Potential Long-Term Effects of a Mind–Body Intervention for Women With Major Depressive Disorder: Sustained Mental Health Improvements With a Pilot Yoga Intervention

doi:10.1016/j.apnu.2014.08.014

Archives of Psychiatric Nursing

Volume 28, Issue 6, December 2014, Pages 377-383

https://doi.org/10.1016/j.apnu.2014.08.014 Get rights and content

Abstract

Despite pharmacologic and psychotherapeutic advances over the past decades, many individuals with major depressive disorder (MDD) experience recurrent depressive episodes and persistent depressive symptoms despite treatment with the usual care. Yoga is a mind–body therapeutic modality that has received attention in both the lay and research literature as a possible adjunctive therapy for depression. Although promising, recent findings about the positive mental health effects of yoga are limited because few studies have used standardized outcome measures and none of them have involved long-term follow-up beyond a few months after the intervention period. The goal of our research study was to evaluate the feasibility, acceptability, and effects of a yoga intervention for women with MDD using standardized outcome measures and a long follow-up period (1 year after the intervention). The key finding is that previous yoga practice has long-term positive effects, as revealed in both qualitative reports of participants' experiences and in the quantitative data about depression and rumination scores over time. Although generalizability of the study findings is limited because of a very small sample size at the 1-year follow-up assessment, the trends in the data suggest that exposure to yoga may convey a sustained positive effect on depression, ruminations, stress, anxiety, and health-related quality of life. Whether an individual continues with yoga practice, simple exposure to a yoga intervention appears to provide sustained benefits to the individual. This is important because it is rare that any intervention, pharmacologic or non-pharmacologic, for depression conveys such sustained effects for individuals with MDD, particularly after the treatment is discontinued.

Section snippets

Background

Major depressive disorder (MDD) is a common debilitating chronic illness, with a lifetime prevalence of 16% in the U.S. (Kessler et al., 2003). Despite pharmacologic and psychotherapeutic advances over the past decades, many individuals with MDD do not achieve remission and experience persistent depressive symptoms and recurrent episodes (Zajecka, Kornstein, & Blier, 2013). As such, many patients become dissatisfied with the usual care and seek out adjunctive or complementary therapies, such as

Methods

The University of Virginia and the Virginia Commonwealth University Institutional Review Boards reviewed and approved the study protocol, recruitment plans, and guidelines for the protection of confidentiality of participants. Written informed consent was obtained from participants prior to their enrollment in the study and verbal consent was obtained prior to audiotaping the participant interviews.

Recruitment

A CONSORT diagram of participant recruitment, enrollment, and completion of the study is shown in Fig. 1. As discussed in-depth elsewhere (Kinser, Bourguignon, Whaley, et al., 2013), 48 women initially expressed interest in the study and, ultimately, 27 women consented to participate in the study and they were allocated to the yoga group or the attention-control group. Nine individuals dropped out very early in the study, all within the first 2 weeks of the intervention period (n = 3 from yoga

Discussion

The purpose of the current study was to evaluate the long-term outcomes of participation in an intervention study for depression in women with major depressive disorder. We evaluated these women 1 year after the intervention period, and the key findings from this study are that: (1) previous yoga practice has long-term positive effects, as revealed in both qualitative reports of participants' experiences and in the quantitative data about depression and rumination scores; and (2) sustained yoga

Acknowledgment

Funded through VCU School of Nursing intramural funding supported by P30 NR011403 (Grap, PI), Center of Excellence for Biobehavioral Approaches to Symptom Management; National Institute of Nursing Research, NIH.

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In a randomized controlled trial in the Netherlands, we studied the (cost)effectiveness of adding a mindful yoga intervention (MYI+TAU) to treatment as usual (TAU) for young women with major depressive disorder (MDD). In this paper, we present the results of the economic analyses. Societal costs and health outcomes were prospectively assessed during 15 months for all randomized participants (n = 171). Symptoms of depression (Depression Anxiety and Stress Scales; DASS) and quality adjusted life years (QALYs) were used as health outcomes in the economic analyses. Mean total societal costs during the 15 months of the study were €11.966 for the MYI+TAU group and €13.818 for the TAU group, differences in mean total societal costs were not statistically significant. Health outcomes (DASS and QALY) were slightly in favour of MYI+TAU, but differences between groups were not statistically significant. Combining costs and health outcomes in cost-effectiveness analyses indicated that MYI+TAU is likely to be cost-effective compared to TAU which was confirmed by sensitivity analyses. Although there were limitations in the cost-effectiveness analysis, findings from this study suggest that MYI+TAU warrants future attention for the potential to be cost-effective compared to TAU for young women with MDD.
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We used data from Waves 2 (2004−05) and 3 (2013−14) of the Midlife in the United States (MIDUS) study. MIDUS initially surveyed a national probability sample of community-living adults aged 24–75 years in 1995 (Wave 1). Tests of cognitive functioning measuring executive function and episodic memory were added in Wave 2 and repeated in Wave 3. We estimated multivariable linear regression models to examine the effect of MBP (Wave 2) on the episodic memory and executive function (Wave 3) while controlling for covariates (sociodemographic factors, health, and cognitive function at Wave 2).
A total of 2097 individuals aged 42–92 years (M = 64 ± 11, 56 % women) were included. After controlling for sociodemographic factors, health and functional status, and prior levels of cognitive function, engaging in MBP was independently associated with a smaller decline in episodic memory (b = 0.11, p = .03), but not executive function (b=0.03, p = .34).
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Potential Long-Term Effects of a Mind–Body Intervention for Women With Major Depressive Disorder: Sustained Mental Health Improvements With a Pilot Yoga Intervention

Abstract

Section snippets

Background

Methods

Recruitment

Discussion

Acknowledgment

Lancet

Explore (New York, N.Y.)

Journal of Affective Disorders

Speaking of ethnography

Effects of yoga on mental and physical health: A short summary of reviews

Evidence-based complementary and alternative medicine: ECAM

Perceived stress scale

Hermeneutic phenomenological research: A practical guide for nurse researchers

Negative life events, perceived stress, negative affect, and susceptibility to the common cold

Journal of Personality and Social Psychology

Perceived stress in a probability sample of the united states

On assessing individual differences in rumination on sadness

Journal of Personality Assessment

Yoga for depression: A systematic review and meta-analysis

Depression and Anxiety

Six-year outcome of cognitive behavior therapy for prevention of recurrent depression

The American Journal of Psychiatry

The perceived stress scale: Factor structure and relation to depression symptoms in a psychiatric sample

Journal of Psychopathology and Behavioral Assessment

The epidemiology of major depressive disorder: Results from the national comorbidity survey replication (NCS-R)

Journal of the American Medical Association

“A feeling of connectedness”: Perspectives on a gentle yoga intervention for women with major depression

Issues in Mental Health Nursing

Feasibility, acceptability, and effects of gentle hatha yoga for women with major depression: Findings from a randomized controlled mixed-methods study

Archives of Psychiatric Nursing