Singing for Postnatal Depression: The SHAPER-PND study protocol

An estimated 13% of new mothers suffer from postnatal depression, with symptoms including fatigue, sadness, low mood and insomnia. Despite positive results with medication and talking therapies, these are not beneficial for all mothers, or barriers to treatment (long waiting lists, fears around medication while breastfeeding) mean that other solutions are needed.


To understand whether community group singing reduces symptoms of postnatal depression in new mothers in South London, the team of researchers from the SHAPER programme (lead by Prof Carmine Pariante, editor of InSPIre the Mind and Dr Daisy Fancourt) set up a randomised clinical trial, SHAPER-PND, to recruit 400 women with symptoms of postnatal depression and their babies. You can read the published protocol paper here. We were also interested in understanding the biological background of postnatal depression and how singing might influence it, so we are collecting saliva and hair samples to look at cytokines, cortisol and oxytocin.


A Melodies for Mums session. Photo credit: Breathe Arts Health Research

I am a project manager and postdoctoral researcher at the SPI Lab — by day a researcher on SHAPER and by night a writer, assistant editor and podcaster for InSPIre the Mind 😉 You can read my blogs on arts and health, yoga and inflammation and yoga and mental health — and stay tuned for our podcast too!


Postnatal depression


It has been found that PND has implications not only for maternal health and wellbeing but also for the relationship between mother and child. A depressed mother is also more likely to report lower feelings of attachment to their baby, and challenges with attachment have long been linked to optimal child development, including mental health problems in the future. Consequently, early intervention is necessary to improve mother-infant interaction to protect future offspring development.


However, many mothers participate in community group activities, such as mother-infant playgroups that are frequently music-based, as they have been shown to provide a sense of personal fulfilment, relaxation and social interaction. There is growing evidence that community group singing is beneficial to mental health.


Inflammation, the stress hormone and the bonding hormone: the biological background in postnatal depression


The most well-studied biological explanation for the benefits of music engagement on mood is the hypothalamic-pituitary-adrenal (HPA) axis, whose main product is cortisol, the stress hormone. According to various studies, singing reduces cortisol levels and increases cytokine levels, showing an impact of singing on inflammation.


It has also been shown that singing increases oxytocin levels, the bonding hormone. Only one study has investigated the biological effects of maternal singing groups, which found a decrease in cortisol and an increase in oxytocin.


A Melodies for Mums session. Photo credit: Breathe Arts Health Research

The SHAPER-PND trial


SHAPER-PND has a unique Hybrid Type II Effectiveness-Implementation design, which means that instead of just the effectiveness for postnatal depression, we are also looking at how the singing intervention can be scaled-up, as in, done across the country and in the future, embedded into the NHS.


This trial is currently recruiting new mothers with symptoms of postnatal depression (according to the Edinburgh Postnatal Depression Scale) and their babies up to the age of nine months across London (primarily in the South London boroughs of Lewisham, Lambeth and Southwark). Mothers will be randomly allocated to either singing sessions or a control group.


The singing sessions, aptly named "Melodies for Mums", run in children's or community venues across ten weeks, delivered by Breathe Arts Health Research. The programme is delivered to groups of 8–12 mothers in weekly sessions that last for one hour. Mothers attend with their babies and are invited to sit in a circle on the floor, surrounded by soft play cushions and mats. Classes start with welcome songs, introducing the babies and mothers to one another, and then involve a range of singing and music activities. Some songs are accompanied by maracas, drums, hand chimes and other instruments that the mothers and babies can play. Classes are led by professional workshop leaders trained by Breathe, with the support of assistants.


A Melodies for Mums session. Photo credit: Breathe Arts Health Research

The control group receive details of other non-music classes available to them in the community, such as messy play, baby swimming or baby massage, where participants will join other mothers and their babies. For the control participants, after the first ten weeks, they are offered a place in the singing programme, but these data will not be part of the study.


The data collection from participants will be done at baseline, before the start of the trial and at weeks 1, 3, 6, 10, 20 and 36 post enrolment in the study. A package of measurements will be collected from participants during Zoom calls or on an online database for clinical, mechanistic and implementation outcomes at different stages of the trial. Clinical assessments will include questionnaires and interviews for demographics, mental health, and social measures, together with biological samples: saliva (diurnal cortisol & session cortisol, oxytocin and cytokines) and hair (3-month output of cortisol).


We hope this study will bring evidence to the field of social prescribing and arts in health — and offer an art's-based activity that many mothers can participate in with their babies to improve their mental health.


Share with your network! The next 10-week programme is starting on:

Tuesday 4th October 2022 10.30–11.30 at Sunnyhill Children's Centre 13.30–14.30 at Stockwell Children's Centre

Thursday 6th October 2022 13.30–14.30 at Pilgrim's Way Children's Centre

Register your interest here: https://breatheahr.org/forms/breathe-melodies-for-mums-shaper-registration-form/

The findings of this study will be published in peer-review journals. Participants will receive a newsletter with a summary of the study's results. For more details on the protocol, you can read the protocol paper and consult the trial registration. This trial (NCT04834622) is part of the SHAPER programme, a Scaling-up Health-Arts Programme to scale up arts interventions.