Literature Review of PICOT Question Essay

Literature Review of PICOT Question Essay

Each Student must prepare a literature review in relation to the chosen PICOT (see my PICOT framework document that will be uploaded) that will serve as

the literary basis for the Practice Proposal. This is an opportunity to read as a scholar and

develop competence in analyzing the key elements of a research article and review outcomes

that reflect a heuristic process.Literature Review of PICOT Question Essay


The Student should select a minimum of Five primary research

studies from the literature search that was conducted to justify the PICOT. Next analyze these

manuscripts to consider how the purpose, methodology, results, and discussion support how

your research question will add knowledge to the nursing practice.


Last, write a short paper (6-

9 pages in total). Include a complete citation for each manuscript. See rubric to review points

that faculty will use to grade the assignment.

**A 5 point deduction will be taken for each page over the maximum page limit. **Literature Review of PICOT Question Essay

Literature Review

A major depressive disorder is characterized by persistent low mood, diminished interest, and loss of pleasure. Other symptoms include psychomotor changes, appetite, and weight disturbances. The etiology of MDD is multifactorial, where both the environmental and genetic factors can be implicated. Music therapy – where music elements are used as an intervention, has been applied in various contexts; in both group and individual therapy. The therapeutic method is not widespread compared to pharmacological interventions, which have been used for a longer time. However, the use of music to impose a therapeutic change need to be investigated due to potential positive implications.

In line with the PICOT question, various research studies were selected using various search terms such as “music,” “MDD,” and “pharmacotherapy.” The PICOT question compares music therapy against pharmacological interventions in improving psychological, behavioral, affective, and cognitive outcomes within 12 weeks. Due to limited literature on the use of music therapy in MDD, this PICOT question was formulated to address the literature gap. Thus, the research question was:among patients diagnosed with Major Depressive Disorder (MDD) (P), does music therapy (I) compared to pharmacological interventions (C) result in improved psychological, behavioral, affective, and cognitive outcomes(O) within 12 weeks? (T)Literature Review of PICOT Question Essay


Aalbers et al. (2017) reviewed various randomized clinical trials and controlled clinical trials on the use of music therapy in depression. Study participants’ characteristics included age, gender, ethnicity, and residence. Study participants included those with MDD according to DSM-V. Because MDD relates to other psychological conditions, disorders such as anxiety, schizophrenia, and dementia, which may co-occur with MDD, were also included. Any form of music therapy, ranging from re-creative to compositional methods were employed in the study. The implications of music therapy were compared with other forms of therapy such as TAU, psychological therapies, and pharmacological interventions. The effects of music therapy on the participants were evaluated by secondary outcomes such as social and occupational functioning, quality of life, and cost-effectiveness.

The study employed a search strategy on the Cochrane Common Mental Disorders Group, where more than 40,000 randomized clinical trials were selected for various disorders. Electronic searches were carried out in various databases such as PubMed, Embase, and the World Health Organization. Two review authors extracted data using a standardized data extraction form. The following data characteristics were evaluated; source, methods, participants, intervention, outcomes, results, and notable conflict of interest.

Bueno-Notivol et al. (2020) conducted a systematic review to evaluate the prevalence of depressive symptoms during the COVID-19 pandemic. Two of the study researchers searched for cross-sectional studies that reported the prevalence of depression. Various research databases such as MEDLINE, PubMed, and Web of Science were analyzed. Studies only met the inclusion criteria if they reported cross-sectional data on the prevalence of depression during the COVID-19 outbreak. The studies were to be based on community-based samples and had described methods used to diagnose depression. The study researchers designed a data extraction form, which was used to extract information on the country, sample size, prevalent rates of depression, and the proportion of women.

The articles were assessed using independent reviewers for methodological validity. Possible disputes from the reviews were resolved through discussions or involving a third reviewer. Various analysis tools were used, such as the generic inverse variance, Freeman and Turkey’s double arcsine, and Hedges Q statistic.

The study conducted by Cuijpers et al. (2020) employed a meta-analysis methodology where databases were used to identify randomized trials evaluating the effect of psychotherapies on depression. The study researchers searched PubMed, PsycINFO, EMBASE, and Cochrane Library databases using search words such as depression and psychotherapies with filters for randomized controlled trials. To evaluate the potential risk of bias, two other independent researchers were involved. Any disagreement was resolved through discussion. Pharmacotherapy was assessed using therapeutic dose and their titration schedule. However, psychotherapies were evaluated using the treatment manual and the verification of treatment integrity. Participant characteristics such as type of depressive disorder, recruitment method, and target group were used.Literature Review of PICOT Question Essay

The outcome measures for the study were evaluated using treatment response, which was defined as a 50% reduction in depressive symptoms. The remission rate was also assessed using the number of patients with depressive symptoms below a specific cut-off on a validated rating scale. The researchers conducted a pairwise meta-analysis for all comparisons using a random-effects pooling model. Heterogeneity was determined by calculating a 95% confidence interval. Further analyses were conducted using separate pairwise and network meta-analyses for studies that focused on chronic or treatment-resistant depression. A series of sensitivity analyses were also conducted in studies where pharmacotherapy was optimized.

An exploratory design was applied in a research study by Ray & Götell (2018) to measure the effectiveness of music therapy and music activities on depression symptoms. The baseline depressive symptoms were compared with symptoms after two weeks of music therapy. The study was conducted in a nursing home where residents were recruited using referrals from the clinical staff, including nurses, social workers, and recreational therapists. The inclusion criteria for the participants included stable comorbidities, ability to hear with or without an assistive device, and no current psychiatric disorder other than dementia and depression. Nursing home residents who did not show depressive symptoms were omitted from the studies.

The study participants underwent music therapy in a small group of four to six people. The study instruments included the Cornel Scale for Depression measures, which was used to evaluate the severity of depression symptoms in patients with dementia. Another instrument used was the Music in Dementia Assessment Scale to evaluate the wellbeing of nursing home residents. The MIDAS instrument was chosen for its higher therapist inter-rater reliability.

Yang et al. (2019) conducted a meta-analysis study where the researchers searched databases such as the China Biology Medicine Database, Cochrane Library, and Web of Science. The study participants were women diagnosed with postpartum depression. Thus, the age and the delivery mode were not limited. Women diagnosed with other conditions were excluded. In the experimental group, the type of music was not limited, unlike the control group in which a standard treatment was offered. The main outcomes for the study were depression and anxiety were the main outcomes including variables such as sleep, pain, and satisfaction. Continuous data were analyzed using standardized mean differences and 95% confidence interval. The heterogeneity of the data was evaluated using P- and 12 values.Literature Review of PICOT Question Essay



The scientific studies employed various statistical tools depending on their methodologies. Although Aalbers et al. (2017) does not indicate the statistical data analysis techniques used, the rest of the scientific studies indicated their analysis techniques. Bueno-Notivol et al. (2020) used a generic inverse variance with a random effect model. Meta-regression and subgroup analyses were conducted to evaluate the heterogeneity of the study data. Sensitivity analyses were conducted on individual data to determine the influence they had on the overall result. The data were manipulated using Metaprop package, STATA statistical software. However, Cuijpers et al. (2020) methodology was a meta-analysis, and thus data were analyzed by summarized using plots for the main outcomes. Then, contrast-based analyses were performed to compare the efficacy and acceptability of the data. The researchers used tests such as local and global inconsistency to assess the consistency of the network.

Moreover, Ray & Götell (2018) used IBM Statistics Package for Social Sciences software to perform a repeated-measures ANOVA to compare baseline depressive symptoms after music therapy. Yang et al. (2019) used Review Manager software from Cochrane, London, UK, to perform the meta-analysis. Continuous data were analyzed using standardized mean differences with a 95% confidence interval.

All the scientific studies compared the effect of therapeutic interventions on clinical outcomes of depressed patients except Bueno-Notivol et al. (2020), which evaluated the prevalence of depression during the COVID-19 outbreak. Bueno-Notivol et al. (2020) established that the prevalence of depression during the previous outbreaks, such as SARS and Ebola, were between 3 to 73%. This may be attributed to the faster containment of the past outbreaks. Consequently, the mortality rate, infection rates, and prevalence within the general population were considerably lower.Therefore, the length and uncertainty of the COVID-19 outbreak precipitated higher levels of depression. Bueno-Notivol et al. (2020)supported the incorporation of mental health services during the COVID-19 patient management. This includes monitoring for psychological symptoms and social needs within the general population. A sudden worsening of situations has been associated with the rise of mental health issues during the COVID-19 outbreak. Thus, patients and families exposed to the outbreak exhibit helplessness and lack of motivation and consequently manifest depression. Due to the lockdown and the depressive symptoms, affected patients are unlikely to seek medical interventions.Literature Review of PICOT Question Essay

Studies that evaluated the effect of music therapy compared to other therapeutic interventions on demonstrated variable results. For instance, Aalbers et al. (2017) noted no differences between music therapy and psychological therapy in alleviating the severity of depressive symptoms when using patient-reported and clinician-rated outcomes. Notably, the studies did not establish any correlation in quality of life for participants that left the intervention earlier, and those who completed the study. Interestingly, the review authors did not establish any differences between participants on active and those or receptive music therapy in mitigating the severity of depressive symptoms. Conversely, Yang et al. (2019) noted significant differences between depressive symptoms and music therapy in the experimental group against the control group. Specifically, the results determined that sight, pain, sleep, satisfaction, and maternal attachment were significantly different. Nonetheless, the study did not establish any correlation between music therapy and anxiety between the control and the experimental groups. Thus, music therapy improves postpartum depression marked by improvement in sight, sleep, and attachment of the mothers to their babies.

Like the findings by Yang et al. (2019), Ray & Götell (2018) demonstrated that music therapy had positive effects on the patients’ behavioral and cognitive functioning. For instance, caregiver-implemented interventions incorporated with appropriate training correlated with decreased behavioral disturbances such as depressive symptoms. However, Cuijpers et al. (2020) analyzed pharmacotherapy against psychotherapy in improving the clinical outcomes of depressed patients. The acceptability of depressants was a critical factor in pharmacotherapeutic techniques. Particularly, patients demonstrated lower acceptability of pharmacological interventions due to the side effects associated with such interventions. Consequently, patients readily accepted psychotherapy to pharmacotherapy. The study also established that most patients with MDD receive psychotropic medication without psychotherapy, although this is not the optimal option available for their care. Both psychotherapy and pharmacotherapy have consequences. However, patients are likely to prefer psychotherapy, although a combined therapy has been recommended for moderate depression.Literature Review of PICOT Question Essay

The studies reported various strengths and limitations. Aalbers et al. (2017) report that clinician-rated depression, patient-reported outcomes, and participants leaving the study jeopardized the validity and quality of evidence realized. Further, the inconsistency of results was found concerning anxiety when comparing patient-reported depression. Overlap confidence intervals were noted. Moreover, there was variation in effect sizes and high heterogeneity. The study also reported imprecision, stemming from a downgrading of the quality of evidence for adverse events and quality of life. Other potential biases in the study included the failure of other study reports to provide all the information required to perform a meta-analysis.

Bueno-Notivol et al. (2020) considered the lack of randomization of the sample to be a key study limitation. Again, some data were collected online, highlighting possible selection bias such as oversampling of younger and more educated people. Another key limitation was heterogeneity, which resulted from using different scales to assess for depression. The study recommended future studies to focus on the epidemiology of sub-populations, including outpatients, elderly people, and health workers. A study by Cuijpers et al. (2020) noted that the sample was too small to extrapolate to a larger population. However, Ray & Götell (2018) noted that the MIDAS tool was still being tested for validity and was not therefore reliable. Still, the video sample was reduced, and it failed to analyze all the 62 videos from participants. Lastly, Yang et al. (2019) established that their integrity and applicability of evidence were questionable. Interestingly, the meta-analysis was based on a smaller sample, which affected the reliability of the research evidence.Literature Review of PICOT Question Essay


Aalbers, S., Fusar‐Poli, L., Freeman, R. E., Spreen, M., Ket, J. C., Vink, A. C., … & Gold, C. (2017). Music therapy for depression. Cochrane Database of Systematic Reviews, (11).

Bueno-Notivol, J., Gracia-García, P., Olaya, B., Lasheras, I., López-Antón, R., & Santabárbara, J. (2020). Prevalence of depression during the COVID-19 outbreak: a meta-analysis of community-based studies. International Journal of Clinical and Health Psychology, 100196.

Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020). A network meta‐analysis of the effects of psychotherapies, pharmacotherapies, and their combination in treating adult depression. World Psychiatry, 19(1), 92-107.

Ray, K. D., & Götell, E. (2018). The use of music and music therapy in ameliorating depression symptoms and improving wellbeing in nursing home residents with dementia. Frontiers in medicine5, 287.

Yang, W. J., Bai, Y. M., Qin, L., Xu, X. L., Bao, K. F., Xiao, J. L., & Ding, G. W. (2019). The effectiveness of music therapy for postpartum depression: A systematic review and meta-analysis. Complement Ther Clin Pract37(101225531), 93-101. Literature Review of PICOT Question Essay