The Effect of Music Therapy on Sleep Quality and Depression in Menopausal Women
Condition: Menopause
MeSH terms: Depression
Study type: Interventional

Summary: 
      About one-third of women experience no or mild symptoms during their menopausal life, while
      another third experience moderate symptoms, while the remaining one-third may experience
      severe symptoms.

      It is stated that hormone therapy, one of the pharmacological methods, is accepted as an
      effective and standard method in the management of menopausal symptoms, including sleep
      disorders and depression, despite its side effects. However, due to the health risks
      associated with hormone therapy, it is stated that many women do not want to use this
      treatment option and turn to complementary and alternative medicine to alleviate menopausal
      symptoms. It is stated that physical, mental and psychological problems of women can be
      treated with non-pharmacological methods such as relaxation, breathing exercises, touch
      therapy, and music therapy as a complementary and alternative medicine approach in the world
      and in Turkey.

      It is stated that the healing effect of music has been known among societies since ancient
      times. Today, with technological developments, it is stated that music does not only rest the
      soul, but also has a cognitively stimulating effect and a motivating effect in cases where
      verbal communication cannot be performed. When the national and international literature is
      examined, there are many studies on non-pharmacological methods for menopausal symptoms,
      while the effect of music therapy on depression in menopausal women was examined in only one
      study in Turkey. However, no study was found in which the music therapy method was used for
      both depression and sleep quality in menopausal women.

      For this reason, the aim of the study was to determine the effect of music therapy, which is
      a non-pharmacological method, on sleep quality and depression in menopausal women.
    

Detailed description: 
      According to WHO, the menopausal period is not a pathological process, but is expressed as
      one of the biological stages of a woman's life. The menopausal period is defined as the
      transition to old age, which begins with regression in ovarian functions and decreased
      reproductive capacity, and in time, reproductive ability ends.

      Approximately one-third of women experience no symptoms or mild symptoms during the
      menopausal period, while the other third experience moderate symptoms, while the remaining
      one-third may experience severe symptoms. The symptomatology experienced in this period is
      characterized by a hypoestrogenic state that occurs due to regression in ovarian function in
      60% to 80% of women . In addition to symptoms such as insomnia, vaginal dryness, irregular
      menstrual bleeding, depressed mood, irritability, headache, forgetfulness, and dizziness,
      vasomotor symptoms such as changes in body thermoregulation and night sweats can be observed
      in menopausal women as a result of insufficient secretion of sex hormones.

      Sleep problems are defined as one of the important problems seen in menopausal women It is
      stated that hot flashes and especially night sweats seen in the menopausal period may cause
      sleep disorders with the slowdown in serotonin metabolism due to hypoestrogen. While sleep
      problems can negatively affect mood and activities of daily living in women, it has been
      reported that they have a wide-ranging negative impact on quality of life, mood, productivity
      and physical health, especially in women with severe sleep problems. It is stated that sleep
      disorders do not only affect the quality of life in women in the menopausal period, but may
      cause social burdens by jeopardizing their lives and health in the long run.

      It is stated that depression affects approximately 350 million people worldwide and is a
      global burden. It is stated that depression is seen twice as often in women as in men, and
      that the risk of depression may increase during periods when women experience hormonal
      changes such as puberty, pregnancy, and transition to menopause.It is stated that the
      menopausal period, in which hormonal changes are experienced intensively, is not associated
      with psychiatric diseases alone, but the risk of its occurrence increases, especially in
      women in the perimenopausal period, even if there is no previous history of depressive
      disorder.

      It is stated that hormone therapy, one of the pharmacological methods, is accepted as an
      effective and standard method in the management of menopausal symptoms, including sleep
      disorders and depression, despite its side effects. However, due to the health risks
      associated with hormone therapy, it is stated that many women do not want to use this
      treatment option and turn to complementary and alternative medicine to alleviate menopausal
      symptoms. It is stated that physical, mental and psychological problems of women can be
      treated with non-pharmacological methods such as relaxation, breathing exercises, touch
      therapy, and music therapy as a complementary and alternative medicine approach in the world
      and in Turkey.

      It is stated that the healing effect of music has been known among societies since ancient
      times. Today, with technological developments, it is stated that music does not only rest the
      soul, but also has a cognitively stimulating effect and a motivating effect in cases where
      verbal communication cannot be performed. The importance of music therapy and its
      relationship with treatment was emphasized by Florence Nightingale in the early 1800s, and it
      was used as a therapeutic approach, accepted the power of the use of appropriate music in the
      healing of patients and defined music therapy as a part of the healing process Lafcı in 2018
      found that music therapy had positive effects on sleep and anxiety in women with breast
      cancer. Kavurmacı in 2019 found that music therapy positively affects sleep quality in their
      study with students. It is stated that music has a therapeutic effect on mental illnesses
      such as depression by regulating the stress response of the hypothalamus-pituitary-adrenal
      axis. According to the meta-analysis results in which music therapy studies applied to
      patients with digestive tumors were examined, it was determined that the sleep quality could
      be improved and the level of depression could be reduced in those who received music therapy.
      It was found that music therapy had a significant effect on sleep quality and depression in
      patients who applied to the psychiatry outpatient clinic due to insomnia in Iran. Koçak in
      2022 found that music therapy positively affects depression in menopausal women.

