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Patient introduction
Depression is associated with symptoms such as mood instability, impulsiveness, withdrawal from social life, suicidal thoughts and as a result, other physiological problems such as loss of appetite, weight and development of ulcers and back pain. Existing evidence suggests that music therapy can help in creating a therapeutic effect and hence relieve these symptoms. However, as a matter of fact, music therapy should not be a substitute to the standard care for these patients but instead should be used alongside standard care as a complementary modality.
As a case study, I interviewed a 67-year old man with a 6 –year’s history of depression. The 67-year old as subjective data for the patient showed, developed depression after the demise of his wife. The patient experienced a wide spectrum of depression symptoms that ranged from minor to severe. As a nursing diagnosis to help this patient I arrived at poor coping abilities as well as risk of inflicting self-harm. Subsequently, I reviewed existing literature with regard to alternative and complementary therapies for depression and developed the following clinical question, “In adult patients diagnosed with depression (P), does music therapy along with standard care (I) help reduce symptoms (O) compared to standard care only” I found two recent research articles that showed a lot of relevance with this clinical question.
The first article, in a study conducted by Chan et al. (2012), which was guided by the objective to determine the effectiveness of music therapy in elderly persons with depression, this intervention was associated with improved patient outcomes and compared to other approaches, music therapy is less invasive and cheap and its patient outcomes are desirable. As strength for this study; is that it uses a randomized controlled approach as the design. This approach to research is associated with considerably high level of evidence and thus, it makes a huge contribution in terms of understanding the clinical question. The reliance of primary data as well as a comparatively large sample size is a contribution to the validity and the reliability of the findings. The study used a sample size of 50 elderly patients with depression (n=24-intervention group under music therapy and n=26-control group) (Chan et al., 2012). Going by the findings of the study, the intervention group, as compared to the control group showed improved depression symptoms as well as reduction in depression levels. Apart from only reducing depression symptoms, the intervention group registered improved outcomes on other clinical areas such as the management of chronic diseases and hypertension. The findings of this study clearly indicate that music therapy is beneficial to patient with depression and as a therapeutic modality; I should be used alongside standard care for depression patients. As the study concludes, the use of music therapy is non-invasive, hence subjecting the patient to less pain and discomfort. Moreover, music therapy is cheap and can be used without huge financial implications. The researcher recommends that however, further studies should be done on the same form of therapy but with a focus on the emotional side-effects that depression patients may experience after listening to music (Chan et al., 2012).
According to a second article by Erkkilä et al. (2011), as one of the disabling disease, depression immensely affects the quality of life of the person suffering from it. Moreover it leads to the loss of general functioning of the body. Depression is one of the major challenges facing the people of Finland with its prevalence ranging between 5 -6.5 percent of the general population. Apparently one of the effective treatment plans that have been discovered is the use of music therapy which has been seen as a more workable alternative solution. Through music patients suffering from depression are in a position of connecting with their emotions and developing relationships. As such, free improvisation which is a specific therapy technique that uses music has been seen as a way of ‘self-projection and free association’ that facilitates the connection between the emotional memories and images (Erkkilä, 2011).
According to this article the research was limited to working elderly people who consisted of 79 adults who were suffering from unipolar depression. As for their age it was ranging between 18 to 50 years. They were either suffering from depression F32 or F33 in accordance to the ICD-10 classification.
The data collection, analysis and interpretation of findings undertaken by this article were commendable and contribute to the high level of evidence presented by the article. This means that its findings can be applied in a clinical setting and be used to influence daily practice.
As unearthed by the two studies, it is indubitable that music therapy has a beneficial effect and possibly, it use on this patient alongside the standard care offered to depression patients, could result to better management of symptoms and to some degree help relieve the patient some of the symptoms discussed above. Additionally, the two articles engaged an appreciable amount of literature review and despite the differences in settings and sample sizes; the two are quite in agreement in relation to the effectiveness of music therapy. Guided by the hierarchy of evidence, these two research articles present a high level of evidence (I).
Interacting with fellow healthcare workers as well as undertaking this exercise has been of great assistance and contribution to the understanding of not only depression but also other common psychiatric problems. There is surely a lot that can be learnt from a hands-on experience and my understanding various clinical issues and the fundamental approaches towards developing and testing new interventions. With every encounter with a patient, in any clinical setting presents a new learning opportunity and utilizes this kind of reflective interaction with patients, new knowledge can be developed and help in addressing some of the clinical problems facing not only psychiatric settings but the larger health sector.
There is the need for healthcare providers working in psychiatric settings to realize and acknowledge that evidence-based practice has a lot of benefits that can be harnessed and utilized to improve patient outcomes and make this tool part and parcel of their daily practice.
As a healthcare provider, I believe in an inquiry-oriented approach towards practice and a lot of unexploited knowledge can be generated and applied as evidence-based practice to help in improving patient outcomes. It is thus my wish to be more inquisitive and seek to gain from every encounter with a patient so as to use these as a basis for creating new knowledge. I believe that the future presents more equal opportunities to interact with similar patients and through reflective practice; I hope to further utilize the skills gained and at the same time, improve the ones that I currently possess.
References
Chan, M. F., Wong, Z. Y., Onishi, H., & Thayala, N. V. (2012). Effects of music on depression in older people: a randomised controlled trial. Journal of clinical nursing, 21(5‐6), 776-783.
Erkkilä, J., Punkanen, M., Fachner, J., Ala-Ruona, E., Pöntiö, I., Tervaniemi, M., & Gold, C. (2011). Individual music therapy for depression: randomised controlled trial. The British journal of psychiatry, 199(2), 132-139.
