Developing a community-led music intervention to support antenatal mental health in The Gambia

Abstract

Stress, anxiety and depression in pregnancy affect not only the mother but can also have long-term adverse effects on her child. Mental health problems in the perinatal period are a particular challenge in low- and middle-income countries (LMICs) where they can be at least twice as frequent as in higher-income countries (HICs). It is thus of high priority to develop new low-cost, low-resource, non-stigmatising and culturally appropriate approaches to reduce symptoms of anxiety and depression in pregnancy. Using a mixed-methods approach, this thesis aims to investigate how a community-led music intervention can be developed and implemented within The Gambia to help reduce symptoms of antenatal common mental disorders (CMDs). The first study summarises findings from 14 focus group discussions with a variety of stakeholders (health workers, musicians and pregnant women). A pictorial representation presents the three main contributing factors to mental distress symptoms: economic, social, and spiritual. The next study finds that two existing self-report tools, the Edinburgh Postnatal Depression Scale (EPDS) and the Self-Reporting Questionnaire (SRQ-20), can be used in The Gambia to measure antenatal CMD symptoms. A different distribution of scores is found, with the SRQ-20, which has more somatic items, giving higher scores. Differences in factor structures of the EPDS in a Gambian versus UK context shows potential differences in the expression of CMD symptoms between the two cultures. The final study demonstrates that a community health intervention through musical engagement (CHIME) can be co-developed and is feasible to administer within a Gambian context. Results also suggest a beneficial effect of CHIME compared to standard care and a potential greater reduction in symptoms in participants with higher levels of CMD symptoms. This thesis is the first to highlight the potential of music interventions to support women’s perinatal mental health care in a LMIC context.