PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

MEENU CHERIAN

1st YEAR M.Sc. (NURSING)

PSYCHIATRIC NURSING

YEAR 2011-2012

ST. PHILOMENA’S COLLEGE OF NURSING

#4 CAMPBELL ROAD, VIVEKNAGAR P. O

BANGALORE 560047

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

1

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1.

NAME OF THE

CANDIDATE AND

ADDRESS

MEENU CHERIAN

1STYEAR M.SC. (NURSING)

ST. PHILOMENA’S COLLEGE OF

NURSING

#4 CAMPBELL ROAD, VIVEKNAGAR

P.O

BANGALORE 560047

2.

NAME OF THE

INSTITUTION

ST. PHILOMENA’S COLLEGE OF

NURSING.

3.

COURSE OF THE

STUDY AND

SUBJECT

1st YEAR M.SC. (NURSING )

PSYCHIATRIC NURSING

4.

DATE OF

ADMISSION TO

THE COURSE

3rd MAY 2011

5.

TITLE OF THE

STUDY

A STUDY TO ASSESS THE

EFFECTIVENESS OF YOGA THERAPY

ON STRESS AMONG PATIENTS WITH

DEPRESSION ADMITTED IN A

SELECTED HOSPITAL AT

BANGALORE.

6. BRIEF RESUME OF THE INTENTED WORK

2

6.1NEED FOR THE STUDY

Depression is a common mental disorder that presents with depressed mood,

loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or

appetite, low energy, and poor concentration. These problems can become chronic or

recurrent and lead to substantial impairments in an individual's ability to take care of

his or her everyday responsibilities. At its worst, depression can lead to suicide, a

tragic fatality associated with the loss of about 850 000 lives every year1.

According to WHO, by the year 2020, depression is projected to reach 2nd

place of the ranking of Disability Adjusted Life Years (DALY) calculated for all ages

and both sexes. Today, depression is already the 2nd cause of DALYs in the age

category 15-44 years for both sexes combined. Depression is common, affecting

around 121 million people worldwide. According to WHO in 2008, 9.1% of general

population in Bangalore suffers from depression1. People with depression may lose

interest in activities that once were pleasurable, or suffer cognitive impairments (e.g.,

difficulty concentrating, remembering details, making decisions). They may

contemplate or attempt suicide. Depressed mood is a normal reaction to certain life

events, a symptom of many medical conditions2.

 

In India, there are very few population-based data on prevalence of

depression. Chennai Urban Rural Epidemiology Study (CURES) conducted a study

and the aim of the study was to determine the prevalence of depression in an urban

3

south Indian population. Subjects were recruited from the Chennai Urban Rural

Epidemiology Study (CURES), involving 26,001 subjects randomly recruited from

46 of the 155 corporation wards of Chennai (formerly Madras) city in South India.

25,455 subjects participated in this study (response rate 97.9%). Depression was

assessed using a self-reported and previously validated instrument. The overall

prevalence of depression was 15.1% and was higher in females. The prevalence of

depression was higher in the low income group (19.3%) compared to the higher

income group (5.9%, p<0.001). Prevalence of depression was also higher among

divorced (26.5%) and widowed (20%) compared to currently married subjects

(15.4%, p<0.001). They concluded that among urban south Indians, the prevalence of

depression was 15.1%. Old age, female gender and lower socio-economic status are

some of the factors associated with depression in this population3.

Emotional and mental issues, be it stress, depression, or anxiety are often the

result of long-term tension patterns, which create blockages in our energy flow. Yoga

therapy can help to create greater emotional well-being by releasing tension and

dissolving the emotional blocks that hold us back from living a happy, healthy life. A

regular yoga therapy practice over the long term can be a powerful tool for emotional

healing and integration. Yoga may improve the mood and fight depression by

reducing perceptions of stress, anxiety and fatigue, while enhancing the energy and

sense of well-being. Yoga is considered under the Complementary and Alternative

system of medicine (CAM) interventions. A significant proportion of subjects who

seek help from CAM, the world over have cross sectional, diagnosable depression. In

India yoga forms a large part of CAM. Depression perhaps ranks first among the

psychiatric conditions researched for yoga interventions. There is no single yoga

4

procedure or package that has been used by different researchers. Each yoga school

advocates a set of practices. The physical and psychological well-being achieved by

yoga was considered as a bye-product and necessary step in achieving the end4.

‘Depression matters because depressive victims matter’. More to the point,

treatment matters because recovery programs give you cause for hope, and for faith;

and because it works, and it saves lives. The number of depression victims in the

United States and around the world is hard to pin down, but many studies had shown

that it is in terms of millions. That is, of course, a startling statistics, one suggests the

central role of depression treatment in shaping the future of communities and

societies around the globe. With so many prospective affected people in the world,

the success or failure of programs ultimately affects all of us5.

