Health services and music : perspectives among women with postnatal depression and their health care providers

Postnatal depression (PND) is a depressive disorder that may impact up to a third of all postpartum women worldwide, with rural Australian women being more than one-and-a-half times more likely to develop PND than their urban counterparts. The factors affecting the development of PND are broadly biological, psychological and social. The social determinants of health, in addition to lower levels of access to appropriate health care and support services, are the underlying risk factors for PND among rural women. The treatments used for those experiencing PND include pharmacological, psychological, psychosocial, complementary and alternative therapies. However, some women prefer non-pharmacological treatments largely because of their desire to continue breastfeeding, and the stigma associated with mental ill health and medication use. In addition, women in rural and remote areas encounter various difficulties accessing specialist health care and PND-specific health services. Complementary and alternative therapies have come to take a more prominent role in health care. It has been reported that music, yoga, massage, and meditation have been effective in relieving stress, anxiety and reducing pain. Music therapy, in particular, has taken on a more prominent role in health care, including mental health, and has been utilised among those experiencing depression, stress and anxiety. However, very few studies have explored music as therapy for PND. Thus, this research explores the effectiveness of music as a therapy option for women with PND, particularly for those women living in rural and remote areas. This study aims to examine the perspectives of, and issues concerning rural Tasmanian women with PND where access to services is limited or non-existent and particularly, to explore what role music plays in alleviating PND. In relation to the research aim, the study responds to the following research questions: 1) What are health care providers’ perspectives regarding current PND health care services, what improvements are required, and what impact does music have on PND? 2) What are the current services available to and accessed by women with PND? 3) What are the lived experiences and perceptions of rural women concerning PND? 4) What impact has music had in reducing the effects of PND among rural Tasmanian women? and 5) What are the implications and recommendations for health services and policy makers to address PND using music therapy? Two theoretical frameworks underpin this study: phenomenology and feminism. Phenomenology helps to examine the everyday subjective experiences of an individual’s lived world, whereas feminism is used to understand the lived experience of what it means to be a woman experiencing PND and seeking care. This approach provided a perspective of PND that is juxtaposed to gender and the powerful medical model of health and disease. Utilising an explorative research approach, qualitative methods were used to address the study’s aims and questions. Semi-structured interviews were used to gather data from 23 key health care providers (HCPs), including general practitioners (GPs), child and family health nurses (CHN), psychologists and psychiatrists, perinatal mental health co-ordinators and music therapists. In-depth interviews were conducted with 20 women who had been clinically diagnosed with PND, who were identified through media campaigns, advertisements, or purposive snowball sampling. All interviews were analysed using thematic analysis via NVivo v10.0 software. The study provides insights into the everyday experiences of women with PND, the perspectives of HCPs within rural settings, and how these factors impact service access, acceptance, and utilisation. It was shown that there is an augmentation in current health care services due to reduced funding across the health care sector. In addition, there is poor recognition and diagnosis of PND among HCPs; and, due to the stigma of mental illness, and specifically, PND, women have a tendency to fabricate the truth about coping in order to reduce further intrusion from HCPs. While current treatments for PND emphasise the use of medication; women in the study seek to avoid medication in favour of psychological and complementary therapies, such as music, to cope. However, there are various barriers to accessing these complementary treatments. The research discusses the complexities of obtaining a diagnosis and receiving subsequent treatment for PND in rural and remote Tasmania. The study delivers insight into various service provision issues, while offering an understanding of the needs, desires and challenges encountered by women with PND as well as the HCPs who strive to care for these women. Improvements to current PND health care processes and treatments are also suggested from both the women as well as the HCPs. Although music was recognised as a complementary treatment, current services require further training and development centred on improved education, screening, and diagnosis of PND to make music therapy a viable option.