EBHC 481 Research Methodology And Evidence Based Healthcare

Introduction

Mental health refers to the cognitive, emotional and behavioural wellbeing of individuals and also governs the way by which people think, behave and feel. In other words, this state of psychological wellbeing is characterized by an absence of mental disorders and also includes the ability of an individual to enjoy life, whilst maintaining a balance between psychological resilience and life activities (Clement et al. 2015). According to the WHO (2014) a person’s wellbeing is encompassed in relation to the realization of the capability of the person to cope with stressful events of life.

However, there are a range of risk factors that increases the potential of an individual to suffer from poor mental health. Some of the most common mental disorders are anxiety disorders, mood disorders, and schizophrenia. Mental health nurses are entitled with the responsibility of working in specialized fields and have the duty of providing care to people suffering from a plethora of mental disorder and/or illness. The primary focus of a mental health nurse is to work in collaboration with people and carers for overcoming the illness symptoms and continuing personal recovery (Hunter et al. 2015). Thus, implementation of an evidence based practice in mental health would prove imperative in enhancing the optimal wellbeing of the affected people.

EBP and mental health nursing- Mental health has been identified as a national practice priority in Australia. The National safety priorities in mental health plan provides a direction in recognising, evading and decreasing harm to the affected people, residing across different environments that has the provision of providing care to those with mental health disorders. Mental health has also been identified as the topic of interest owing to the fact that the nation considers safety of mentally ill people to be of utmost importance. Safety has been recognised as an essential component of the quality of national plan. The National Mental Health Working Group also works towards implementing the priority plan, with the aim of providing leadership in the four priority areas (Commonwealth of Australia 2016). These areas are characterised by a collective effort of the stakeholders in preventing adverse events, doing less harm, and increasing the safety of mental health services. Evidence based practice (EBP) refers to a multidisciplinary approach of clinical practice that involves the conscientious usage of best available evidences that would help in making essential decisions related to patient care.  This problem solving approach is imperative to mental health practice owing to the fact that EBP will facilitate a systemic search of relevant literature that are most relevant to a clinical question (Baker and Tickle-Degnen 2014).

The process will also help in making decision about particular mental health programs and/or intervention that is based in best available evidences. These would be informed by experiential evidences related to the domain of mental health. In other words, the three stages of EBP that will guide the process of clinical decision making encompass (1) gathering evidences, (2) interpreting evidences, and (3) applying the learnings in practice (Brownson 2017). The primary benefit of EBP in mental health is that it would provide assistance to the healthcare professionals to remain updated with the clinical relevant and best interventions that can be implemented upon patients. The fundamental principle of EBP can be associated with the fact that specific design in study help in providing unbiased answers to a range of clinical questions. Thus, in relation to a clinical question that concerns treatment, high quality randomised have been found most effective in producing valid estimates regarding the effectiveness of the treatment being investigated (Farrelly et al. 2016).

Clinical question- Clinical questions are required to be relevant to the problem or the group of patients who shall be treated in a way that facilitates the easy search for an answer. The clinical questions are either foreground or background. A foreground question was formulated during the research that unravelled answers for specific knowledge related to depression, a mental illness, in order to inform clinical decisions. A PICO framework was adopted for the process. This mnemonic is made up of four components that helped in formulation of the search strategy via the identification of key concepts related to the clinical question (Considine et al. 2017). The research question in relation to mental health was as follows:

Does the administration of music therapy prove effective in reducing symptoms of mental disorders?

The three components for the aforementioned clinical question is given below.

Table 1- PICO framework

The search strategy involved creating an organised structures of essential search terms or key phrases that were fed into three electronic databases. The CINAHL Complete, EBSCO Health, and PsycInfo international database were selected for retrieval of the articles. The search terms that were fed into the databases were ‘mental’, ‘health’, ‘depression’, ‘anxiety’, ‘illness’, ‘disorder’, ‘mood’, ‘schizophrenia’, ‘obsessive compulsive disorder’, ‘symptoms’, ‘music’, ‘therapy’, ‘intervention’, and ‘management’.

