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The Effectiveness of Music Therapy for Postpartum Depression A Complementary Therapies in Clinical Practice 37 (2019) 93–101 Contents lists available at ScienceDirect Complementary Therapies in Clinical Practice journal homepage: www.elsevier.com/locate/ctcp The effectiveness of music therapy for postpartum depression: A systematic review and meta-analysis T Wen-jiao Yanga, Yong-mei Baib, Lan Qinc, Xin-lan Xuc, Kai-fang Baoa, Jun-ling Xiaoa, ∗ Guo-wu Dinga, a School of Public Health, Lanzhou University, Lanzhou, 730000, China b School of Public Health, Capital Medical University, Beijing, 10069, China c School of Mathematics and Statistics, Lanzhou University, Lanzhou, 730000, China 1. Introduction rehabilitative approaches, relational approaches, and music listening, among which, music listening is the most convenient to conduct [18]. Postpartum depression usually refers to depression that occurs A systematic review and meta-analysis published in 2009 found that within one year after giving birth [1]. According to some current re- music therapy based on standard care reduced depression and anxiety search reports, the prevalence of postpartum depression is higher than in people with mental disorders [19]. Another meta-analysis also re- 10% and lower than 20% but can be as high as 30% in some regions vealed a positive effect of music therapy on the alleviation of depression [1–3]. Postpartum depression symptoms include emotional instability, and anxiety symptoms [20]. However, the efficacy of music therapy sleep disorders, poor appetite, weight loss, apathy, cognitive impair- cannot be generalized to patients with other diseases because women ment, and in severe cases, suicidal ideation [4,5]. Postpartum depres- with postpartum depression are a special group whose main symptom is sion threatens the health of the mother, as well as the physical and depression. Therefore, it is necessary to research the effectiveness of mental health of the baby. Studies have reported that the children of music therapy on postpartum depression alone. No review or meta- mothers with postpartum depression were more likely to be under- analysis has focused on the effectiveness of music therapy for post- weight and developmentally-delayed and maternal depression has been partum depression and only a few epidemiological studies have made associated with adverse psychological outcomes in children 10 years relevant findings. In the epidemiological studies, patients suffering later. Postpartum depression may lead to chronic or recurrent depres- from postpartum depression usually listened to instrumental, soothing sion, which not only threatens human health but also causes great music, such as light music, pure music, and lullabies. After listening to burden to the caregivers of postpartum mothers [6]. the music, not only were the patients' anxiety and depression relieved Although antidepressants and psychotherapy are commonly used to but also sleep quality, satisfaction, and pain were improved [4,18]. relieve depressive symptoms, both of them are associated with poor However, the results of the studies were inconsistent. For example, a adherence and antidepressants may cause unwanted side effects. In recent randomized controlled trial showed that music therapy had a particular, mothers with postpartum depression may forgo anti- positive effect on reducing depression and anxiety symptoms [21], depressants to avoid exposure to their babies [7,8]. Music therapy, as while an earlier trial reported that music therapy had no significant an alternative therapy, has no obvious side effects or adverse reactions effect on anxiety relief in postpartum women [22]. Thus, evidence for [9]. It is a non-invasive treatment with good tolerance, is inexpensive, the effectiveness of music therapy for postpartum depression is still and requires little time and energy [10,11]. Music therapy has been controversial. Therefore, we quantitatively integrated all randomized found to effectively reduce negative emotions and improve physiolo- controlled studies and conducted a meta-analysis to explore the effec- gical symptoms [4,12]. Some studies have suggested that music therapy tiveness of music therapy for postpartum depression. is a special language which can affect the brain and emotional system, thus affecting cognitive, linguistic, and athletic ability [13,14]. Another 2. Methods study reported that the positive effect of music therapy was stronger when used in combination with pharmacotherapy [9]. Therefore, music 2.1. Search strategy therapy has been increasingly used in antidepressant therapy because of its effectiveness and the aforementioned advantages [15]. It has also This meta-analysis was completed with the guidance of Preferred been used to prevent and improve prenatal depression and postpartum Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) depression [16,17]. There are three categories of music therapy: [23], and it was registered in PROPESPO (CRD42019138002). Eligible ∗ Corresponding author. E-mail address: [email protected] (G.