Abstract
Objective:
This paper aims to evaluate the preventive effects of light music on postpartum anxiety and depression in primiparous women.
Methods:
This retrospective study analyzed 120 primiparous women admitted to our hospital from June 2022 to June 2024. Participants were divided into two groups based on the postpartum nursing methods they received: those who received standard care (standard care group: n = 58) and those who received light music therapy (music therapy group: n = 62). Outcomes included Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS), Pittsburgh Sleep Quality Index (PSQI), salivary cortisol, salivary alpha-amylase (sAA), exclusive breastfeeding (EBF) rates, and World Health Organization Quality of Life Brief Version (WHOQOL-BREF) scale scores at 3-day and 6-week postpartum.
Results:
At 6 weeks postpartum, the music therapy group showed significantly lower scores of EPDS, PASS, and PSQI compared to the standard care group (P < 0.05). Salivary cortisol and sAA levels were also significantly reduced (P < 0.05). Additionally, the music therapy group exhibited higher EBF rates (79.03% vs. 53.45%, P < 0.05) and significantly improved scores across all domains of WHOQOL-BREF (P < 0.05).
Conclusion:
Light music therapy significantly alleviates postpartum psychological distress, reduces physiological stress, and improves breastfeeding rate and quality of life, which supports its clinical adoption.
Keywords: music therapy, anxiety, depression, postpartum, primiparity
KEY MESSAGES
-
(1)
Light music therapy significantly reduces postpartum anxiety and depressive symptoms in primiparous women
-
(2)
Music therapy lowers physiological stress markers, including salivary cortisol and alpha-amylase
-
(3)
Music therapy significantly improves exclusive breastfeeding rates and sleep quality compared with standard care
-
(4)
Music therapy can improve maternal quality of life across physical, psychological, social, and environmental domains
INTRODUCTION
Postpartum anxiety and depression are prevalent among first-time mothers, driven by hormonal fluctuations, physiological recovery challenges, and psychosocial stressors such as role adaptation and inadequate social support.[1,2] Primiparous women face heightened vulnerability due to inexperience in infant care and unmet expectations of motherhood.[3] These psychological disturbances impair mother–infant bonding, reduce breastfeeding rates, and elevate the risk of long-term cognitive–emotional deficits in offspring.[4] Despite clinical urgency, current interventions such as pharmacotherapy and cognitive–behavioral therapy face several limitations.[5] Pharmacological approaches show limited efficacy with concerning side-effect profiles, and a recent network meta-analysis of 11 studies revealed that only estradiol and brexanolone were more effective than placebo, while the efficacy of other antidepressants was limited.[6] However, brexanolone had a higher early dropout rate than most other antidepressants, suggesting that its side effects may be more concerning.[6] Antidepressants raise concerns about lactation safety, whereas traditional psychotherapy is hindered by limited accessibility.[7]
Nonpharmacological approaches such as music therapy have gained attention for their safety and acceptability. A neuroimaging study revealed that structured musical stimuli enhance prefrontal–amygdala connectivity and promote top–down regulation of stress responses.[8] A systematic review in nonperinatal populations demonstrated significant reductions in anxiety and cortisol levels following music-based therapy.[9] In obstetric care, music therapy has shown promise in labor pain management and prenatal stress reduction.[10] A previous study reported a decrease in pain levels among laboring women exposed to self-selected music.[10] While preliminary evidence supports music’s potential in mental health, critical gaps remain regarding its effects on postpartum emotional well-being.[10,11] Despite existing studies on music therapy during pregnancy and labor, research specifically targeting the prevention of postpartum anxiety and depression in primiparous women remains insufficient—particularly studies that examine psychological outcomes and physiological biomarkers alongside functional measures such as breastfeeding success.[12]
This retrospective cohort study addressed these research gaps by using a light music therapy protocol at 3 days and 6 weeks postpartum. The 6-week duration was selected because most cases of postpartum depression and anxiety emerge within the first 6 weeks after delivery.[2] This paper hypothesizes that light music reduces postpartum anxiety and depression in primiparous women, improves physiological stress, enhances breastfeeding outcomes, and elevates overall quality of life compared with standard care. By analyzing psychological scales, stress biomarkers, and breastfeeding efficacy, this study aims to clarify the clinical utility of music therapy in postpartum emotion regulation.
