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

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.

This project aims to explore how music-based approaches can be used to support women's mental health during pregnancy and after birth in The Gambia. Focus groups and interview approaches, along with observations and recordings from the national archives, will delineate the existing roles of music, particularly singing, during pregnancy and birth in The Gambia, providing a foundation from which to design and evaluate culturally-appropriate interventions to reduce symptoms of anxiety and depression and facilitate mother-infant caregiving. In parallel, we will develop and embed new curricula on perinatal mental health at the local medical and nursing schools.

The potential beneficiaries of this project are:

Pregnant women and new mothers:
Even though mental distress during pregnancy and after birth will affect 1 in 5 women, the absence of mental health services in The Gambia, coupled with the stigma associated with mental illness in general, results in high levels of unmet need in this group. The development of a low-cost, low-resource intervention, that is rooted in local health and cultural practices, will address this unmet need, alleviating symptoms of anxiety and depression before and after birth, benefitting the women, their families and society at large.

Infants and children:
Early child development is known to be significantly impacted by a woman's mental state during pregnancy and immediately after birth. Supporting women in the perinatal period, both in terms of their mental health and their caregiving capacities will provide strong foundations for their infants' cognitive and socio-emotional development.

Health professionals in The Gambia:
The new curricula that we will establish at the medical and nursing schools in The Gambia will provide the skills and knowledge needed in local communities to recognise and tackle mental health challenges in the perinatal period, despite the current barriers to tackling these issues (high levels of stigma, specific beliefs and attitudes around mental illness, lack of appropriate tools for the detection and evaluation of mental health issues).

Partner organisations: Ministry of Health and Social Welfare (MOH&SW) and National Centre for Arts and Culture (NCAC):
Our partner organisations bring a wealth of local expertise and infrastructure in biomedical research, health and social policy and arts and culture. The project, which cuts across each of these areas, will provide a unique opportunity for these organisations to work with each other, as well as with world-leaders in music and mental health to address a shared goal, in developing sustainable approaches for promoting mental health and wellbeing in The Gambia. The contributions we will make to the National Centre for Arts and Culture, in terms of new audio and video material from the exploratory qualitative work around existing roles of music in the perinatal period, will support the NCAC in their important goal to preserve and disseminate traditional music practices and knowledge.

Health organisations in the UK:
Low-cost, low-resource interventions for perinatal mental health also have applicability in higher income countries such as the UK, where there is an increasing need to provide innovative healthcare with limited resources. The co-development, reciprocal learning and knowledge sharing from current project will provide a model for UK-based health organisations and policymakers to consider the impact of creative and arts-based activities on health, well-being and social cohesion.