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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2017-021251 on 17 July 2018. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 25, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-021251 on 17 July 2018. Downloaded from Could listening to music during pregnancy be protective against postnatal depression and poor wellbeing post-birth? Longitudinal associations from a preliminary prospective cohort study. ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2017-021251 Article Type: Research Date Submitted by the Author: 19-Dec-2017 Complete List of Authors: Fancourt, Daisy; University College London Research Department of Epidemiology and Public Health, Department of Behavioural Science and Health Perkins, Rosie; Royal College of Music, Centre for Performance Science; Imperial College London, Faculty of Medicine MENTAL HEALTH, Depression & mood disorders < PSYCHIATRY, Maternal Keywords: medicine < OBSTETRICS http://bmjopen.bmj.com/ on September 25, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 18 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-021251 on 17 July 2018. Downloaded from 1 2 3 Could listening to music during pregnancy be protective against postnatal depression 4 5 and poor wellbeing post-birth? Longitudinal associations from a preliminary 6 7 prospective cohort study. 8 9 10 a,b b,c 11 Daisy Fancourt PhD and Rosie Perkins PhD * 12 13 a 14 Department of Behavioural Science and Health, University College London, London WC1E 15 7HB 16 b Faculty ofFor Medicine, peer Imperial College review London, London SW7only 2AZ 17 18 c Centre for Performance Science, Royal College of Music, London SW7 2BS 19 * Corresponding author: Dr Daisy Fancourt, 1-19 Torrington Place, London, WC1E 7HB, 20 21 [email protected] 22 23 24 25 26 27 28 29 30 31 32 http://bmjopen.bmj.com/ 33 34 35 36 37 38 39 40 on September 25, 2021 by guest. Protected copyright. 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 18 BMJ Open: first published as 10.1136/bmjopen-2017-021251 on 17 July 2018. Downloaded from 1 2 3 Abstract 4 Objectives: This study explored whether listening to music during pregnancy is longitudinally 5 6 associated with lower symptoms of postnatal depression and higher wellbeing in mothers postbirth. 7 8 9 Design: Prospective cohort study. 10 11 12 Participants: We analysed data from 395 new mothers aged over 18 who provided data in the third 13 trimester of pregnancy and 3 and 6 months later (0-3 and 4-6 months post birth). 14 15 16 Primary and secondaryFor outcome peer measures: Listeningreview to music was only categorised as ‘rarely; a couple of 17 18 times a week; every day <1hr; every day 1-2hrs; every day 3-5hrs; every day 5+hrs’. Postnatal 19 depression was measured using the Edinburgh Postnatal Depression Scale (EPDS), and wellbeing was 20 21 measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Multivariate 22 linear regression analyses were carried out to explore the effects of listening to music during 23 24 pregnancy on depression and wellbeing post birth, adjusted for baseline mental health and potential 25 confounding variables. Sensitivity analyses stratified by baseline mental health and used inverse 26 27 probability weighting to account for differential non-response. 28 29 30 Results: Listening during pregnancy is associated with higher levels of wellbeing (β=0.40, SE=0.15, 31 95%CI 0.10 to 0.70) and reduced symptoms of postnatal depression (β=-0.39, SE=0.19, 95%CI -0.76 32 http://bmjopen.bmj.com/ to -0.03) in the first 3 months postbirth. However, effects disappear by 4-6 months post-birth. These 33 34 results appear to be particularly found amongst women with lower levels of wellbeing and high levels 35 of depression at baseline and amongst those with a history of mental health conditions. 36 37 38 Conclusions: Listening to music could be recommended as a way of supporting mental health and 39 40 wellbeing in pregnant women; in particular those who demonstrate low wellbeing or symptoms of on September 25, 2021 by guest. Protected copyright. 41 PND. 42 43 44 45 46 Keywords 47 Postnatal depression, wellbeing, mental health, music, perinatal 48 49 50 51 Strengths and limitations of this study 52 • This preliminary prospective cohort study tracked a sample of women across the perinatal 53 54 period providing data at 12 week intervals. 55 56 • The data include a rich set of variables on music listening behaviours amongst participants. 57 58 2 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 18 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-021251 on 17 July 2018. Downloaded from 1 2 3 • We adjusted for all identified confounding variables in our analyses and ran a series of 4 sensitivity analyses to test our assumptions. 5 6 • The data are not nationally representative, although there is a clear spread of participants from 7 varying socio-economic backgrounds as well as variations in the levels of exposure and 8 9 outcome variables. 10 • As this is a cohort study and not interventional, it is not possible to confirm csausality. 11 12 13 14 Funding statement 15 The study was funded by Arts Council England Research Grants Fund, grant number 29230014 16 For peer review only 17 (Lottery). D.F. is supported by the Wellcome Trust [205407/Z/16/Z]. The study was approved by the 18 NHS REC (15/SS/016). The study team acknowledge the support of the National Institute of Health 19 20 Research Clinical Research Network (NIHR CRN). The authors would like to thank the hospitals 21 involved as Participant Identification Centres as well as Miss Sunita Sharma, Prof Aaron Williamon 22 23 and Sarah Yorke for their support with the study. 24 25 26 Competing interests statement 27 28 Both authors declare no conflict of interest. 29 30 31 32 http://bmjopen.bmj.com/ 33 34 35 36 37 38 39 40 on September 25, 2021 by guest. Protected copyright. 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 3 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 18 BMJ Open: first published as 10.1136/bmjopen-2017-021251 on 17 July 2018. Downloaded from 1 2 3 Introduction 4 Perinatal mental health problems affect around 20% of women at some point during the perinatal 5 6 period (1). In terms of conditions characterised by negative symptomology, postnatal depression 7 (PND) is one of the most common problems, and is a debilitating condition characterised by fatigue, 8 9 irritability, insomnia and anhedonia; symptoms which in 25% of affected women last for at least one 10 year (2). Over the last two decades, there has been significant research into the effects of PND on 11 12 mother and infant as well as attention paid to how it can be prevented or managed (3,4). However, in 13 terms of conditions relating more to the absence of positive symptomology, such as low hedonic or 14 15 eudemonic wellbeing, there has been much less research. The few studies that do exist have found 16 that negative mood,For as indicated peer by the Edinburgh review Postnatal Depression only Scale, has a correlation of 17 18 just -0.46 with positive experiences of motherhood (5). This suggests that, as in the wider population, 19 depression and wellbeing are separate constructs in the context of perinatal mental health and a 20 21 positive perinatal experience is more than simply the inversion of negative mood (6). Building on this, 22 women even without PND have been found to demonstrate impairments in emotional problems and 23 24 vitality, suggesting that even in the absence of depression mothers can have impaired wellbeing (7). In 25 light of this, a review has argued that psychological wellbeing defined as a multidimensional 26 27 construct should be an integral part of maternity care (8), and a more recent construct analysis has 28 highlighted the importance not just of identifying PND but also of identifying women with sub- 29 30 optimal perinatal wellbeing and supporting them to achieve positive psychological functioning (9). 31 32 http://bmjopen.bmj.com/ In seeking to support the perinatal mental health of women, the pregnancy period has been 33 34 highlighted as critical.
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