MATERIALS AND METHODS
Study Design
A total of 153 primiparous women were assessed for eligibility between June 2022 and June 2024 at the Affiliated Suzhou Hospital of Nanjing University Medical School. Among them, 5 were excluded due to carrying twins, and 28 were excluded due to incomplete data. Ultimately, 120 cases were enrolled in the final analysis. The participants were divided into two groups based on the postpartum nursing methods they received. Those who received standard care were classified into the standard care group (n = 58), and those who received light music therapy were classified into the music therapy group (n = 62). Two independent researchers reviewed electronic health records and follow-up questionnaires to ensure data consistency, and discrepancies were resolved through discussion.
The study protocol received approval from the Ethics Committee of the Affiliated Suzhou Hospital of Nanjing University Medical School (202200156SZKJCYY). Informed consent was obtained in writing by all participants. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.[13]
Sample Size Calculation
The sample size estimation was based on a post hoc power analysis using the primary outcome of the Edinburgh Postnatal Depression Scale (EPDS) score. A previous study indicated an average EPDS decrease of 2.1 points [standard deviation (SD) = 2.4] in the standard care group.[14] Assuming a clinically meaningful between-group difference of 1.5 points for music therapy, a power analysis was conducted using G*Power 3.1 (Heinrich-Heine-Universität Düsseldorf, German) with a two-tailed independent t-test (α = 0.05, 1 − β = 0.80). The formula was n = [(Zα/2 + Zβ)2 × 2 × σ2]/δ2, where σ represents estimated variance, and δ represents effect size. The calculation result suggested a minimum requirement of 52 participants per group. The final study included 62 participants in the standard care group and 58 cases in the music therapy group, and this threshold was exceeded to provide adequate statistical power.
INCLUSION AND EXCLUSION CRITERIA
Inclusion criteria were as follows: (1) primiparous women with singleton pregnancies delivered at ≥37 weeks’ gestation; (2) availability of complete postpartum medical records, including nursing logs and standardized psychological assessments at baseline and follow-ups; (3) absence of prepregnancy psychiatric diagnoses, such as major depressive disorder and generalized anxiety disorder; and (4) normal hearing function.
Exclusion criteria were as follows: (1) multiple pregnancies; (2) incomplete postpartum follow-up data; (3) concurrent participation in psychotherapy or use of psychotropic medications during the study period; (4) severe obstetric complications, including eclampsia and postpartum hemorrhage requiring transfusion; (5) newborns with congenital anomalies or neonatal intensive care unit admission; (6) participants with poor adherence; and (7) hospital stay of less than 3 days.
Nursing Methods
The standard care group received standardized postpartum care. This included routine physiological monitoring of vital signs, uterine contraction patterns, and lactation progression during hospitalization. Nursing staff provided basic breastfeeding guidance, emphasizing proper latching techniques and feeding frequency, supplemented by written educational materials on newborn care. Pain management followed a stepwise approach: nonpharmacological strategies such as perineal cold therapy and positional adjustments were prioritized, and oral analgesics were administered only upon patient request for moderate-to-severe discomfort. Psychological support included brief daily check-ins addressing immediate physical recovery concerns, without emotional counseling or sensory interventions. Environmental controls maintained ambient noise levels below 55 dB in maternity wards, and no intentional auditory stimulation was provided. Adherence to the standard care protocol was systematically verified through electronic nursing documentation, including medication administration timestamps and daily progress notes. Postdischarge follow-up involved weekly 15- to 20-minute telephone check-ins by nurses to assess maternal and infant health and breastfeeding challenges, alongside with an outpatient visit at 6 weeks postpartum for maternal physical recovery assessments. No proactive mental health screening or counseling was provided unless participants spontaneously reported distress.
