Clinical effectiveness, implementation effectiveness and cost-effectiveness of a community singing intervention for postnatal depressive symptoms, SHAPER-PND: randomised controlled trial.

Abstract

Postnatal depression (PND) affects up to one in four mothers. However, they may experience barriers to access to conventional treatments, indicating a need for alternatives such as arts-based interventions. A previous trial showed that a 10-week singing intervention could alleviate symptoms of PND. To evaluate, in a larger sample and across a longer timeframe than previously, the clinical effectiveness, implementation effectiveness and cost-effectiveness of the Melodies for Mums (M4M) singing intervention for symptoms of PND. One-hundred and ninety-nine mothers experiencing symptoms of PND (Edinburgh Postnatal Depression Scale score ≥10) and their babies were randomised to 10 weeks of in-person singing sessions (M4M, <i>n</i> = 133) or an active control (existing community-based mother-baby activities, <i>n</i> = 66). Mothers were re-assessed at weeks 6, 10, 20 and 36 for depression, healthcare use for themselves and their babies, and health-related quality of life according to the EQ5D-3. The perceived acceptability (Acceptability of Intervention Measure), appropriateness (Intervention Appropriateness Measure) and feasibility (Feasibility of Intervention Measure) of the activity were also assessed at week 6. Trial registration number: NCT04834622. Mothers in both groups experienced attenuation of depressive symptoms by week 10; however, those in the singing group maintained lower EPDS scores than those in the control group at week 20 (10.7 <i>v</i>. 12.2 (mean difference 95% CI [-2.96, -0.22]), <i>P</i> = 0.023) and week 36 (9.85 <i>v</i>. 11.4 [-2.93, -0.19], <i>P</i> = 0.026). Mothers in the singing group were also more likely to remain in the study (77 <i>v</i>. 57%, <i>χ</i>²(1) = 12.92, <i>P</i> < 0.001) and found their programme more acceptable (4.75 <i>v.</i> 4.0 [0.25, 0.83], <i>U</i> = 2436.5, <i>P</i> < 0.001), appropriate (4.25 <i>v</i>. 3.88 [0.12, 0.62], <i>U</i> = 2241.5, <i>P</i> < 0.001) and feasible (4.75 <i>v</i>. 4.0 [0.41, 0.91], <i>U</i> = 2568.0, <i>P</i> < 0.001). Finally, M4M was associated with 15 extra days of health and was found to be cost-effective (£126-539 per dyad). M4M had a long-lasting effect on symptoms of PND and was perceived to be more suitable than existing activities; thus, M4M represents a worthwhile investment for healthcare systems as an intervention for mothers experiencing symptoms of PND.