Harmony march 2017 by Dept of Medical Informatics

THE HAR MONY Bulletin CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH VOLUME VI

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ISSUE I

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MARCH 2017

EDITOR’S DESK Modern brain imaging studies have confirmed the power of music experiences to stimulate brain functions, regulate moods and emotions and reduce clinical depression symptoms. There are international guidelines to integrate interactive therapies like psychiatric counseling and psychotherapy in the treatment of depression. Further, positive clinical experiences using music in depressive disorders have also indicated that music therapy could be beneficial in addition to medication. In the treatment practice of depression at MGMCRI, music therapy is coupled with medication as a regular medical care for depression treatments. This is also backed by adequate research. The last issue of the Harmony already reported on a randomized controlled study conducted at CMTER in collaboration with the department of psychiatry on the “Effect of group singing improves depression scale scores and loneliness in geriatric individuals with mild depression.” This March 2017 issue also features an original research article on “The effect of adjunct music listening on the outcomes of depressive disorders “ Then there is the news on the Letter of Intent signing ceremony between SBV and Anglia Ruskin th

University for music therapy research. Also, next in line is the announcement of the 4 International Conference of Music Therapy planned on 10 3 2017. There is a photo gallery of the special events organized as a part of 6

anniversary celebrations and an international workshop conducted by Dr. Maria Montserrat Gimeno from the State University of New York at New Paltz on “Guided Imagery and Music.” Have a pleasant reading time.

INSIDE THIS ISSUE Editorial Featured Article CMTER in the Media 6th Anniversary Celebrations of CMTER 4th International Conference on Music Therapy Scientiﬁc Program MOU with Anglia Ruskin University, Cambridge, UK Photo Gallery

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FEATURED ARTICLE Title A STUDY OF THE EFFECT OF ADJUNCT MUSIC LISTENING ON THE OUTCOME OF DEPRESSIVE DISORDERS Balakrishnan K, Sivaprakash B, Sarkar S ,Sundar S Dr.Karthik B alakrishnan, Dept. of Psychiatry Dr.B.Siva Prakash, Professor, Dept. of Psychiatry Dr.Sukanto Sarkar, Asst. Professor, Dept. of Psychiatry Dr.Sumathy Sundar, Director, CMTER

INTRODUCTION Depressive disorders are common & have a major personal/economic & social impact. It is well known that a substantial proportion of patients suffering from depression do not achieve satisfactory clinical remission. Thus, depression is a common reason for the use of complementary therapies such as music. Methods that use music for health-related goals, but do not qualify as “music therapy” may be described as “music medicine”, or simply as “music listening”. Research has documented evidence of significant improvement in depressive scores due to music listening. However, review of the literature indicates conflicting findings too, as well as heterogeneity with regard to study design & methods. Moreover, there is a significant dearth of published Indian research in this context. Socio-cultural factors are important in the application of music in health care. There is also an urgent need to document the utility of complementary treatment methods that can improve the outcome of depressive disorders &maximize response rates. Thus, there is a need to study the effect of adjunctive music listening on the outcome of depression, in the Indian context.

OBJECTIVE This study aimed to test the hypothesis that the addition of music listening to standard care influences the outcome of depressive disorders. Various factors that could modify the effect of adjunctive music listening on the outcome of depressive disorders were also studied, such as socio-demographic variables, interest in music, alexithymia, & various illness-related variables.

METHODS Study design Quasi-experimental study design (pre-test - post-test, non-equivalent groups design; non- randomized intervention study). The study was conducted over a period of one year. Setting Department of Psychiatry, in a tertiary care hospital in Puducherry (Pondicherry), India

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Subjects All consecutive patients, aged 19 to 64 years, with a current depressive disorder (WHO ICD-10 F32, F33, F31.3, and F31.4) were considered for inclusion into the study, irrespective of current medication status. Patients with any of the following were excluded: psychosis, substance dependence, cognitive impairment, intellectual disability, or hearing loss. Patients requiring electroconvulsive therapy or cognitive-behavioural therapy were also excluded from the study. Informed consent was sought.