The relationship between the search terms was established with the use of Boolean operators. ‘AND’ was used for narrowing down the search results. ‘OR’ helped in broadening the search hits by connecting between the synonyms. Truncations (*) and wildcards were used for obtaining search results with different endings of the terms or multiple spellings (McGowan et al. 2016). Search filters that were used for restricting the search to specific articles were as follows:

• English published articles
• Publication year 2013-2018
• Peer reviewed articles

This resulted in extraction of seven relevant articles that are discussed below.

Literature review- Verrusio et al. (2014) conducted a randomised controlled trial where participants with depression were allotted to two groups namely, music and exercise therapy, and pharmacotherapy. Upon assessing the differences that the music therapy intervention brought in the state of mood, it was found that patients subjected to exercise and music demonstrated a noteworthy reduction in the depression and associated anxiety symptoms, at 3-months and 6-months (p<0.05). Average reduction was also observed in the TNF-α from 57.67 to 35.80 pg/ml. The findings of the study established music therapy as a potential candidate for mental health nursing of depression patients. Similar findings were presented in another pilot study that recruited 36 male participants in music therapy sessions conducted over a period of 30 minutes, for six weeks (Hwang and Oh 2013). The sessions comprised of music listening, singing, and instrument playing. The results suggested absence of any significant difference in the impacts of the three types of therapies. However, the patients manifested momentous lessening in their scores related to the presence of depression (3.92-3.03), anger, anxiety (3.46-2.71), and stress disorder (4.10-2.91). The largest diminution in scores with respect to music therapy was as follows: stress and anger following music listening sessions and depression following singing sessions. Thus, it was quite evident from the article that conducting musical activities are an effective intervention in the accomplishment of therapeutic goals among mentally ill patients.

Im and Lee (2014) also conducted a trial, the primary aim of which was to investigate the impacts of music and art therapy on the cognitive function and depression symptoms among older adults. The study based on a pre-test and post-test design and was conducted from January-March 2013, among 94 elderly people who resided in metropolitan areas. Upon conducting a statistical analysis it was found that the depression scores among the older adults diminished after implementation of the music therapy. The therapy was effective in releasing their oppressed feelings, bringing out their emotions and providing them psychological comfort. Although music therapy failed to bring about any cognitive improvement, it was highly effective in reducing presenting complaints of depression. Effectiveness of music therapy in mental health setting has also been established in another randomised trial where 80 schizophrenic patients having depression and psychiatric symptoms were randomised to usual care and music therapy groups. Those in the latter group were subjected to 60 minute long music therapy sessions, held twice a week and demonstrated statistically significant variations in their depression status (p<0.05) and psychiatric symptoms (p<0.05). UCG PANSS and MIG scores were 80.80 ± 22.73 and 65.77 ± 19.18, respectively. Hence, this formed an essential component of EBP in mental health (Lu et al. 2013).

Chung and Woods-Giscombe (2016) conducted a systematic review on the effects of the type, format and dosage of music therapy on individuals diagnosed with schizophrenia. Upon searching six electronic databases, they retrieved articles that elaborated on the fact that music therapy was operative in enhancing management of depression, psychotic symptoms, and anxiety, social behaviour, cognitive functioning, and quality of life among the participants. Furthermore, the articles also suggested that combination of receptive and active music therapy demonstrated an increased likelihood to bring about significant improvements in the mental health outcomes. Music therapy has also been identified as a major form of non-pharmacological therapy for treating anxiety disorder. A quality improvement (QI) project appraised the effects of music therapy on anxiety levels, with the use of a visual analog scale (VAS) and reported that the intervention was responsible for a significant lowering in the VAS scores from 3.1 during pre-intervention, to .897 immediately following the intervention (p= 0.008). Greater score reduction was observed among African Americans, compared to their Caucasian counterparts (Pavlov et al. 2017).

Bidabadi and Mehryar (2015) also opined that music therapy can be considered as an adjunct to standard care services among OCD patients. Upon conducting a randomised controlled trial that allocated patients to two groups namely standard treatment and individual music therapy, those in the second group demonstrated a greater reduction in the total obsessive scores (12.4±1.9 versus 15.1±1.7) (p<0.001). Furthermore, noteworthy differences between the groups were observed in relation to slowness (p=0.019) and checking (p=0.004). Music therapy also proved effective in lowering rates of anxiety (16.9±7.4 vs 22.9±4.6) and depressive symptoms (10.8±3.8 vs 17.1±3.7).

