Developing a Community Singing-Based Intervention for Perinatal Mental Health in The Gambia

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Perinatal mental health problems affect up to 1 in 5 women worldwide. Stress, anxiety and depression in pregnancy affects not only the mother but can also have long-term adverse effects on her child, via biological mechanisms in utero. Postnatal depression can reduce her ability to provide sensitive and responsive caregiving, and this can also impair child development. 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. Our geographical context for this work will be The Gambia, West Africa, where mental health services are minimal, services for perinatal mental health are non-existent and high levels of stigma associated with mental health issues, as well as specific local attitudes and beliefs, impede recognition and prevent help-seeking behaviour. 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 perinatally, for the benefit of both mother and child. The current project suggests that the creative arts - in particular group singing - could show special promise in alleviating perinatal mental distress in The Gambia. In developed countries, such as the UK and the USA, singing in groups has been shown to be a powerful modulator of mood and emotion, evoking positive effects on mental health, well-being and social affiliation via well-attested mechanisms involving synchrony, entrainment and hormonal effects. Music-centred approaches may be particularly fruitful to apply in The Gambia, since there already exist a range of musical practices that specifically engage pregnant women and new mothers. For instance, infant naming ceremonies occur 7 days after birth and are musical celebrations to recognise the new mother and her family, and performances by Kanyeleng groups are closely associated with pregnancy and motherhood. These pre-existing cultural and creative practices provide an excellent context from which to explore, co-design and evaluate culturally-situated music-centred interventions that aim to reduce symptoms of anxiety and depression perinatally and facilitate mother-infant caregiving.PI Stewart and Co-Is Glover, Ramchandani and Cross, bring world-leading expertise across the domains of music and mental health, particularly perinatal mental health, while Co-I Cornelius brings world-leading expertise in the planning, development and analysis of clinical trials. International Co-I McConnell is a leading expert on the actual, as well as the potential roles of music in health contexts in The Gambia, where she has several years of experience in collaborative fieldwork. Within The Gambia we will work with collaborator Buba Darboe at the Ministry of Health and Social Welfare (MOH&SW), who brings understanding of existing health services and access to a network of primary healthcare workers throughout the country, and collaborator Hassoum Ceesay at the National Centre for Arts and Culture (NCAC), who brings understanding of the diversity of local musical practices and the meanings attached to them. We will employ two local graduate-level research assistants, one hosted at each site.