      When the national and international literature is examined, there are many studies on
      non-pharmacological methods for menopausal symptoms, while the effect of music therapy on
      depression in menopausal women was examined in only one study in Turkey. However, no study
      was found in which the music therapy method was used for both depression and sleep quality in
      menopausal women.

      Based on this argument, a study was planned to examine the effect of music therapy on sleep
      quality and depression in menopausal women.

      Material and Method The research will be carried out with menopausal women who applied to
      Çayyolu No. 1 FHC between August 2022 and December 2022. The research was designed as a
      randomized controlled experimental study. The sample of the study was G-Power 3.1.7; By
      comparing the sleep quality scores between the groups, it was planned to have 35 cases in the
      experimental and control groups.Sampling will be done by dividing the menopausal women who
      apply to the FHC, who meet the inclusion criteria, into the experimental and control groups
      at a rate of 1/1. Considering the risk of data loss in both groups, 20% more cases will be
      taken.

      Since the variables to be examined in our study are depression and sleep quality, the type of
      music to be used will be zirgüle makam and Hüseyni makam. When the effects of authorities on
      the human spirit are examined; It is stated that while the zirgüle maqam gives people sleep,
      the huseyni maqam gives people comfort . A WhatsApp group will be created with the
      experimental group. The links of the authority that will be played via Whatsapp will be
      sent.They will be asked to listen to the Hüseyni makam for at least 15 minutes at 11.00 in
      the morning, 5 times a week for 5 weeks, and to listen to the Zirgüle makam for at least 15
      minutes at 20.00 on the same day. Feedback will be received via WhatsApp that the
      participants have listened to the maqam conveyed to them.Before applying music therapy in the
      experimental group, they will be asked to fill out the questionnaires.At the end of the music
      therapy application, the questionnaires made at the beginning will be applied to the
      experimental group again.No application will be made to the control group, and data
      collection forms will be applied twice with an interval of 4 weeks.

      Data Collection Tools

        1. Sociodemographic Information Form The first 9 questions question the participant's
           sociodemographic characteristics such as age, weight, height, occupation, educational
           status, and the next 10 questions consist of questions prepared to determine the
           obstetrical characteristics.While the next question was asked to detect the presence of
           chronic disease in the person, the last two questions were asked to detect the presence
           of cancer and depression.The sociodemographic information form consists of 21 questions
           in total.

        2. Beck Depression Inventory In the study, Beck Depression Inventory will be used to
           evaluate the presence and severity of depression symptoms.The inventory was developed by
           Beck (1961) in order to express the degree of depression objectively through numbers.The
           Turkish adaptation of the inventory was made by Hisli (1988).For each of the 21 items
           that make up the inventory, there are four self-evaluation statements rated from zero to
           three, ranking the severity of the symptom from least to greatest.The lowest score that
           can be obtained from the inventory is 0 and the highest score is 63.The high total score
           indicates the high level of depression or its severity.In addition, a cut-off point of
           17 is recommended for catching clinical depression.

        3. Menopause Symptoms Rating Scale The scale was developed by the Berlin Center for
           Epidemiology and Health Research The validity and reliability study in Turkey was
           conducted by Metintaş in 2009.The 11-item Likert-type scale including menopausal
           complaints consists of 3 sub-dimensions.Somatic complaints sub-dimension; Items 1, 2, 3,
           11, psychological complaints sub-dimension; 4th, 5th, 6th, 7th items and urogenital
           complaints sub-dimension; It includes items 8, 9, 10. For each item; 0 = none, 1 = mild,
           2 = moderate, 3 = severe, 4 = very severe and the minimum score that can be taken from
           the scale is 0, and the maximum score is 44.An increase in the total score obtained from
           the scale indicates that both the severity of the complaints experienced and the quality
           of life are negatively affected.

        4. Pittsburg Sleep Quality Scale (PUKÖ) It was developed by Buysse in 1989, and its
           validity and reliability study in Turkey was performed by Ağargün in 1996. PUKÖ consists
           of a total of 24 questions. 19 of the questions are self-evaluation questions, 5 of them
           are answered by the spouse or relative.Question 19 is not taken into account in scoring.
           PUKO; It consists of seven items evaluating subjective sleep quality, sleep delay, sleep
           duration, sleep efficiency, sleep disturbance, use of sleeping pills, and impairment in
           daytime work. Each component is evaluated with a score between 0-3.The scale total score
           is between 0-21. A PUKÖ total score of 5 and above indicates poor sleep quality.Its
           diagnostic sensitivity is 89.6% and its specificity is 86.5%. It takes 5-10 minutes to
           complete the scale

      Evaluation of Data The data will be analyzed in SPSS program. Student's t test will be used
      for two independent group variables with normal distribution, Mann Whitney U test for data
      that is not normally distributed, and chi-square test for categorical variables
    

Intervention name(s): music therapy
Intervention type(s): Other
Intervention description(s): Feedback will be received via WhatsApp that the participants have listened to the maqam conveyed to them.Before applying music therapy in the experimental group, they will be asked to fill out the questionnaires.At the end of the music therapy application, the questionnaires made at the beginning will be applied to the experimental group again.No application will be made to the control group, and data collection forms will be applied twice with an interval of 4 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: music therapy; depression; sleep quality