Conclusion- Thus, it can be concluded that the systematic review was of the highest evidence, followed by the individual studies, and the pre-test and post-test trials. The findings presented above will greatly benefit evidence-based practice in mental health. Hence, the use of music therapy as a non-pharmacological intervention can be implemented across mental health settings, to reduce the severity of different mental disorders such as, depression, mood disorder, anxiety, and schizophrenia. The above evidences were helpful in establishing the fact that music not only acts in the form of a medium that facilitates the processing of trauma, emotions, and grief, but can also be exploited as a changeable or comforting instrument for mental dysregulation. To conclude, patients diagnosed with mental disorders are able to recognise the soulfulness of music in a similar way, when compared to people without any mental illness. The evidences support that music therapy can be considered as an effective therapeutic modality for persons with mental disorder.

References

Baker, N. and Tickle-Degnen, L., 2014. Evidence-based practice. Willard and Spackman’s occupational therapy, 12th edn. Lippincott, Philadelphia, pp.398-412.

Bidabadi, S.S. and Mehryar, A., 2015. Music therapy as an adjunct to standard treatment for obsessive compulsive disorder and co-morbid anxiety and depression: A randomized clinical trial. Journal of affective disorders, 184, pp.13-17.

Brownson, R.C., 2017. Dissemination and implementation research in health: translating science to practice. Oxford University Press.

Chung, J. and Woods-Giscombe, C., 2016. Influence of dosage and type of music therapy in symptom management and rehabilitation for individuals with schizophrenia. Issues in mental health nursing, 37(9), pp.631-641.

Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J.S.L. and Thornicroft, G., 2015. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological medicine, 45(1), pp.11-27.

Commonwealth of Australia, (2016). National safety priorities in mental health: a national plan for reducing harm. [online] Canberra: Australian Health Ministers’ Advisory Council. Available from https://www.health.gov.au/internet/main/publishing.nsf/content/DB6FC7B04519D195CA257BF000217B28/$File/safety.pdf. [Accessed on 18 September 2018].

Considine, J., Shaban, R.Z., Fry, M. and Curtis, K., 2017. Evidence based emergency nursing: Designing a research question and searching the literature. International emergency nursing, 32, pp.78-82.

Farrelly, S., Lester, H., Rose, D., Birchwood, M., Marshall, M., Waheed, W., Henderson, R.C., Szmukler, G. and Thornicroft, G., 2016. Barriers to shared decision making in mental health care: qualitative study of the Joint Crisis Plan for psychosis. Health Expectations, 19(2), pp.448-458.

Hunter, L., Weber, T., Shattell, M. and Harris, B.A., 2015. Nursing students’ attitudes about psychiatric mental health nursing. Issues in Mental Health Nursing, 36(1), pp.29-34.

Hwang, E.Y. and Oh, S.H., 2013. A comparison of the effects of music therapy interventions on depression, anxiety, anger, and stress on alcohol-dependent clients: A pilot study. Music and Medicine, 5(3), pp.136-144.

Im, M.L. and Lee, J.I., 2014. Effects of art and music therapy on depression and cognitive function of the elderly. Technology and Health Care, 22(3), pp.453-458.

Lu, S.F., Lo, C.H.K., Sung, H.C., Hsieh, T.C., Yu, S.C. and Chang, S.C., 2013. Effects of group music intervention on psychiatric symptoms and depression in patient with schizophrenia. Complementary therapies in medicine, 21(6), pp.682-688.

McGowan, J., Sampson, M., Salzwedel, D.M., Cogo, E., Foerster, V. and Lefebvre, C., 2016. PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of clinical epidemiology, 75, pp.40-46.

Pavlov, A., Kameg, K., Cline, T.W., Chiapetta, L., Stark, S. and Mitchell, A.M., 2017. Music therapy as a nonpharmacological intervention for anxiety in patients with a thought disorder. Issues in mental health nursing, 38(3), pp.285-288.

Ueda, T., Suzukamo, Y., Sato, M. and Izumi, S.I., 2013. Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis. Ageing research reviews, 12(2), pp.628-641.

World Health Organization, (2014). Mental health: a state of well-being. Available from https://www.who.int/features/factfiles/mental_health/en/  [Accessed on 18 September 2018].