PROCEDURE The study protocol was approved by the institutional ethical committee. Ninety-eight patients were screened with reference to the specified inclusion & exclusion criteria. Five were excluded from the study, based on exclusion criteria. Ninety-three patients were included, after obtaining informed consent. Patients were categorized into 3 groups (A, B & C), based on need for hospitalization & access to a suitable digital music playback device with headphones. Patients in Group A received daily sessions of investigator-supervised adjunctive music listening for a duration of 10 sessions (30 min each), in the in-patient unit, followed by 20 sessions of self-administered home-based music listening, along with standard care. Patients in Group B received only home-based music listening (30 sessions), along with standard care. Patients in Group C received standard care alone, without adjunctive music listening. Appropriate / suitable music tracks from various musical genres (Indian classical, Western classical, New Age) were selected and compiled into several playlists. Subjects in groups A & B listened to a music playlist selected by them, through headphones, while reclining on a couch, in a quiet room, in the evening. Subjects were rated using the following tools: Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Schalling-Sifneos Personality Scale for alexithymia (SSPS), Interest in Music Scale (IIM), Clinical Global Impressions Scale: Illness severity (CGI-S) & Clinical Global Impressions Scale: Change / Improvement (CGI-C). Ratings on MADRS & HARS were obtained at baseline, day 10 & day 30. Ratings on IIM & SSPS were done at baseline only. CGI-S was applied at baseline, day 10 & day 30. CGI-C was applied at day 10 & day 30. 3 patients dropped out during the study. Analysis was done on 90 subjects who completed the study.

RESULTS The mean age of the sample was 39 ± 11.08 years. Age of the study subjects ranged from 19 to 60 yrs. Majority of the subjects in group A were from the middle class. Most of the subjects in groups B & C were from the lower / upper lower class. Majority of subjects in all 3 groups were married. There was no significant difference between the 3 groups in terms of depression, anxiety & CGI-S scores at baseline. Patients in group A had marginally higher interest in music, & a marginally higher level of alexithymia. Western classical music (JS Bach) was chosen by the largest number of patients, in both groups.

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The overall depression, anxiety & CGI-S scores were lower in all 3 groups at 30th day compared to baseline. Though the fall in depression score over a period of 1 month was highest in group A, no statistically significant difference was noted. However, fall in anxiety scores seemed to be approaching statistical significance (p = 0.053), with the largest fall noted in group A. No significant difference was noted between the experimental groups (A & B), in terms of change in depression scores over one month. No significant correlation was noted between interest in music and change in depression & anxiety scores, in the experimental groups (A & B). A significant correlation between alexithymia and change in depression was noted only in group B (p = 0.041). No significant association was found between type of music selected & outcome, in the experimental groups (A & B). One of the objectives of the study was to analyze the predictive effect of sociodemographic variables, clinical variables & alexithymia, on the influence of adjunctive music listening on the outcome of depressive disorders. In patients with a moderate baseline depression score, area of domicile emerged as a significant predictor (p = 0.004). In patients with moderate anxiety level, total duration of illness and current duration of illness emerged as significant predictors (p < 0.001), along with marital status (p = 0.044). In patients with severe anxiety level, total duration of illness & age emerged as significant predictors (p < 0.05).

CONCLUSION A sequential combination of hospital-based / clinician-supervised adjunctive music listening followed by homebased music listening, resulted in the largest fall in both depression & anxiety scores, over a period of 1 month, in patients with depressive disorders. However, the fall in depression scores were not statistically significant, while the reduction in anxiety scores approached statistical significance. However, these results need to be interpreted with caution, in view of the short follow-up period, which is a limitation of this study. It is conceivable that the results would have been different with a longer study period, such as 3-6 months. It is noteworthy that no significant correlation was noted between interest in music and change in depression & anxiety scores. Interestingly, the type of music selected by many subjects seemed to transcend socio-cultural context. Overall, the results of this study are encouraging. Further research is recommended to study the effect of adjunctive music listening on the outcome of depressive disorders, in the Indian context, with a larger sample & longer follow-up.