According to WHO study, it was determined that 9.1% of the general

population in Bangalore suffers from depression. Another study conducted in

Bangalore looked at the prevalence of depression in the college-age population (mean

age 18-20 years). This population showed a 20.7% prevalence of depression (BDI ≥

16), which is remarkably similar to the prevalence observed in Chinese-American

individuals. Perhaps most significant to this study was the finding that 25% of men in

the Bangalore study were depressed, but only 18% of women were depressed6.

Depression is a disorder, and those affected by this are unhealthy individuals

who need professional medical help to get better. From mood disorders, to

personality disorders, depression treatment is vital to the recovery process because

5

depression is not something a person can overcome on their own. In more specific

terms, depression exists as both a physical and a psychological phenomenon. If a

person suffers from social anxiety, depression, and a mood disorder, every aspect

needs to be addressed and treated. When the person healed in an effective rehab

centre, it will and must be on his own terms. The practical implication here is that a

person can’t get better if he/she don’t understand how the treatment process works,

and what they can do to make it go forward. There isno substitute for education, and

awareness.The goal of depression treatment, of course, is meaningful recovery:

recovery that lasts, and allows the patient to get back to living life as he/she used to

know it7.

Antidepressants won’t solve problems of people who are depressed because

of a dead-end job, a pessimistic outlook, or an unhealthy relationship. That’s where

different alternative therapies and other lifestyle changes come in. Studies show that

yoga therapy works just as well as antidepressants in treating depression, and its

better at preventing relapse once treatment ends. While depression medication only

helps as long as they are taking it, the emotional insights and coping skills acquired

during yoga therapy can have a more lasting effect on depression. In addition to that,

other effective treatments for depression include meditation, relaxation techniques,

stress management, support groups, and self-help steps. While these treatments

require more time and effort initially, their advantage over depression medication is

that they boost mood without any adverse effects8.

In depression and stress, teaching of yoga therapy is to help the person grow

towards his full potential for personhood, constructive relationships and productive

6

living. The teaching would be more effective if the health care personnel give it.

Among them nurses play a vital role and take initiative to teach the yoga therapy to

reduce the level of stress and depression among patients.

6.2. REVIEW OF LITERATURE

A literature review is an evaluative report of information found in the

literature related to selected area of study. The review describes, summarizes,

evaluates and clarifies this literature. (Queensland university, 1999).

A literature review is a description and analysis of the literature relevant to a

particular field or topic. It gives an overview of what has been said. Who the key

writers are, what are the prevailing theories and hypothesis, what questions are being

asked, and what methods and methodologies are appropriate and useful9.

Review of literature in this study is organized under the following headings.

6.2.1. Literature related to depression among people

6.2.2. Literature related to stress among patients with depression

6.2.3. Literature related to the effectiveness of yoga therapy on depression.

6.2.4. Literature related to effectiveness of yoga therapy on stress.

7

6.2.1 Literature related to depression among people

A descriptive study was conducted to estimate the prevalence rate of

depression among adults with diabetes in U.S. and the sample size was 18814. In this

study, data collected by a standardized telephone survey among U.S. adults aged ≥18

years. The Patient Health Questionnaire diagnostic algorithm was used to identify

major depression. The results showed that age-adjusted prevalence rate of major

depression was 8.3% (95% CI 7.3–9.3), ranging from a low of 2.0% in Connecticut

to a high of 28.8% in Alaska. There were 25-fold differences in the rate among

racial/ethnic subgroups. People with type 2 diabetes who were currently using insulin

had a higher rate than people with type 1 diabetes (P = 0.0009) and those with type 2

diabetes who were currently not using insulin (P = 0.01). They concluded that major

depression was highly prevalent among people with diabetes; the prevalence rate

varied greatly by demographic characteristics and diabetes types10.

A descriptive study was conducted to assess the prevalence of late-life

depression in a community and the sample size was 34. A systematic review of

community-based studies of the prevalence of depression in later life (55+) was

assessed. Literature was analysed by level of severity at which depression was

defined and measured. The reported prevalence rates vary enormously (0.4-35%).

Arranged according to level of severity, major depression is relatively rare among the

elderly (weighted average prevalence 1.8%), minor depression is more common

(weighted average prevalence 9.8%), while all depressive syndromes deemed

clinically relevant yield an average prevalence of 13.5%. There is consistent evidence

8

for higher prevalence rates for women and among older people living under adverse

socio-economic circumstances. They concluded that depression is common in later

life11

A descriptive study was conducted to evaluate the prevalence of depression in

a rural area in the South of Cataloni. This study was analysing the different age

groups, identifying the causal factors of depression and determining whether there

were gender differences. The samples were 157 women and 160 men. The results

indicated a high risk of depression in the elderly participants of that small rural

community. Widowers suffer more depression than widows and the loneliness,

illness, and task of caregiver were predictive variables for depression in these elderly

men. The loss of the ability to perform activities of daily living associated with

ageing has a greater effect on depression disorders in men than in women12.

