Preventive Effects of Light Music on Postpartum Anxiety and Depression in Primiparous Women

Student summary

Why This Research Matters

Postpartum anxiety and depression are common problems after childbirth. In Canada, a national survey of recent mothers found that about 18% reported symptoms consistent with postpartum depression and about 14% symptoms consistent with a postpartum anxiety disorder (nearly a quarter reported either), and many cases go undetected without formal screening. Medications exist, but they raise concerns about safety during breastfeeding, so researchers keep looking for non-drug options nurses can offer at the bedside. This retrospective study from a hospital in China, published in the journal Noise and Health, asked whether a structured program of "light music" (soft instrumental listening) could help prevent postpartum anxiety and depression in first-time mothers.

The researchers reviewed records for 120 primiparous (first-time) mothers treated between June 2022 and June 2024. Fifty-eight women had received standard postnatal nursing care alone, while 62 women had received the same standard care plus a structured light music program. The music intervention began within 24 hours of birth: twice-daily 30-minute sessions combined five minutes of guided breathing with soft instrumental tracks played through noise-canceling headphones at a gentle volume. After discharge, participants borrowed an audio player loaded with the same music library and received brief weekly telephone counselling, with app-based tracking of how often they used it.

At three days postpartum, the two groups looked similar on every measure. By six weeks postpartum, the music group showed meaningfully lower depression scores (Edinburgh Postnatal Depression Scale) and lower anxiety scores (Perinatal Anxiety Screening Scale) than the standard care group, whose scores had actually risen slightly over the same period. Sleep quality, measured with the Pittsburgh Sleep Quality Index, was also better in the music group across all its component domains. When the researchers looked at the proportion of women who anxiety screening flagged as clinically significant at six weeks, the music group had a much lower rate (about 6% versus about 21%); depression screening rates were lower too, though that particular difference did not reach statistical significance.

The study also measured physiological stress directly using saliva samples. Both cortisol (a stress hormone) and salivary alpha-amylase (a marker of sympathetic nervous system activity) dropped further in the music group than in the standard care group by six weeks. This matters because it links a subjective feeling of "less anxious" to an objective biological signal of reduced stress-system activation, strengthening the case that something physiological, not just a placebo effect, was happening.

Two additional outcomes stood out. Exclusive breastfeeding at six weeks was reported by about 79% of the music group compared with about 53% of the standard care group. And scores on the WHOQOL-BREF quality-of-life questionnaire were higher in the music group across all four domains it measures: physical health, psychological well-being, social relationships, and environment.

The authors propose several possible mechanisms: soft music may promote dopamine and serotonin activity linked to mood regulation, shift the balance of the autonomic nervous system toward calming (parasympathetic) activity, and improve sleep, which itself is closely tied to mood. Better sleep and lower stress hormones may also support the physiological reflexes involved in milk letdown, which could partly explain the breastfeeding difference.

As a nursing student, this study is a useful example of how a low-cost, low-risk nursing intervention can be layered onto standard postpartum care without displacing medical care. But it is important to read the results cautiously. This was a retrospective study, meaning nurses did not randomly assign women to groups; women (or their care team) essentially selected which pathway they followed, which opens the door to selection bias. It came from a single hospital in one country, so the specific music library, cultural music preferences, and care setting may not transfer directly to a Canadian unit. Adherence to home listening was tracked by self-report through an app, which is less reliable than an objective measure. Still, the consistency of the findings across psychological, physiological, and functional measures makes light music a plausible, low-risk complementary strategy worth further controlled study before being adopted as routine practice.

Faculty notes

Educational Relevance

This retrospective cohort study (Cai & Wang, Noise and Health, 2025) examined whether a structured light music program, added to standard postpartum nursing care, could reduce postpartum anxiety and depression symptoms in primiparous women. The sample (n=120, drawn from 153 initially screened) was split into a standard care group (n=58) and a music therapy group (n=62) treated at a single Chinese hospital between June 2022 and June 2024. Power analysis indicated a minimum of 52 participants per arm, which the final sample exceeded.

Inclusion criteria required singleton pregnancies at 37+ weeks, complete records, no pre-existing psychiatric diagnosis, and normal hearing; exclusions included multiple gestation, concurrent psychotropic treatment, severe obstetric or neonatal complications, and poor intervention adherence. The music intervention was well-specified for a nursing pedagogy discussion: it used a curated 32-track instrumental library (mean length 4.2 minutes), began within 24 hours postpartum, ran as twice-daily 30-minute sessions (5 minutes of guided breathing plus music) via noise-canceling headphones at 40-45 dB, and continued post-discharge via a loaned device plus weekly 15-20 minute telephone/online counselling, with adherence tracked through a mobile app. Standard care kept ambient noise below 55 dB and included brief daily check-ins without emotional counselling, plus similar weekly post-discharge phone contact — a design choice worth discussing, since it controls for "attention" to some degree while isolating the music/breathing component as the differentiating variable.

At three days postpartum the groups were equivalent on the Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS), and Pittsburgh Sleep Quality Index (PSQI). By six weeks, the music group showed significantly lower EPDS and PASS scores than standard care (both P<0.001), while the standard care group's scores had risen modestly over the same interval. PSQI total and all seven component scores favored the music group (P<0.05, total P<0.001). Clinically significant anxiety (PASS>21) was lower in the music group (6.45% vs 20.69%, P=0.022); the corresponding depression threshold comparison (EPDS>13: 4.84% vs 12.07%) was not statistically significant, a useful point for discussing the difference between continuous-score effects and dichotomized clinical-threshold effects. Salivary cortisol and alpha-amylase both declined further in the music group by six weeks (both P<0.001), supporting a physiological/HPA-axis-mediated pathway rather than a purely subjective effect. Exclusive breastfeeding at six weeks was higher in the music group (79.03% vs 53.45%, P=0.003), and all four WHOQOL-BREF domains (physical, psychological, social, environmental) favored the music group (P<0.05).

For classroom discussion, the retrospective, non-randomized design is the central appraisal point: allocation to group was not controlled by the researchers, so baseline motivation, socioeconomic factors, or unmeasured confounders (partner support, infant temperament, home environment, external music exposure) could plausibly explain part of the effect. The single-center, single-culture sample limits generalizability to Canadian or other Western postpartum units, where music preference, care models, and ambient hospital noise standards differ. Post-discharge adherence relied on self-report via app rather than objective tracking. The fixed, pre-selected music library may not match individual patient preference, a modifiable design limitation the authors themselves note.

Instructionally, this article works well for teaching students to distinguish observational associational designs from RCTs, to interpret converging biopsychosocial outcome measures (self-report scale, physiological biomarker, and functional/behavioral outcome) as a strength even in a lower-evidence design, and to practice appraisal language around confounding and selection bias before considering practice change. It also offers a concrete, protocol-level example (session timing, duration, volume, headphone use) that could inform a future pilot or quality-improvement proposal in a Canadian postpartum unit, provided it is framed as hypothesis-generating rather than practice-changing evidence.