-w. Ding). https://doi.org/10.1016/j.ctcp.2019.09.002 Received 9 April 2019; Received in revised form 12 September 2019; Accepted 12 September 2019 Available online 16 September 2019 1744-3881/ © 2019 Elsevier Ltd. All rights reserved. W.-j. Yang, et al. Complementary Therapies in Clinical Practice 37 (2019) 93–101 Table 1 Research strategies for each research database. Database Search Strategy PubMed ((((“Depression, Postpartum" [Mesh]) OR ((((depressi*[Title/Abstract] OR blues [Title/Abstract] OR distress [Title/Abstract] OR bipolar [Title/Abstract] OR bi-polar [Title/Abstract] OR dysthymi* [Title/Abstract] OR melancholia [Title/Abstract]))) AND ((postpartum [Title/Abstract] OR post-partum [Title/Abstract] OR postnatal [Title/Abstract] OR “post natal” OR “post birth” [Title/Abstract] OR “after delivery” [Title/Abstract] OR “after birth” [Title/Abstract] OR puerperium [Title/Abstract] OR puerperal [Title/Abstract]))))) AND (((“Randomized Controlled Trial” [Publication Type] OR “Randomized Controlled Trials as Topic" [Mesh])) OR ((RCT [Title/Abstract] OR random [Title/Abstract] OR “controlled clinical trail” [Title/Abstract] OR placebo [Title/Abstract] OR “drug therapy” [Title/Abstract] OR trail [Title/Abstract] OR groups [Title/Abstract])))) AND ((((music [Title/Abstract] OR rhythm*[Title/Abstract] OR melod [Title/Abstract] OR sing [Title/Abstract] OR song*[Title/Abstract] OR compose [Title/Abstract] OR improvis*[Title/Abstract] OR audio [Title/Abstract] OR auditory [Title/Abstract] OR sound*[Title/Abstract] OR percussion [Title/Abstract] OR tempo*[Title/Abstract] OR acoustic [Title/Abstract] OR voice [Title/Abstract] OR vocalize [Title/Abstract]))) OR (“Music" [Mesh] OR “Music Therapy" [Mesh])) Web of Science TS: (RCT OR random OR “controlled clinical trail” OR placebo OR “drug therapy” OR trail OR groups) AND TS: (postpartum OR post-partum OR postnatal OR “post natal"OR “post birth” OR “after delivery” OR “after birth” OR puerperium OR puerperal) AND TS: (depressi* OR blues OR distress OR bipolar OR bi-polar OR dysthymi* OR melancholia) AND TS: (music OR rhythm* OR melod OR sing OR song* OR compose OR improvis* OR audio OR auditory OR sound* OR percussion OR tempo* OR acoustic OR voice OR vocalize) The Cochrane Library ((((postpartum OR postnatal OR post-partum OR puerperium OR puerperal):ti, ab, kw OR (after birth):ti ,ab, kw OR (post natal):ti, ab, kw OR (post birth):ti, ab, kw OR (after delivery):ti, ab, kw) AND ((depressi* OR blues OR distress OR bipolar OR bi-polar OR dysthymi* OR melancholia):ti,ab,kw)) OR (MeSH descriptor: [Depression, Postpartum] explode all trees)) AND ((MeSH descriptor: [Music] explode all trees) OR (MeSH descriptor: [Music Therapy] explode all trees) OR ((music OR rhythm* OR melod OR sing OR song* OR compose OR improvis* OR audio OR auditory OR sound* OR percussion OR tempo* OR acoustic OR voice OR vocalize):ti, ab ,kw)) AND ((MeSH descriptor: [Randomized Controlled Trials as Topic] explode all trees) OR ((RCT OR random OR “controlled clinical trail” OR placebo OR “drug therapy” OR trail OR groups):ti, ab, kw)) Embase ((‘music'/exp) OR (‘music therapy'/exp) OR (music:ab, ti OR rhythm*:ab, ti OR melod:ab, ti OR sing:ab, ti OR song*:ab, ti OR compose:ab, ti OR improvis*:ab, ti OR audio:ab, ti OR auditory:ab, ti OR sound*:ab, ti OR percussion:ab, ti OR tempo*:ab, ti OR acoustic:ab, ti OR voice:ab, ti OR vocalize:ab,ti)) AND (((postpartum:ab, ti OR ‘post partum':ab, ti OR postnatal:ab, ti OR puerperium:ab, ti OR puerperal:ab, ti OR ‘post natal':ab, ti OR ‘post birth':ab, ti OR ‘after delivery':ab, ti OR ‘after birth':ab,ti) AND (depressi*:ab, ti OR blues:ab, ti OR distress:ab, ti OR bipolar:ab, ti OR ‘bi polar':ab, ti OR dysthymi*:ab, ti OR melancholia:ab,ti)) OR (‘postnatal depression'/exp) AND ((‘randomized controlled trial (topic)'/exp) OR (‘randomized controlled trial'/exp) OR (rct:ab, ti OR random:ab, ti OR placebo:ab, ti OR trail:ab, ti OR groups:ab, ti OR ‘controlled clinical trail':ab, ti OR ‘drug therapy':ab,ti) CBM (“音乐"[不加权:扩展]OR"音乐疗法"[不加权:扩展]OR(音乐 OR音律 OR韵律 OR 乐曲 OR歌唱)[关键词]) AND (((产后 OR 母亲 OR 产褥期 OR 分娩)[关 键词]) AND ((抑郁 OR 忧郁)[关键词])) OR "产后抑郁"[不加权:扩展]) AND (“随机对照试验"[不加权:扩展]OR(随机对照 OR 对照 OR 随机)[关键词]) CBM = China Biology Medicine Database. studies were searched in PubMed (1966–November/2018), Embase 2.2.3. Interventions for the control group (1974–November/2018), the China Biology Medicine Database The control group was only offered standard treatment, including (1978–November/2018), the Cochrane Library (1993–November/ drug treatment, psychological treatment,
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