A systematic review of observational studies was conducted to assess the

frequency of depression after stroke. In this study, out of 418 references, 98 reports

that is 51 studies were eligible for inclusion. Among this 19 studies were using DSM-

IV criteria to define depression and the rest of the studies used Hamilton depression

Rating scale, Montgomery Asberg Depression Rating Scale, Beck depression

Inventory, and geriatric depression scale. There was considerable variation in the

reported frequency of depression after stroke across individual studies. The estimate

showed that depressive symptoms are present in 33% of all stroke survivors at any

time. The smallest pooled frequency with standardized questionnaires was from

studies that used the Hamilton Depression Rating Scale where as the highest

9

frequency was in studies that used Montgomery Asberg Depression Rating Scale.

They concluded that one third of all people experiences significant depressive

symptoms at some time after the onset of stroke13.

A correlational study was conducted to examine the 12-month prevalence of

Major Depressive Episode (MDE) and correlates of DSM-IV in adults age 50 years

and over in Ukraine. The correlates included demographic factors, mental health and

alcohol history, physical conditions, and impairments in functioning. In this study, a

cross-sectional survey was conducted in Ukraine using the Composite International

Diagnostic Interview (CIDI-3.0) as part of the World Health Organization-World

Mental Health Survey Initiative. The sample included were 1843 respondents age 50-

91. Unadjusted and adjusted odds ratios were used to examine associations of the risk

factors with 12-month MDE in men and women separately. The results showed that

12-month prevalence of MDE was 14.4% in women and 7.1% in men. In both sexes,

history of MDE before age 50 and poor self-assessed mental/physical health was

significantly associated with MDE. In men, living alone, 5+ physician visits, and role

impairment, but not alcoholism, were associated with depression; In women, poverty,

history of anxiety disorder, medical conditions, and cognitive and self-care

impairment were significant14.

A descriptive studyconducted on gender differences in depression included a

mixture of patients with, first-episode, chronic and recurrent depression. 301

participants were included and assessment by means of questionnaires and interviews

regarding psychiatric diagnoses, personality traits and disorders, stressful life events,

10

family history, and treatment responsewere made.. The result showed that female

patients had a higher level of neuroticism and more residual anxiety symptoms after

treatment of the depression. There were no gender differences in severity of

depression, psychiatric co-morbidity (including personality disorders), stressful life

events prior to onset, family loading of psychiatric disorders, or treatment outcome.

They concluded that a higher level of anxiety and neuroticism among females with a

recent onset of depression was noticed, whereas, other clinical characteristics of first-

episode depression were equivalent between male .and female patients15.

From the above literature, it is very clear that there are many etiologic factors

like medical disorders, for depression and the prevalence of depression is more in

rural areas and among older people.

6.2.2. Literature related to stress among patients with depression.

An observational study was conducted to examine the associations between

stressful events and depression treatment outcomes. A nationwide sample of 580

people with depressive disorders was recruited from 18 hospitals in Korea. Number

of stressful events in the last 12 months and subjective perception of stress were

ascertained, and were dichotomized by median values. Participants commenced on

antidepressant treatment were re-evaluated at 1, 2, 4, 8, and 12weeks later.

Assessment scales for evaluating depression by Hamilton Depression scale (HAMD),

anxiety by Hamilton Anxiety Scale (HAMA), global severity (CGI-s), and

11

functioning (SOFAS) were administered at baseline and at every follow-up visit. The

result showed that higher baseline perceived stress was significantly associated with

worse 12-week antidepressant treatment outcomes. In terms of depression, anxiety,

and global severity and baseline number of stressful events was not associated with

any treatment outcomes. They concluded that depressive patients with higher level of

perceived stress at the time of commencing treatment had less favourable outcomes

after antidepressant treatment. This may represent a group requiring more specific

assessment and more intensive management in order to improve treatment response16.

A descriptive study was conducted to examine the effect of stressful events on

depression. The study done over 1 year in 14 women with unipolar depression who

were compared with demographically matched groups of women with bipolar

disorder (n = 11), chronic medical illness (n = 13), or no illness or disorder (n = 22).

The method used was interview assessments of life events, severity, and

independence of occurrence. This study confirmed the hypothesis that unipolar

women were exposed to more stress than the normal women, had significantly more

interpersonal event stress than all others, and tended to have more dependent events

than the others. They concluded that unipolar women by their symptoms, behaviours,

characteristics, and social context generate stressful conditions, primarily

interpersonal, that have the potential for contributing to the cycle of symptoms and

stress that create chronic or intermittent depression17.

