Methods
In the target population of patient with depression, can the use of music therapy as an intervention as compared to standard care improve the sleep patterns within the timeframe of 6 to 12 months?
This research question had been developed using the PICOT format which is one of the most useful and systematic format that has been used in the evidence based research. The PICOT format stands for five interconnected elements relevant to an evidence based research, population, intervention, comparison, outcome, and timeframe. In this question, the population selected is the patients with depression, and the intervention selected is music therapy, the comparison selected in standard treatment regimen, the desired outcome is improved sleep patterns, and the selected time frame is six to twelve months. Hence, it can be easily concluded that the question fits the PICOT format perfectly (Saimbert, Pierce & Hargwood, 2016).
Depression is a very common mental health issues and it is prevalent in a variety of different age groups (Petrovsky, Cacchione & George, 2015). Among the various other symptoms that are associated with diagnosis of depression, the complaint of inability to fall asleep is all too common. According to the recent statistical reports, the percentage of Australians living with depression is close to three million, and almost 50% of them present with a co-occurring disorder of insomnia, which further worsens the depression symptoms (Beyondblue.org.au, 2018). The impact of sleep deprivation is extreme on depression, the negative thoughts, anxiety and restlessness which is associated with depression symptoms act as significant challenges in obtaining a peaceful sleep (Tai, Wang & Yang, 2015). This in turn further deteriorates the negative thought pattern of a depression, aggravating the hopelessness, helplessness, and can even provoke suicidality among the patients. Hence, discovering a non-pharmacological and nontoxic intervention for promoting sleep patterns among the patients with depression is the key topic area which I have selected for this research paper (Tsai et al., 2014).
This PICO questions had been developed by a number of different trial and error methods. I had to rephrase the question and the elements or phrases chosen a couple of times to avail the best available research hits. For instance, I had to change the time frame selected a couple of times from 3 months to 6 months and ultimately to 12 months to be able to get optimal results in the research, especially to ensure getting finding primary evidence and systematic reviews in the study. Ultimately, my peers have helped me as well in modifying and improvising and I am extremely grateful for their support and assistance.
Results
A number of different databases have been used in the research study in order to avail the most relevant primary research evidences. However, the main database from which the article have been chosen and used in the research paper had been Medline. There are various contributing factors that has propelled the choice of Medline as the chosen database for the research paper. First and foremost, it has to be mentioned that Medline is an excellent resource for medical or clinical research studies as it provides the access to peer-reviewed and complete research articles along with the articles being authorative evidences (McGowan & Murray, 2016). Along with that, Medline is the only database that contains more than 12 million references to scientific literature. Along with that, the Medline is the only database which can provide the access to most extensive research articles, hence it has been chosen for this study as the main database.
However, there have been other databases used for the research as well which helped us to sort out the articles to be used the study and for collecting a few key supporting articles that has been used in this assignment. The three article databases used in this article had been devoid of any available pre-set filters, as a result these databases helped in only obtaining article for the preliminary research for the study and obtain supporting paper for the articles. The databases used had been Google scholar, Cochrane library, and PubMed database. Each of the database has helped us arrive at a list of apt supportive literature based on which the final search will be performed using Medline database. In this case the search strategy has used Boolean operators and different delimiters such as abstract, peer reviewed and only 2014 onwards to ensure that the research articles chosen for the final paper are relevant, accurate and recent. The subject headings for the final search had been different combinations of the research phrases selected for the paper. The search phrases used for the assignment had been ‘depression’, ‘sleeping patterns’, ‘insomnia’, ‘music therapy’, ‘standard treatment’, ‘intervention’, ‘sleep cycle’.
First and foremost, I had used the three pre-set filter databases, Google scholar, Cochrane library and PubMed, to gather preliminary research evidence to start the paper on the topic area. After which the research question was crafted using the PICOT format (McGowan & Murray, 2016). After which the Medline database was accessed through the MYSCU library and preliminary research was carried out using three of the search phrases and Boolean operator ‘OR’. The first search had been successful with overwhelming results of 99000 hits. In order to narrow down the evidence list and enhance the relevance and accuracy of the research, I applied the limiter of full text, which narrowed down the results to 3099 results. After which I added one more limiter of English language to further narrow down the research, which narrowed the result hits to 3068 articles.
Discussion
After which I had to apply a third limiter of abstract available to reduce the evidence size further, which brought the total result to 2900 hits. Then I had to limit the study to only Australia based researches and peer reviewed which helped narrow down the research to 98 article and then I had limited to age group as the older adults which narrowed the results further to 98 results. The last limiter applied had been depression as a major heading which helped narrow down the result obtained to 19 articles, out of which I selected five most relevant articles for the paper on the basis of my best understanding.
Two primary research articles which had been used in the research study as the main articles for the assignment had been a pilot project and a systematic review. It has to be mentioned in this context that both of these articles which had been used for this academic research study had been based on the effectiveness of the music therapy in the context of improving sleep quality and duration for the elderly patients with depression which had been the target population chosen for the research paper. Elaborating on the first research article, by Lund and Pederson (2016), the primary aim of the article had been to determine the effectiveness of sound pillows to improve the sleep quality for the elderly patients with depression and bipolar disorders. Undoubtedly, this research study had focused on the a novel product, a sound pillow which had been infused with a customized designed playlists, especially calm music for the target patients to use for 30 days straight. The data was collected in the form of short semi structured interviews four times throughout the listening period with respect to the follow up data collection. The result of this primary evidence described that music listening is extremely helpful in facilitating better sleep quality in the patients that are struggling with depression. The research study had been a pilot project which had been clear and succinct in providing key information regarding the chosen topic area and has helped in determining the best possible data in the most easy to understand format. This research article has also been the only article to focus on only older adults as the target population al;igning with the criteria of this research study effectively, hence, it had been chosen for this research paper.
