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Efficacy of yoga and psychosocial training programme for caregivers of persons with schizophrenia
Abstract
Aim: To study the efficacy of a need based psychosocial and yoga programme on burden and coping of caregivers of in-patients with schizophrenia
Method: 137 consenting family caregivers of in-patients with schizophrenia were randomized into one of the four need-based interventions (one week – one hour): yoga (n=36), psychosocial (n=32), combined (n=30), care as usual (n=39). Outcome measures (burden, coping, knowledge, anxiety and depression, social support) were rated by trained mental health professionals who were blind to the group status at the start of the study, end of the intervention, 1 month and 3 months post intervention.
Results: RMANOVA showed that caregivers in all four groups improved significantly in all outcomes over time. However there were no significant differences across the groups in the burden and coping of caregivers over the 3 months study period. The improvement in knowledge about the illness in the combined intervention group was significantly more than in the other groups (F=2.62; p<0.01). Significant positive correlations was observed between patient’ symptom severity and burden of the caregivers both at the baseline (r=0.197; p<0.05) and at the final follow-up (r=0.307; p<0.01)
Conclusion: This study has not shown any difference in the reduction of burden and improvement of coping among the caregivers of persons with schizophrenia, across the four groups over three months period. The most important determinant of the burden of caregivers was severity of patient’ symptoms. Future studies may employ longer duration of interventions and follow-up focusing on caregivers who continue to perceive high burden despite their patients receiving care as usual, for conclusive results.
... It was observed that caregivers (n = 137) of inpatients with schizophrenia were able to perform all the asanas (or postures) properly, understand its benefits and feel relaxed. The feasibility and usefulness of the yoga programme were endorsed by the caregivers qualitatively and quantitatively with significant reduction in burden in those attending yoga as compared to those in the waitlist group (Jagannathan, Hamza, Thirthalli, Nagendra, Kare, et al., 2012). ...
... A number of studies have advocated the provision of yoga within community settings (Baspure et al., 2012;Jagannathan, Hamza, Thirthalli, Nagendra, Kare, et al., 2012;Varambally et al., 2013). It was observed that barriers such as logistic factors to attend a session in a tertiary care centre had an effect on adherence to yoga (Baspure et al., 2012). ...
Background
Evidence-based strategies for treating mental health conditions need to be scaled up to address the mental health treatment gap in low- and middle-income countries. Most medical and psychological interventions for the treatment of mental health conditions have been developed and evaluated in high-income countries. However, the imperative of scaling up such interventions potentially ignores local realities, and may also discredit or replace local frameworks for responding to distress.
Aims
This article aims to develop a framework for the cultural adaptation of social interventions which are developed within, and draw upon, local contexts, to ensure they are acceptable, feasible and effective.
Method
A case study approach is used to discuss the feasibility of developing and adapting psychosocial interventions which are embedded in local knowledge, values and practices.
Results
The first case study introduces yoga as an alternative and/or complementary, and culturally relevant, approach for people experiencing mental health conditions in India. The second case study is a cross-cultural adaptation of a psychosocial intervention from the United Kingdom to fit the local idioms of distress and service context in Sierra Leone, as the country battled with the Ebola outbreak. We use these case studies to develop a Cultural Adaptation Framework, which recognises that people and their mental health are products of their culture and society, to inform the future development, adaptation and evaluation of sociocultural interventions for people experiencing mental health conditions in low- and middle-income countries.
Conclusion
The Cultural Adaptation Framework can be used to ensure interventions are culturally relevant and responsive to local conditions prior to evaluating in experimental studies.
... 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. ...
... This indicates that the improvement in the caregivers cannot be merely attributed to patients getting better. In a previous study on caregivers of inpatients with psychosis (Jagannathan, 2010), there was a highly significant improvement in the patients. This may have reduced the stress and burden in the caregivers, thus masking the effects of yoga. ...
The use of yoga as an intervention for caregivers of patients with psychosis has been poorly studied. The current study aimed to test the efficacy of a brief yoga program as an intervention in caregivers of outpatients with functional psychotic disorders using a randomized controlled research design.
Caregivers who agreed to participate in the study (n=29) were randomized into yoga (n=15) or wait-list group (n=14). They were assessed at baseline and at the end of 3 months. Patients who were randomized into the yoga group were offered supervised yoga training thrice a week for 4 weeks, after which they were instructed to practice at home for the next 2 months. Due to the small sample size and some variables not being normally distributed, non-parametric statistical analysis was used.
Results showed significantly reduced burden scores and improved quality of life scores in the yoga group as compared to the wait-list group at the end of 3 months. There were no significant changes in anxiety and depression scores in caregivers, or psychopathology scores in patients.
In caregivers of outpatients with functional psychosis, 4 weeks of training followed by 3 months of home practice of a yoga module offered significant advantage over waitlist. Yoga can be offered as an intervention for caregivers of patients with severe mental disorders. Methods of providing yoga intervention closer to the community or use of flexible modules at hospitals needs further study.
