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

全世界多达五分之一的妇女受到围产期心理健康问题的影响。怀孕期间的压力、焦虑和抑郁不仅会影响母亲，还会通过子宫内的生物机制对她的孩子产生长期的不利影响。产后抑郁症会降低她提供敏感和反应性照顾的能力，这也会损害儿童的发育。围产期心理健康问题在低收入和中等收入国家是一项特别的挑战，在这些国家发生的频率至少是高收入国家的两倍。我们这项工作的地理背景将是西非的冈比亚，在那里，心理健康服务很少，围产期心理健康服务不存在，与心理健康问题相关的高度耻辱，以及特定的当地态度和信仰，阻碍了认识和阻止寻求帮助的行为。因此，高度优先发展新的低成本、低资源、不污名化和文化上适当的办法，以减轻围产期焦虑和抑郁症状，造福母亲和儿童。目前的项目表明，创造性的艺术——特别是集体歌唱——在冈比亚可以在减轻围产期精神痛苦方面显示出特别的希望。在发达国家，如英国和美国，集体演唱已被证明是情绪和情感的强大调节剂，通过包括同步、娱乐和荷尔蒙效应在内的充分证明的机制，对心理健康、福祉和社会关系产生积极影响。在冈比亚，以音乐为中心的方法可能特别有效，因为已经存在一系列专门针对孕妇和新妈妈的音乐实践。例如，婴儿命名仪式在出生后7天举行，这是一种音乐庆祝活动，以表彰新妈妈和她的家人，Kanyeleng团体的表演与怀孕和母亲密切相关。这些已有的文化和创造性做法为探索、共同设计和评估文化背景下以音乐为中心的干预措施提供了良好的环境，旨在减少围产期焦虑和抑郁症状，促进母婴护理。PI Stewart和合伙人Glover， Ramchandani和Cross在音乐和心理健康领域，特别是围产期心理健康领域带来了世界领先的专业知识，而Co-I Cornelius在临床试验的规划，开发和分析方面带来了世界领先的专业知识。国际合作i McConnell是冈比亚健康环境中音乐实际和潜在作用的领先专家，她在那里有几年的合作实地工作经验。在冈比亚，我们将与卫生和社会福利部（MOH&SW）的合作者Buba Darboe合作，他带来了对全国现有卫生服务和初级卫生保健工作者网络的了解，并与国家艺术和文化中心（NCAC）的合作者Hassoum Ceesay合作，他带来了对当地音乐实践多样性及其含义的了解。我们将雇用两名当地的研究生水平的研究助理，在每个站点主持一个。

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.