Limitations
The second systematic review which is used had been by Feng et al. (2017), which also focussed on the effectiveness of music therapy to improve the sleep patterns in the older adults struggling with insomnia due to mental illnesses. The meta analysis design utilized all available literature, especially relevant clinical trials, and the database information has been identified from PubMed, Embase, the Cochrane Library. The results indicated that the insomnia issues of the older adults are effectively managed by the use of music therapy as a standalone intervention. Along with that, the authors have also concluded that music associated relaxation is the best possible intervention method to help the older adults struggling with insomnia and associated mental illnesses such as depression. The clear and succinct design and thorough and extensive meta-analysis had been the key reason for selecting this article as the second choice of systematic review.
A few other articles had been rejected due to relevancy and authenticity issues in the research study including the study by Huang, Chang, Hsieh and Lai (2017), which had been a RCT judging the effect of music video intervention in adults with sleep disturbance due to the small sample size and partial irrelevance. The study by Zhao, Bai, Bo and Chi (2016) on effectiveness of music therapy for older adults with depression was rejected for lack of focus on sleep improvement. The article by Shum, Taylor, Thayala and Chan (2014) had been rejected due to irrelevance as well as it had not focussed on depression. The last study rejected had been by Gaewlai et al. (2018) which had a very small sample size limiting the transferability of the study.
References:
Beyondblue.org.au (2018). Statistics and references. Retrieved from https://www.beyondblue.org.au/about-us/research-projects/statistics-and-references [Accessed on 10th Nov]
Feng, F., Zhang, Y., Hou, J., Cai, J., Jiang, Q., Li, X., … & Li, B. A. (2017). Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis. International journal of nursing studies. Doi: 10.1016/j.ijnurstu.2017.10.011
Gaewlai, P., Vallibhakara, S. A. O., Perkins, K. M., Chantra, M., Sephu, S., Wisajun, P., & Awirutworakul, T. (2018). Comparative Effectiveness of Active Group Music Therapy in Major Depressive Disorder Compared to Standard Group Psychotherapy: A Randomized Controlled Trial. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND, 101(4), 529. Retrieved from https://www.jmatonline.com/index.php/jmat/article/view/8902
Huang, C. Y., Chang, E. T., Hsieh, Y. M., & Lai, H. L. (2017). Effects of music and music video interventions on sleep quality: A randomized controlled trial in adults with sleep disturbances. Complementary therapies in medicine, 34, 116-122. Doi: 10.1016/j.ctim.2017.08.015
Lund, H. N., & Pedersen, I. N. (2016). Pilot Project: Sound pillow treatment to improve sleep quality for patients with depression or bipolar diagnosis with sleeping problems. European Psychiatry, 33, S80. Doi: 10.1016/j.eurpsy.2016.01.026
McGowan, J. E., & Murray, K. (2016). Exploring resilience in nursing and midwifery students: a literature review. Journal of advanced nursing, 72(10), 2272-2283. Doi: 10.5195/jmla.2018.345
Petrovsky, D., Cacchione, P. Z., & George, M. (2015). Review of the effect of music interventions on symptoms of anxiety and depression in older adults with mild dementia. International psychogeriatrics, 27(10), 1661-1670. Retrieved from https://www.cambridge.org/core/journals/international-psychogeriatrics/article/review-of-the-effect-of-music-interventions-on-symptoms-of-anxiety-and-depression-in-older-adults-with-mild-dementia/DE257F0A0B088D33695A8AE9DE676C75
Saimbert, M., Pierce, J., & Hargwood, P. (2016). Developing Clinical Questions for Systematic Review. Comprehensive Systematic Review for Advanced Practice Nursing, 79. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=2SsODAAAQBAJ&oi=fnd&pg=PA79&dq=pico+framework+mcgowan&ots=IPmybxVYJJ&sig=LTbKkzO4-jFEfNxdndoqmr4JKvg#v=onepage&q&f=false
Shum, A., Taylor, B. J., Thayala, J., & Chan, M. F. (2014). The effects of sedative music on sleep quality of older community-dwelling adults in Singapore. Complementary therapies in medicine, 22(1), 49-56. Doi: 10.1016/j.ctim.2013.11.003
Tai, S. Y., Wang, L. C., & Yang, Y. H. (2015). Effect of music intervention on the cognitive and depression status of senior apartment residents in Taiwan. Neuropsychiatric disease and treatment, 11, 1449. Doi: 10.2147/NDT.S82572
Tsai, H. F., Chen, Y. R., Chung, M. H., Liao, Y. M., Chi, M. J., Chang, C. C., & Chou, K. R. (2014). Effectiveness of music intervention in ameliorating cancer patients’ anxiety, depression, pain, and fatigue: A meta-analysis. Cancer nursing, 37(6), E35-E50. Retrieved from https://journals.lww.com/cancernursingonline/Abstract/2014/11000/Effectiveness_of_Music_Intervention_in.14.aspx
Zhao, K., Bai, Z. G., Bo, A., & Chi, I. (2016). A systematic review and meta?analysis of music therapy for the older adults with depression. International journal of geriatric psychiatry, 31(11), 1188-1198. Doi: 10.1002/gps.4494
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