... Jagannathan et al., [3] in a randomized controlled study provided caregivers of in-patients with schizophrenia yoga intervention. It was noticed that irrespective of the intervention, with reduction in patient symptoms, the burden of the caregivers also reduced. ...
Background:
To test the feasibility and effectiveness of an audio-visual self-help audio-visual yoga manual on burden of Indian caregivers of persons with schizophrenia, living in the community.
Methods:
An earlier developed yoga program for caregivers of schizophrenia was remodeled into an audio-visual self-help manual in three languages and validated by mental health and yoga experts. 48 consenting primary family caregivers of outpatients with schizophrenia were screened, recruited, and allotted randomly to Yoga or Care as Usual Group. Participants in Yoga group were taught yoga from the self-help manual (1 session of 1 h every month for 5 months). The caregivers were asked to follow the manual for the remaining month at home. Assessments of burden, perceived stress, quality of life, and anxiety-depression were conducted by a rater blind to the group status at baseline and at the end of every month.
Results:
Post factoring for missing data, Repeatedmeasure ANOVA was conducted; which showed that there was no significant difference between the group that practiced the selfhelp yoga manual and the care as usual group. The caregivers who practiced yoga at home maintained an average of 50% attendance and "very well" level of yoga performance.
Conclusion:
The audio-visual self-help yoga manual was found to be feasible to use by the caregivers even though its effectiveness could not be ascertained due to high attrition.
... Hence, the unintentional exposure of the similar intervention in TAU group cannot be excluded completely. An earlier study conducted with caregivers of schizophrenia in this hospital documented similar results (Jagannathan, 2010). Further, the carers who participated in the group intervention demonstrated significantly more reduction in EE than the caregivers in TAU group at onemonth follow-up after the intervention. ...
Background: Family interventions in chronic psychosis are well established through systematic reviews and meta-analyses. Such reviews report that family intervention might reduce relapse, improve compliance with medication and reduction in levels of expressed emotion (EE) . However, most of the previous researches have been conducted in caregivers with chronic schizophrenia, and the effects of family interventions in the early stages are largely unknown.
Materials and Methods: Using a quasi-experimental nonequivalent comparison group design, we evaluated the effectiveness of a 7 session group intervention among 59 caregivers of patients with first episode psychosis. Outcome variable measured were carers EE and social support. Carers were recruited from inpatient psychiatry units of a tertiary mental health centre in South India. Follow-up assessments were carried out after 1 and 3 months of intervention. Descriptive and inferential statistics were applied to the data.
Results and conclusion: Carers in the intervention group reported reduction of EE and improvements in social support at 1 month follow-up assessment. However, these benefits were not sustained at 3 months follow-up. Overall, both groups showed significant changes in all outcome variables over the time period.
... [6] In the Indian setting, most of the caregivers do not consider the caregiving process to be burdensome or stressful (as they considered it their responsibility); hence, studies have opined that interventions or support will be effective only for those caregivers who express a felt need for these interventions. [7] Further, the resilience of Indian caregivers could be higher than reported in western studies. A reason for this is the strong family and value system present in the country which helps the patient and caregivers cope with the the burden effectively. ...
URL: http://www.jpgmonline.com/text.asp?2014/60/4/355/143950
... The participants were 137 family caregivers of inpatients with schizophrenia who were recruited to be part of a four arm, single blind randomized controlled trial, to test the efficacy of yoga and psychosocial programme on the burden and coping of caregivers of patients with schizophrenia (Jagannathan et al., 2012). The sample was recruited from the in-patient wards of the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore, India -a tertiary care centre, 900-bed teaching hospital with training and research facilities in psychiatry and other neurosciences. ...
Background
Family caregivers experience significant burden in taking care of their patients with schizophrenia. Research on predictors of caregiver burden in India, where families are the primary caregivers of schizophrenia patients, is lacking.
Aim
To study the predictors of burden experienced by the family caregivers of first admission in-patient schizophrenia patients in India.
Methods and Materials
Family caregivers of 137 schizophrenia patients admitted to an in-patient facility of a hospital in south India were interviewed using the Burden Assessment Schedule. The coping, knowledge about schizophrenia, perceived social support of the caregivers and illness severity, psychopathology and disability experienced by the patients were also assessed.
Statistical Analysis: Bivariate correlation and multivariate regression analysis were used to study the association of different factors on burden.
Results
Duration of illness and levels of psychopathology and disability had significant direct correlation with total burden score; perceived social support had significant inverse correlation with total burden score. There was a high correlation between psychopathology and disability (p < 0.001). Two separate regression analysis, each including total PANSS score (psychopathology) or total IDEAS score (disability) showed that duration of illness and perceived social support were significant predictors of burden in addition to psychopathology and disability.
Conclusion
During the first hospitalization, in addition to symptom reduction and disability limitation, focus should be on enhancing social support in order to reduce caregiver burden among family members of schizophrenia patients.
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