Prenatal listening to songs composed for pregnancy and symptoms of anxiety and depression: a pilot study

There is good evidence that if a mother is anxious, depressed or stressed while she is pregnant, this is not only distressing for the mother, but it can also cause problems for her future child [1]. The child is at increased risk for anxiety and depression, behavioural problems such as Attention Deficit Hyperactivity Disorder (ADHD) and conduct disorder, as well as sub-optimal cognitive development [2]. There is also an increased risk of physical problems such as asthma and altered immune function [3, 4]. All this appears to be, at least in part, due to fetal programming. The mother is also more likely to suffer from postnatal depression if she is anxious or depressed while pregnant and her baby is likely to be premature and smaller for gestational age [5]. These consequences can occur with mild to moderate symptoms of anxiety and depression, not only with severe stress or a clinically diagnosed mental illness [6]. It is therefore very important both to detect and to help ameliorate symptoms of anxiety and depression in pregnant women [7]. Many women do not want pharmacological interventions at this time, and with less severe symptoms it may not be appropriate. Thus there is a need to find non-pharmacological methods of intervention. Psychological therapies such as cognitive behavioural therapy or interpersonal therapy can be effective but these are often not available for the large numbers of women who could benefit.

There is a large body of research showing that listening to music can alter mood and arousal [8]. In terms of clinical applications, it can, for instance, lessen anxiety before dentistry [9] and reduce anxiety and depression in older adults [10]. A study with pregnant women who listened to music prior to amniocentesis showed that it reduced both state anxiety and cortisol levels [11], while an intervention that involved pregnant women learning to sing lullabies during pregnancy was found to aid emotional expression, reduce the amount of self-reported anxiety and contribute to a positive experience during pregnancy [12]. Interestingly, animal studies have shown that exposure to music during pregnancy can benefit brain development in the offspring. Chikahisa et al. [13] showed that if mice were played Mozart in the perinatal period it enhanced the learning performance and altered the brain Brain Derived Neurotrophic Factor/ Tropomyosin Kinase B (BDNF/TrkB) signaling in the adult offspring. Sheikhi and Saboory [14] have shown that exposure of pregnant rats to classical music throughout pregnancy resulted in the offspring having significantly higher cell density in the parietal cortex while Kim et al. [15] have shown that exposure to music during pregnancy increased neurogenesis in the motor and somatosensory cortex of the rat pups.

In this small pilot study we explored the possibility that listening to original songs specially composed for the prenatal period may reduce symptoms of anxiety and depression in pregnant women over a period of 12 weeks. We used a control condition of sitting quietly and undisturbed, which has been shown in an acute study to reduce anxiety and cortisol levels [16]. Proof of efficacy would justify investment into music as an accessible, inexpensive and non-stigmatizing method with potential to improve the mother’s mental health and benefit both the mother and child.

The study was conducted between March 2014 and August 2015. The Ethics committee at Goldsmiths, University of London, approved this study. Informed consent was obtained online, prior to the start of the questionnaires.

There were no significant differences in baseline gestational age in weeks (mean ± SD) at baseline (13.7 ± 9.0 versus 18.2 ± 7.7) or days spent relaxing or listening (38.8 ± 21 versus 44.3 ± 23.7) between the control (n = 16) and music group (n = 20) respectively, who completed the study.

Table 2 shows the baseline and 12-week scores for symptoms of anxiety (Trait and State) and symptoms of depression (EPDS). Paired t-tests demonstrated significantly lower scores in the music group at week 12 compared to baseline in all 3 measures. The effect sizes for Trait anxiety, State anxiety, and Depression were 0.80, 0.64, and 0.92, respectively. In the control group, no significant differences were found [See Additional file 1 for complete dataset].

The results of this small study look promising, in that over the 12-week period, participants’ symptoms of anxiety and depression decreased significantly in the music group and did not change significantly in the control group. It is of note that the baseline scores in both groups are above average [19]; it appears that women with somewhat raised symptoms of anxiety and depression chose to take part in the study.

There are several obvious limitations to this study. The first is the high attrition rate. This may well be because the investigators had no direct contact with the participants, as all recruitment and follow up was online. It may also be that only some women find listening to music helpful or enjoyable; but an intervention that benefits a subgroup could still be of great value. Though only the music group showed significant reduction in anxiety and depression, the interaction between group and time was not statistically significant using a Mixed Analysis of Variance (ANOVA). This is likely due to the small numbers, and emphasizes the need for a larger study, with personal contact and better retention. We also do not know if other music would be equally effective. The songs used here were specifically composed and designed to have a calming effect.

Despite these limitations, the magnitude of reduction of the scores in the music listening group is notable, from a mean of 38.5 to 30.6 for Trait anxiety and from a mean of 8.4 to 3.75 for the EPDS. We know that the means of the scores for these questionnaires generally tend to remain quite stable over pregnancy [20], and reductions of this magnitude could be clinically significant.

These results do suggest that further research in this area is warranted. Listening to music during pregnancy is a potentially enjoyable, inexpensive and non-stigmatizing intervention that may also be beneficial for the future child.