019;10:778. doi: 10.3389/fpsyg.2019.00778.
    1. Osborne S, Biaggi A, Chua TE, Du Preez A, Hazelgrove K, Nikkheslat N, et al. Antenatal depression programs cortisol stress reactivity in offspring through increased maternal inflammation and cortisol in pregnancy: the Psychiatry Research and Motherhood - Depression (PRAM-D) Study. Psychoneuroendocrinology. 2018;98:211–221. doi: 10.1016/j.psyneuen.2018.06.017.
    1. Braun V, Clarke V. Thematic analysis. 2012.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner