Yoga-based intervention for caregivers of outpatients with psychosis: A randomized controlled pilot study
Highlights
► Caregivers of patients with psychosis were able to learn and practice a yoga module. ► 4 months yoga practice produced notable improvement in burden and quality of life. ► Yoga can be an effective intervention for caregivers of patients with psychosis. ► A large proportion of caregivers were unable to enroll due to logistic issues. ► Provision of yoga services closer to the community needs to be examined.
Introduction
The prevalence of psychosis (including schizophrenia) is consistently reported to be more than 1% throughout the world. As well as the strain on financial and health care resources, psychosis leads to social and psychological anguish for patients and their families, which is difficult to measure. Caregivers of patients with any illness have been found to have higher levels of stress and depression, and more likely to have lower levels of subjective well-being, physical health, and self-efficacy than non-caregivers (Pinquart and Sorensen, 2003). Among chronic diseases, caregivers of patients with schizophrenia have been reported to have higher subjective and objective burden than caregivers of patients with physical illnesses, particularly in families with poor social support (Magliano et al., 2005). This highlights the need for interventions for these caregivers.
Yoga has been found to be useful in many physical and mental disorders, particularly those associated with stress, and specific yoga modules have been designed for stress reduction and depression (Naveen et al., 2010). Yoga has been shown to be an effective treatment for dysthymia (Janakiramaiah et al., 1998) and major depression (Janakiramaiah et al., 2000).
Several studies have looked at yoga as a stress-relief package for caregivers of patients with dementia. A pilot study of yoga and meditation intervention for dementia caregiver stress (Waelde et al., 2004) found pre/post comparisons leading to statistically significant reductions in depression and anxiety and improvements in perceived self-efficacy. Another feasibility study of the effect of yoga on the physical health and coping of informal caregivers randomized 17 caregivers of patients with disabilities into yoga or control group (Van Puymbroeck et al., 2007). The study found that yoga training was feasible but required testing in a larger sample for its efficacy. However, these studies were not specific to patients with psychosis, and the needs of these caregivers may be quite different. Jagannathan et al. conducted a randomized controlled trial of yoga as an intervention for caregivers of inpatients with schizophrenia (Jagannathan, 2010). This methodologically sound study randomized consenting caregivers into four interventional groups; a brief yoga program, psychosocial intervention, combined yoga and psychosocial intervention, and waitlist. The results did not show any significant differences in the reduction of burden and improvement of coping among the caregivers in the four study groups. However, the inpatient population in this study may not represent the majority of patients with psychosis. We are not aware of any study specifically looking at yoga intervention in caregivers of outpatients with psychosis.
In this context, we studied the effects of a structured yoga module for caregivers of outpatients with psychosis on their burden, depression, anxiety, and quality of life.
Section snippets
Materials and methods
The study was conducted in the department of Psychiatry at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore. The patients were recruited from the outpatient services of NIMHANS. Specific exclusion and inclusion criteria were used to recruit the patients. The Institutional Ethics Committee approved the study. The study was registered with the Clinical Trial Registry of India with number CTRI/2011/06/001792.
Primary caregivers (aged between 18 and 60 years) of
Demographic variables
Of the 525 caregivers screened, 29 caregivers consented to participate and completed the baseline assessments. 18 caregivers (case: 7, control: 11) completed all three follow-ups. Two subjects follow up could not be completed. Out of the 9 caregivers who dropped out, 7 were in yoga group and 2 were in control group.
The yoga and control groups were comparable on socio-demographic variables such as age (Z = −0.764, sig. = 0.445) and gender (M:F 6:9 and 6:10, χ2 = 0.42, sig. = 0.52), whereas the subjects
Discussion
The significant impact of schizophrenia and psychosis on families, especially on the primary caregivers, is well documented. Caregivers of patients with psychotic illnesses have been shown to suffer from extremely high rates of stress-related illnesses such as anxiety, depression, and also to have high burden levels and poor quality of life. Among the various interventions for caregivers, yoga as an intervention has been reported to help caregivers of patients with dementia (Waelde et al., 2004
Conflicts of interest
No conflicts of interest to declare.
Acknowledgements
We acknowledge funding support from the Dept. of AYUSH, Government of India, through the Central Council for Research in Yoga and Naturopathy to Dr. Shivarama Varambally for the research project “Efficacy of Brief yoga program for caregivers of out-patients with schizophrenia”. We also acknowledge technical help from Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore for the yoga module used in the study.
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