The music therapy group received structured light music therapy in addition to standard postpartum care. A hospital-curated music library comprising 32 instrumental tracks (mean duration 4.2 ± 1.2 min) was utilized based on previous experiences,[15] featuring classical compositions and culturally adapted folk melodies. Participants selected their preferred genres from the music library via a tablet-based interface during admission, with options updated daily to minimize habituation. Music therapy was initiated within 24 hours postpartum. Sessions were conducted twice daily (09:00–09:30 and 17:00–17:30) in private postpartum rooms using noise-canceling headphones (Bose, QuietComfort 35 II, USA), and playback volume was calibrated to 40 to 45 dB. Each 30-minute session began with 5 minutes of breathing exercises guided by the nurses. The breathing exercises consisted of (1) a 1-minute preparatory phase (sitting upright with hands placed on the lower ribs to monitor diaphragmatic movement); (2) a 3-minute rhythmic breathing phase (inhale for 4 seconds through the nose, hold for 2 seconds, and exhale for 6 seconds through pursed lips at a 6–8 breaths/min pace); and (3) a 1-minute recovery phase (natural breathing). This was followed by continuous music playback. Nursing staff documented real-time adherence through a checklist system, confirming proper device placement and ensuring environmental quietness (background noise <55 dB).
Post-discharge continuity was maintained through a loaned audio device (Sony, NW-A105 Walkman, Japan) with preloaded tracks, synchronized to the original nursing schedule. Additionally, participants received weekly 15- to 20-minute online counseling sessions focused on stress management techniques. Compliance after discharge was monitored through a mobile application—WeChat (Tencent Inc., China). Participants were required to send the information of time, duration, and specific tracks they listened to during each session to a specific WeChat chat group. Self-reported adherence was verified during weekly follow-up calls.
Observation Indicators
Baseline Characteristics
Baseline characteristics were systematically extracted from electronic medical records and structured admission questionnaires. Key variables included maternal age at delivery, gestational age, and neonatal birth weight. Delivery mode (vaginal or cesarean) and intrapartum analgesia usage (pharmacological/nonpharmacological) were documented through operative notes. Socioeconomic factors included educational levels (categorized as ≤high school and >high school), marital status, and annual family income. All data underwent dual-entry verification by independent researchers to ensure accuracy, and inconsistent records were cross-checked against nursing shift documentation.
Psychological Outcomes
Psychological outcomes were assessed at two time points: baseline (3-day postpartum) and 6-week postpartum.
The EPDS was used to evaluate depressive symptoms.[16,17] This 10-item questionnaire measures depressive mood, anxiety, and self-blame tendencies. Each item is scored from 0 to 3, which yields a total score ranging from 0 to 30. A score of 13 or higher indicates a high risk of clinical depression. The Cronbach’s α for the EPDS is 0.88.
Anxiety symptoms were measured using the Perinatal Anxiety Screening Scale (PASS).[18,19] The 31-item tool assesses four dimensions: acute anxiety and adjustment; general worry and specific fears; perfectionism, control, and trauma; and social anxiety. Each item is scored from 0 (no symptom) to 3 (severe symptom), which yields a total range of 0 to 93. A threshold score of 21 or higher identifies clinically relevant anxiety. The PASS has a Cronbach’s α of 0.95.
Sleep Quality
The Pittsburgh Sleep Quality Index (PSQI) evaluates sleep disturbances across seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction.[20,21] Each domain is scored from 0 (no difficulty) to 3 (severe difficulty), which yields a total score ranging from 0 to 21. Total scores exceeding five indicate sleep problems. The PSQI has a Cronbach’s α of 0.82. All assessments were conducted in private settings by trained nurses who were not informed of participants’ group allocation, and electronic data entry was employed to minimize errors.
Physiological Outcomes
Salivary cortisol and alpha-amylase measurement: Saliva was collected between 07:00 and 08:00 a.m. to control for diurnal variation. Participants were asked to refrain from eating, drinking, or brushing their teeth for 30 minutes prior to sampling. Saliva samples were centrifuged at 3000 × g for 15 minutes (Eppendorf 5430R, Germany) and stored at −80°C until analysis. Salivary cortisol levels were quantified using enzyme-linked immunosorbent assay using a high-sensitivity salivary cortisol kit (Salimetrics, Catalog No. 1-3002, USA). The absorbance was measured at 450 nm, with 620 nm as the reference wavelength, using a SpectraMax M5 microplate reader (Molecular Devices, USA). The assay has a lower limit of sensitivity of 0.007 µg/dL, with intra-assay coefficients of variation <7% and inter-assay coefficients of variation <10%. Salivary alpha-amylase (sAA) activity was analyzed using kinetic assays on the same samples. After thawing, 20 µL of saliva was mixed with 100 µL of substrate solution (α-amylase FS Kit, DiaSys Diagnostic Systems GmbH, Germany) containing 4,6-ethylidene-G7PNP. Absorbance at 405 nm was monitored every 30 seconds for 5 minutes using a UV-1800 spectrophotometer (Shimadzu Corporation, Japan). Enzyme activity (U/mL) was calculated based on the rate of substrate hydrolysis. Laboratory personnel analyzing salivary samples were blinded to group allocation to prevent measurement bias.
Breastfeeding Efficacy
Exclusive breastfeeding (EBF) was defined as infant nutrition derived solely from breast milk, without formula supplementation. EBF rates at 3 days and 6 weeks postpartum were calculated based on maternal self-reports.
Quality of Life
Quality of life was assessed using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) scale, with a Cronbach’s α = 0.89.[22,23] The 26-item tool evaluates four domains: physical health, psychological well-being, social relationships, and environmental factors. Each item was rated on a 5-point Likert scale ranging from 1 (very poor) to 5 (very good). The scoring for each domain was calculated as follows: the mean score for each domain was obtained by summing the item scores within the domain and dividing by the number of items. The mean score was then multiplied by 4 to obtain the domain score. The domain scores were then transformed into a 0 to 100 scale using the following formula: Transformed score = [(Domain score − Minimum possible score)/(Maximum possible score − Minimum possible score)] × 100. A higher score indicates better functioning.
Statistical Analysis
Data were analyzed using IBM SPSS Statistics 24.0 (IBM Corp., Armonk, NY, USA), and tables were created using Microsoft Excel 2021 (Microsoft Corporation, Redmond, WA). Continuous variables were assessed for normality using the Shapiro–Wilk test. Normally distributed data were expressed as mean ± SD and compared between groups using independent t-tests, while intragroup comparisons at different time point were evaluated using paired t-test. Categorical variables, presented as frequencies (percentages), were compared using χ2 tests or Fisher’s exact tests when expected counts were <5. A P value <0.05 was defined statistical significance.
RESULTS
Baseline Characteristics
Baseline characteristics, including maternal age, gestational age, neonatal birth weight, marital status, maternal educational levels, annual family income, delivery mode, and intrapartum analgesia usage, showed no significant differences between the standard care group and music therapy group (P > 0.05). These findings confirm the comparability of baseline profiles and support the validity of subsequent outcome comparisons [Table 1].
Table 1.
Comparison of Baseline Characteristics between Two Groups.
| Item | Standard Care Group (n = 58) | Music Therapy Group (n = 62) | Statistic | P |
|---|---|---|---|---|
| Maternal age (year) | 28.34 ± 3.45 | 28.12 ± 3.28 | t = 0.359 | 0.729 |
| Gestational weeks | 39.12 ± 0.87 | 39.04 ± 0.92 | t = 0.489 | 0.626 |
| Neonatal weight (g) | 3285.34 ± 412.67 | 3312.19 ± 398.54 | t = − 0.363 | 0.718 |
| Marriage status (n, %) | χ2 = 0.284 | 0.594 | ||
| Married | 55 (94.83%) | 60 (96.77%) | ||
| Unmarried | 3 (5.17%) | 2 (3.23%) | ||
| Educational levels (n, %) | χ2 = 0.044 | 0.833 | ||
| ≤High school | 15 (25.86%) | 15 (24.19%) | ||
| >High school | 43 (74.14%) | 47 (75.81%) | ||
| Family annual income (n, %) | χ2 = 0.109 | 0.947 | ||
| <80,000 CNY | 10 (17.24%) | 12 (19.35%) | ||
| 80,000–150,000 CNY | 32 (55.17%) | 34 (54.84%) | ||
| >150,000 CNY | 16 (27.59%) | 16 (25.81%) | ||
| Delivery mode (n, %) | χ2 = 0.231 | 0.631 | ||
| Vaginal | 38 (65.52%) | 38 (61.29%) | ||
| Cesarean | 20 (34.48%) | 24 (38.71%) | ||
| Intrapartum analgesia (n, %)* | χ2 = 0.213 | 0.645 | ||
| Pharmacological | 22 (57.89%) | 20 (52.63%) | ||
| Nonpharmacological | 16 (42.11%) | 18 (47.37%) |
CNY = Chinese Yuan.;*Intrapartum analgesia limited to vaginal deliveries
Psychological Outcomes
Psychological outcomes revealed significant intergroup differences over time [Table 2]. Baseline scores of EPDS and PASS did not differ between groups (P > 0.05). At 6 weeks postpartum, the music therapy group showed lower EPDS and PASS scores compared to the standard care group (P all < 0.05).
Table 2.
Comparison of Psychological Indicators between Two Groups.
| Psychological Outcome | Group | 3-Day Postpartum | 6-Week Postpartum |
|---|---|---|---|
| EPDS | Standard care group (n = 58) | 7.82 ± 1.15 | 8.23 ± 1.20* |
| Music therapy group (n = 62) | 7.79 ± 1.08 | 6.45 ± 0.95 | |
| t | 0.147 | 9.039 | |
| P | 0.883 | <0.001 | |
| PASS | Standard care group (n = 58) | 17.23 ± 1.80 | 18.57 ± 1.64* |
| Music therapy group (n = 62) | 17.15 ± 1.82 | 13.81 ± 1.33* | |
| t | 0.242 | 17.51 | |
| P | 0.809 | <0.001 |
EPDS = Edinburgh Postnatal Depression Scale, PASS = Perinatal Self-Rating Anxiety Scale; *Compared to 3-day postpartum, P < 0.05.
No significant intergroup differences were observed in the incidence of depression (EDPS score >13) and anxiety (PASS score >21) at 3 days postpartum (P > 0.05). At 6 weeks postpartum, the music therapy group demonstrated a depression incidence comparable to that of the standard care group (4.84% vs. 12.07%, χ2 = 2.051, P = 0.152). However, the music therapy group demonstrated a significantly lower anxiety incidence compared to the standard care group (6.45% vs. 20.69%, χ2 = 5.257, P = 0.022). These results highlight the progressive preventive efficacy of music therapy against postpartum psychological disorders.
Sleep Quality
The PSQI scores at 3 days postpartum did not differ between groups (P > 0.05). At 6 weeks postpartum, the music therapy group demonstrated significant improvements across all seven sleep dimensions (P all < 0.05). These findings indicate that music therapy comprehensively enhances various aspects of sleep quality in postpartum women and may help alleviate postpartum depression and anxiety [Table 3].
Table 3.
Comparison of Sleep Quality between Two Groups.
| PSQI Domain | Group | 3-Day Postpartum | 6-Week Postpartum |
|---|---|---|---|
| Total score | Standard care group (n = 58) | 10.45 ± 1.88 | 9.26 ± 1.75* |
| Music therapy group (n = 62) | 10.20 ± 1.92 | 8.02 ± 1.69* | |
| t | 0.720 | 3.948 | |
| P | 0.473 | <0.001 | |
| Subjective sleep quality | Standard care group (n = 58) | 1.85 ± 0.48 | 1.67 ± 0.42* |
| Music therapy group (n = 62) | 1.82 ± 0.50 | 1.23 ± 0.35* | |
| t | 0.335 | 6.250 | |
| P | 0.739 | <0.001 | |
| Sleep latency | Standard care group (n = 58) | 1.65 ± 0.52 | 1.48 ± 0.44* |
| Music therapy group (n = 62) | 1.62 ± 0.51 | 1.16 ± 0.38* | |
| t | 0.319 | 4.272 | |
| P | 0.750 | <0.001 | |
| Sleep duration | Standard care group (n = 58) | 1.54 ± 0.47 | 1.34 ± 0.42* |
| Music therapy group (n = 62) | 1.56 ± 0.45 | 1.12 ± 0.35* | |
| t | 0.238 | 3.125 | |
| P | 0.812 | 0.002 | |
| Habitual sleep efficiency | Standard care group (n = 58) | 1.44 ± 0.38 | 1.29 ± 0.32* |
| Music therapy group (n = 62) | 1.42 ± 0.36 | 1.18 ± 0.28* | |
| t | 0.296 | 2.007 | |
| P | 0.767 | 0.047 | |
| Sleep disturbances | Standard care group (n = 58) | 1.58 ± 0.44 | 1.43 ± 0.39* |
| Music therapy group (n = 62) | 1.55 ± 0.42 | 1.21 ± 0.32* | |
| t | 0.382 | 3.387 | |
| P | 0.703 | 0.001 | |
| Use of sleep medication | Standard care group (n = 58) | 0.72 ± 0.26 | 0.64 ± 0.14* |
| Music therapy group (n = 62) | 0.70 ± 0.25 | 0.59 ± 0.18* | |
| t | 0.430 | 1.690 | |
| P | 0.668 | 0.094 | |
| Daytime dysfunction | Standard care group (n = 58) | 1.67 ± 0.45 | 1.34 ± 0.38* |
| Music therapy group (n = 62) | 1.65 ± 0.43 | 0.86 ± 0.30* | |
| t | 0.240 | 7.706 | |
| P | 0.803 | <0.001 |
PSQI = Pittsburgh Sleep Quality Index; * Compared to 3-day postpartum, P < 0.05.
Physiological Measurement
At 3 days postpartum, no significant differences between groups were observed in cortisol or sAA levels (P > 0.05, Table 4). The music therapy group had significantly lower salivary cortisol and sAA levels at 6 weeks postpartum than the standard care group, suggesting that music therapy may alleviate postpartum anxiety through modulation of the neuroendocrine system.
Table 4.
Comparison of Physiological Indicators between Two Groups.
| Group | Cortisol (µg/dL) |
sAA (U/mL) |
||
|---|---|---|---|---|
| 3-Day | 6-Week | 3-Day | 6-Week | |
| Standard care group (n = 58) | 0.63 ± 0.12 | 0.49 ± 0.05* | 65.34 ± 8.45 | 58.20 ± 7.80* |
| Music therapy group (n = 62) | 0.65 ± 0.09 | 0.34 ± 0.04* | 64.87 ± 8.20 | 50.35 ± 7.15* |
| t | 1.037 | 18.20 | 0.309 | 5.752 |
| P | 0.302 | <0.001 | 0.758 | <0.001 |
sAA = salivary alpha-amylase; *Compared to 3-day postpartum, P < 0.05.
Breastfeeding Efficacy and Quality of Life
At 6 weeks postpartum, the music therapy group had a higher EBF rate than the standard care group (79.03% vs. 53.45%, P = 0.003). Baseline (3-day) WHOQOL-BREF scores showed no intergroup differences across all domains (P > 0.05). At 6 weeks postpartum, the music group demonstrated significantly higher scores in physical health, psychological well-being, social relationship, and environmental factors (P all <0.05, Table 5). These findings suggest that music therapy can deliver clinically significant benefits that extend beyond symptom reduction to enhance mother–infant bonding and overall postpartum experience.
Table 5.
Comparison of World Health Organization Quality of Life Brief Version Score.
| WHOQOL-BREF Domain | Time Point | Standard Care Group (n = 58) | Music Therapy Group (n = 62) | t | P |
|---|---|---|---|---|---|
| Physical health | 3-Day | 61.37 ± 7.42 | 62.09 ± 7.33 | 0.535 | 0.594 |
| 6-Week | 65.28 ± 6.77* | 73.64 ± 6.52* | 6.890 | <0.001 | |
| Psychological well-being | 3-Day | 58.31 ± 8.07 | 58.96 ± 7.89 | 0.446 | 0.656 |
| 6-Week | 63.42 ± 7.18* | 76.38 ± 6.83* | 10.13 | <0.001 | |
| Social relationships | 3-Day | 64.75 ± 6.71 | 65.23 ± 6.55 | 0.397 | 0.693 |
| 6-Week | 68.33 ± 6.24* | 77.89 ± 5.93* | 8.605 | <0.001 | |
| Environmental factors | 3-Day | 59.51 ± 7.28 | 60.17 ± 7.12 | 0.502 | 0.617 |
| 6-Week | 63.15 ± 6.47* | 71.22 ± 6.08* | 7.044 | <0.001 |
WHOQOL-BREF = World Health Organization Quality of Life scale; *Compared to 3-day postpartum, P < 0.05.
DISCUSSION
Postpartum anxiety affects approximately 8.5% of women globally, and depression occurs in 10% to 15%, collectively posing critical threats to maternal and infant health.[24,25] These disorders impair mother–infant bonding, disrupt breastfeeding continuity, and increase the risk of long-term cognitive and emotional sequelae in offspring.[2,4] The findings of this study revealed that light music effectively prevents these psychological burdens, modulates stress responses, and enhances functional outcomes.
Postpartum anxiety and depression are primarily caused by rapid hormonal changes, such as sharp declines in estrogen, progesterone, and thyroid hormone levels, as well as social and familial factors.[2,4] Primiparous women, due to their lack of experience in adapting to maternal roles, often experience heightened psychological stress, which leads to higher rates of postpartum anxiety and depression.[26] However, conventional nursing methods face limitations, including lactation safety concerns associated with antidepressants and accessibility barriers to psychotherapy.[6]
Our study found that the music therapy group showed significantly milder anxiety and depressive symptoms at 6 weeks postpartum compared with the standard care group. Additionally, the proportion of participants screening positive for clinically significant anxiety and depression was markedly lower in the music therapy group. These results aligned with previous studies demonstrating therapeutic effects of music on anxiety and depression.[27,28] However, prior research primarily focused on treating diagnosed cases, whereas this study highlights the preventive role of music. The mood-enhancing effects of music may stem from its ability to modulate neurotransmitters such as dopamine, serotonin, and endorphins.[29] Dopamine release during pleasurable music listening mediates reward processing and motivation.[30] Serotonin levels, which are often depleted in depression, may be stabilized through regular music exposure, contributing to improved mood stability and reduced anxiety.[30] Additionally, music stimulates the production of endogenous opioids such as β-endorphins, which provide analgesic effects and generate feelings of pleasure and well-being.[30] These neurochemical changes collectively form the biological basis for music’s therapeutic effects on postpartum psychological health. Studies also suggested that soothing music can reduce amygdala activation, thereby alleviating anxiety and depressive symptoms.[31,32]
Cortisol and sAA levels reflect the body’s stress response.[33] Psychological stress activates the hypothalamic–pituitary–adrenal (HPA) axis, increases cortisol production, and promotes sAA release.[34] HPA axis hyperactivity, commonly observed in postpartum anxiety and depression, creates a self-perpetuating cycle of stress reactivity and psychological distress.[35] Our findings revealed that women who received music therapy had lower cortisol and sAA levels than those in the standard care group. These findings align with previous studies indicating that music can reduce cortisol levels in peripartum women.[36] Music may interrupt this cycle by modulating autonomic nervous system activity, and research has shown decreased sympathetic and increased parasympathetic activation following music exposure.[35] Elevated cortisol levels correlate positively with severity of anxiety and depression.[37,38] The concurrent reduction in cortisol and sAA suggests that music therapy simultaneously targets the HPA axis and sympathetic nervous system, resulting in a comprehensive attenuation of the stress response.
