Title: Study on Group Music Therapy for Chronic Depression: Refinement and Feasibility (SYNCHRONY)
Funder: Department of Health and Social Care

Abstract: Background: Despite a range of treatment options, around one in every five patients diagnosed with depression does not fully respond to treatment and continues to experience persistent symptoms for two years or more1. Whilst a range of psychological and pharmacological treatments are available, treatment may only manage to maintain lower symptom levels. In such cases, it is possible for both patients and clinicians to become discouraged with treatment2. Music therapy offers a new and appealing approach to patients as it encourages creativity, nonverbal interaction and emotional expression. Current evidence suggests individual music therapy is effective in reducing depression symptoms but to date, few studies of group music therapy for depression exist, and none have been conducted within an adult NHS setting3,4. Further studies suggest effectiveness in engaging patients with low therapy motivation and of improving quality of life with patients with severe mental illness5,6. Despite promising evidence, the acceptability and effectiveness of music therapy for helping people with chronic depression is unknown. Within the Medical Research Council Framework7 for the development of complex interventions, further steps are needed to refine music therapy as a group intervention for chronic depression and to ascertain how to best implement a randomised controlled trial methodology in a community context. A feasibility study will enable some conceptual development of the intervention, but more importantly, will provide information on how to best implement this to ensure methodological rigour8,9. Aim: To refine group music therapy as an intervention for chronic depression and assess the feasibility of conducting a randomised controlled trial. In particular: To refine a manual of best practice of group music therapy with music therapists, psychologists and patients with chronic depression Assess the feasibility and gain experiences of conducting a randomised controlled trial methodology with this patient group in a community setting. Plan of investigation: The study will consist of two work packages (WP). The first will refine a group music therapy intervention based on existing manuals in conjunction with patients, music therapists and psychologists whilst the second will be a feasibility study for a randomised controlled trial. WP1: The group music therapy intervention will be refined by compiling practice from existing manuals of individual music therapy for depression10 and group music therapy for patients with depression and severe mental illness11,12. The approach will be presented to four focus groups of music therapists and psychologists, and two focus groups with patients. Particular attention will be paid to how best to implement the intervention in order to maximise service links, patient attendance and engagement. WP2: A randomised controlled trial feasibility study will assess recruitment, outcomes and adherence to manual in 30 patients using treatment and wait-list control groups. Potential benefit to patients: The research will lead to a potentially new intervention for a group of patients with limited treatment options. If successful, it will improve symptoms, quality of life, social engagement and importantly provide patients with new skills and resources to improve and maintain these themselves. Potential benefit to NHS: Whilst the cost of depression is high to the NHS, chronic depression is even greater due to increased service use and hospitalisation rates13,14. This research will provide a new treatment option with potential for symptomatic, quality of life and social engagement gains. Clinical guidelines will be produced which can be disseminated and put into practice quickly by NHS music therapists. Information on the feasibility and variability of outcomes will inform future randomised controlled trials. A protocol and funding application for a full randomised controlled trial will be produced as study deliverables. Such information may inform future music therapy and wider NHS research for chronic depression.

Lay abstract: Depression involves ongoing feelings of sadness or low mood and loss of interest in activities. Around one in five depressed people have 'chronic depression' where symptoms last for longer than two years. Finding the right treatment combination can be difficult and costly. People may give up trying treatments if little improves over time. Music therapy might appeal as it is a different approach, encourages creativity and self-expression. We know individual music therapy can be effective in encouraging people with low motivation to attend therapy and reducing depression. Group music therapy might also improve peoples relationships, quality of life and have positive immediate effects on mood. This study aims to refine music therapy to meet the needs of people with chronic depression and to see if it is effective. This research will use current best practice and ask patients, music therapists and psychologists for their views on how best to set up a music therapy group. We will then run a small study to prepare for a larger effectiveness study. The findings will tell us whether group music therapy is a possible new treatment option for people with chronic depression. By asking people to tell us what it was like when they took part, we will learn how best to provide this and run a larger study. Patients and the public were involved in choosing this research topic and advising on the research design. One of the team applicants was a service-user who has had experience of music therapy. She will advise on all aspects of the study, conduct interviews and help with the analysis. A service-user led group will also advise us throughout the study. We will share our findings by publishing in open access journals, speaking at local and national conferences and workshops with local charities and therapy services.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH