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

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.

A qualitative exploration of active ingredients and mechanisms of action of an online singing programme with mothers experiencing postnatal depression during the COVID-19 pandemic: SHAPER-PNDO study.

“…The online format was implemented directly in response to the suspension of inperson groups due to social distancing restrictions and provided an opportunity to explore whether similar ingredients and mechanisms to improved mental health might be observed by participating online as in person. Our study helps interpret the ndings of the feasibility trial (27) by mapping out programme ingredients that seemed to trigger mechanisms which then impacted PND symptoms, as well as identifying ingredients unique to online delivery such as being able to sing on mute at home which led to increased con dence in singing.…”

“…For example, previous research on virtual choirs has shown that participants engaging virtually report lower and more variable social presence than participants of in-person choirs (29). Yet in the M4M-online intervention, the outcome ndings suggested comparable bene ts to mental health in the in-person intervention (20,27). This raises the question as to whether the 'core' ingredients most responsible for effects were nonetheless still present, even if there were changes to other ingredients that may have been more peripheral.…”

“…The COVID-19 Pandemic led to the suspension of in-person community activities, with group singing deemed as a high-risk activity due to the greater potential for virus transmission via respiratory droplets (23). During this time, many in-person arts activities moved online (24) and M4M was adapted into a sixweek online intervention which aimed to replicate as closely as possible its face-to-face counterpart (25). Online delivery enabled participants to be recruited from across the UK and mitigated COVID-19 related obstacles to participating in group activities such as fear of contracting COVID-19 at a time when access to services and support were severely restricted (25,26).…”

“…During this time, many in-person arts activities moved online (24) and M4M was adapted into a sixweek online intervention which aimed to replicate as closely as possible its face-to-face counterpart (25). Online delivery enabled participants to be recruited from across the UK and mitigated COVID-19 related obstacles to participating in group activities such as fear of contracting COVID-19 at a time when access to services and support were severely restricted (25,26). M4M-online was associated with signi cant reductions in PND symptoms, anxiety and stress with positive effects observed at weeks three and six that were maintained at 6-month follow-up, however no impact of M4M-online was observed on quantitative measures of social support or loneliness (27).…”

Feasibility, clinical efficacy, and well-being outcomes of an online singing intervention for postnatal depression in the UK: SHAPER-PNDO, a single-arm clinical trial

“…The scale-up of the community M4M is underway as part of the larger SHAPER programme [ 25 ], but the COVID-19 pandemic led to the development of an online adaptation of M4M (SHAPER-PNDO), presented here. This was a 6-weekly online intervention adapted from the original community 10-week M4M, as described in the published protocol [ 26 ]. To reduce the risk of disengagement by participants that may happen with online interventions, the duration was shortened from the 10 weeks to 6 weeks, as this is the earliest time point that showed significant antidepressant effects in the community M4M study [ 24 ].…”