Poor sleep quality and insomnia exhibit a bidirectional relationship with anxiety and depression, which often coexist as comorbid conditions.[39,40] Improving sleep quality is a validated strategy for mitigating these disorders.[41] Our findings indicated that music therapy significantly improves sleeping quality. Beyond neurotransmitter regulation, music may enhance sleep by activating the parasympathetic nervous system and slowing heart and respiratory rates to induce relaxation.[42,43] Music can also mask environmental noise and create a tranquil sleep environment.[42] Similarly, breastfeeding and mental health share a complex interplay in postpartum women. Breastfeeding increases the releases of oxytocin and prolactin—hormones that strengthen mother–infant bonding and reduce anxiety.[44,45] Conversely, postpartum anxiety and depression can disrupt lactation by altering hormone levels, undermining breastfeeding confidence, and further reducing milk supply.[44] A systematic review indicated that music incorporating nurturing themes or gentle melodies can enhance milk production, aligning with our findings of improved breastfeeding efficacy.[46] These results suggested music’s dual role in emotional regulation and lactation support. Finally, higher quality-of-life scores in the music therapy group comprehensively reflect its multifaceted benefits in postpartum care. While significant reductions in anxiety symptoms and improvements in physiological markers were observed, the difference in clinically significant depression rates between groups did not reach statistical significance at 6 weeks postpartum, although a clear trend was evident (12.07% vs. 4.84%). This outcome may reflect insufficient statistical power for categorical outcomes with low baseline prevalence, suggesting that larger sample sizes may be needed to detect significant differences in clinical depression rates.
This study has several limitations. The retrospective design introduces potential selection bias, as group allocation was based on clinical practice rather than randomization. Additionally, the single-center sample may limit the generalizability to diverse cultural or healthcare settings because the findings primarily reflect outcomes in a specific cultural context and healthcare system, and may limit their applicability to populations with different perinatal care practices or cultural attitudes towards music. Adherence to post-discharge music sessions was self-reported via a mobile application, which may have introduced measurement inaccuracies. Despite the authors’ efforts to document certain confounding variables, other factors—such as exposure to music outside the nursing protocol and different home environments after discharge (e.g., partner support and infant temperament)—could not be fully controlled, all of which might influence psychological outcomes. While participants were able to select their preferred music genres from our library, the predetermined selection may not have optimally matched individual preferences, potentially affecting nursing efficacy and participant engagement. Future research should priorities multicenter randomized trials with extended follow-up periods to evaluate the sustained effects. Prospective randomized controlled trials with stratification by baseline psychological measures, extended follow-up periods of 6 and 12 months to assess long-term preventive effects, and investigation of dose–response relationships between music exposure and psychological outcomes are recommended. Incorporating objective adherence monitoring tools, such as smartwatch-based music playback tracking, could enhance data reliability. Additionally, future studies should utilize personalized music delivery via smartphone applications with preference-learning algorithms to accommodate individual musical tastes, explore cultural adaptations of music selections for diverse populations, and systematically control for environmental and family support variables through structured assessments and matched controls. Investigating neuroimaging markers as mediators of music’s psychological effects would also provide valuable mechanistic insights into this promising nursing approach.
CONCLUSION
Light music significantly alleviates postpartum anxiety and depression, improves physiological stress responses and breastfeeding outcomes, and holds substantial clinical potential.
Availability of Data and Materials
The datasets generated and analyzed in the current study are available from the corresponding author upon reasonable request.
Author Contributions
Wenting Cai: Led the research design and execution, managed data collection and analysis, and authored the initial draft of the manuscript.
Jiaping Wang: Oversaw the overall research design and supervision, offered technical and theoretical expertise, and conducted the final review and approval of the manuscript.
Ethics Approval and Consent to Participate
This study was approved by the Affiliated Suzhou Hospital of Nanjing University Medical School (202200156SZKJCYY). All patients have provided written informed consent.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgment
We thank the patients and their families for participating in this research.
Funding Statement
This study is funded by the Suzhou Key Medical Discipline Support Program (SZFCXK202109).
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and analyzed in the current study are available from the corresponding author upon reasonable request.
