Music Therapy as an Intervention for Depression: Evidence Review

Clinical Question and PICOT Framework

Nursing Diagnosis: Ineffective coping with psychiatric symptoms exacerbates the difficulties brought on by a mental health disorder. Ineffective coping strategies are evidenced by poor concentration, low self-esteem, and poor self-care.

Population: The population of interest is outpatients suffering from depression.

Intervention: Provide opportunities for patients to listen to music in order to help alleviate or manage symptoms of this psychiatric disorder.

Narrative Discussion of the Evidence

Comparison: Does music therapy contribute to fewer depressive symptoms? How effective is music therapy in helping patients develop suitable coping strategies for depression?

Outcome: Improved quality of life, including reduced depression levels and improved ability to cope with psychiatric symptoms through listening to music.

Clinical Question: Is listening to music effective in lessening psychiatric symptoms in depressive patients receiving music therapy? The purpose of this paper is to explore the effectiveness of using music as an intervention for depressive symptoms and improved quality of life based on existing evidence-based practice.

In Chan et al. (2012), the objective of the study was to determine the impact of music on depression levels in older adults. To achieve this objective, the researchers conducted a randomized controlled study on 50 older adults who listened to their preferred music at home for 30 minutes weekly over eight weeks. Depression scores collected once per week demonstrated that depression levels decreased each week among participants in the music group, compared to a non-music control group observed during the same period.

Comparing and Contrasting the Two Studies

Atiwannapat et al. (2016) conducted research to explore the impacts of "active group music therapy and receptive group music therapy compared to counseling in the treatment of major depressive disorder" (p. 141). The researchers randomly identified and assigned 14 major depressive disorder outpatients to one of three conditions: active music therapy, receptive group music therapy, or group counseling. After assessing participants at baseline, they found that receptive group music therapy is characterized by faster achievement of peak therapeutic effect, whereas active group music therapy produces a higher peak impact overall.

There were notable similarities and differences between both studies that can influence how music therapy is recommended as an intervention for reducing depression levels. First, both studies agree that music therapy is a non-pharmacological intervention that can assist in the management of depression among outpatients. Both studies considered music therapy partly because pharmacological treatment measures are often associated with adverse effects and are sometimes ineffective.

Second, both studies employed a randomized controlled trial design, which is considered a true experiment. This research design enhances the likelihood that study findings are not attributable to chance. Given this shared design, the findings from both studies relatively represent the actual impact of music in outpatient settings.

Third, both studies were conducted in outpatient settings on a weekly basis, which was appropriate for determining how the intervention affected patients with depression. Fourth, both studies grouped participants into distinct categories — one in which the intervention was used and another serving as a control group not subjected to the intervention.

Chan et al. (2012) conducted the trial in participants' homes, where a research nurse visited weekly to gather depression scores for eight weeks; data were collected between July 2009 and June 2010. The study also utilized a one-tailed repeated-measures analysis of covariance (RM ANCOVA) to examine effects, with a medium effect size selected based on findings from prior research. Four categories of music — Malay, Western, Chinese, and Indian — were first introduced to the subjects. For data analysis, Chan et al. (2012) used descriptive statistics to characterize the groups, while a chi-square test was used to assess homogeneity between groups.

Unlike Chan et al. (2012), Atiwannapat et al. (2016) divided participants into three groups and conducted the study as part of group therapy for outpatients with depression. Participants in this study not only listened to music but also sang and played musical instruments. The study also incorporated lyric analysis, songwriting, and drawing in response to music — activities that distinguished it from the simpler listening-based design of the other study. Thus, Atiwannapat et al. (2016) explored a broader range of music-related activities rather than passive listening alone. For data analysis, this study used STATA version 13, Kruskal-Wallis tests, and Fisher's exact test.

While Chan et al. (2012) focused on older patients aged 55 years or more, Atiwannapat et al. (2016) enrolled participants aged between 16 and 65 years. These differences in age group and study period made direct comparison of results difficult. Nevertheless, both articles provide meaningful evidence that music therapy helps reduce depression levels among outpatients.

Using the Newhouse Level of Evidence framework, both studies contained weaknesses that are addressed in the Appendix. Chan et al. (2012) received a rating of I-B good because of its fairly definitive conclusions, which are consistent with an adequate number of well-defined studies (Newhouse, 2006). Atiwannapat et al. (2016) also obtained a Newhouse score of I-B good, reflecting an insufficient sample size but reasonably consistent results and the use of reliable and valid research methodology.