A descriptive study was conducted to assess the level of depression and types

of major stressors, and to identify stressors contributing to depression. The samples

12

were 135 Latina women in rural south eastern North Carolina. In this study they were

using centre for epidemiologic studies depression scale to identify depression. The

results showed that nearly half of the participants (47.6%) had scores of greater than,

or equal to, 16, which suggests the need for early intervention. The most reliable

predictors of stress were difficult to be away from family members, immigration

status and religion, accounting for 34.5% of the total variance in depression18.

A descriptive studywas conducted to measure the prevalence of perceived

stress in adults and association between perceived stress and depression, anxiety and

medication. The sample size was 1275 in which 581 men and 694 women. Perceived

stress was measured with the Perceived Stress Questionnaire (PSQ), with two cut-off

scores, moderate and high stress level. Depression was assessed with the Beck

Depression Inventory (BDI) and anxiety with the State and Trait Anxiety Inventory

(STAI). The prevalence of moderate stress was estimated to be 10%, lowest in the

60–69-year and highest in the 40–44-year age group. Women of 30–34 years had a

higher frequency of moderate stress (11.1%) than men in the same age group (5.9%).

The prevalence of high stress was 4% higher in women (5.5%) than in men (2.2%).

Women in the age groups 30–34 years (12.7%) and 35–39 years (8.1%) reported a

greater proportion of high stress than the men (0 %). Low and moderate stress were

associated with STAI and high stress with the BDI. High stress was associated with

psychotropic drugs. Antidepressants comprised the majority of psychotropic drugs

used. So they concluded that women in the 30 to 39-year age group are exposed to

high stress. Anxiety is more important in moderate stress levels and depression in

high stress levels and should be aware of the suicidal risk associated with high stress

levels19.

13

The above literature shows that depressive patients are having higher level of

perceived stress at the time of commencing treatment and stress should be reduced

for the better effect of treatments that are given for depression.

6.2.3. Literature related to the effectiveness of yoga therapy on depression.

A comparative study was conducted to determine whether the benefits of the

combined treatment of solution focused counselling and yoga is more effective than

counselling treatment alone in the management of major depression within the

Charles Darwin University student population. The number of samples was 90. Out

of that 70 participants completed the study. During the first stage the group received

three solution focused counselling sessions (individually), provided fortnightly by

student counsellor and then in the second stage which commenced two months later,

a combination of three solution focused counselling plus six yoga sessions. The

results showed that 28.57% students got recovered from major depression, 42.8%

partially recovered from depression and another 28.57% didn’t get any recovery from

clinical depression.The results of this study suggest that yoga and counselling has

some influence in decreasing symptoms in clinical depression20

An experimental study was conducted on patients with depression to examine

the effectiveness of mindful and non-mindful physical exercise. The study conducted

among five electronic databases to identify Randomized Controlled Trials (RCTs),

14

which tested the effects of mindful or/and non-mindful physical exercises

on depression. The results were based on 12 RCTs which indicated that both the

mindful and non-mindful physical exercises were effective in their short-term effect

in reducing depression levels or depressive symptoms. Specific comparisons between

RCTs on mindful and non-mindful exercises were not performed because of the

limitations on the designs. They concluded that more well-controlled studies have to

be conducted in the future to address the short- and long-term effects of physical

exercise on alleviating depression21.

An experimental study was conducted to investigate the effects of meditation

with yoga (and psycho education) versus group therapy with hypnosis (and psycho

education) versus psycho education alone on diagnostic status and symptom levels

among 46 individuals with long-term depressive disorders. Out of 46 participants

76% were females and 24% were males. The meditation program included 8 weekly

group sessions of 2 hours each, one 4-hr retreat, and one booster session in Week 12.

Six of the weekly sessions as well as the retreat and booster sessions began with a 40-

min meditation. The hypnosis intervention involved 10 weekly sessions of 1½hrs

each and a 2-hr booster session in Week 12. Results indicate that significantly more

meditation group participants experienced a remission than did controls at 9-month

follow-up. Eight hypnosis group participants also experienced a remission, but the

difference from controls was not statistically significant. Three control participants,

but no meditation or hypnosis participants, developed a new depressive episode

during the study22.

15

The above literature shows that yoga has an influence in reducing the

symptoms of clinical depression and it is helpful for the remission of depression. It

shows that mindful exercises are effective to reduce the level of depression.

6.2.4. Literature related to effectiveness of yoga therapy on stress.

A descriptive study was conducted to assess the effect of yoga on stress and

depressive symptoms in a nonclinical, bi-ethnic sample of adolescents. Fifty-five

students attending one rural public high school were the sample. They received either

2 weeks of yoga followed by 2 weeks removal or 2 weeks of no treatment followed

by 2 weeks of yoga. Primary outcome measures were the Center for Epidemiological

Studies Depression Scale and Perceived Stress Scale (PSS). The results showed that

significant (p < .05) treatment effects were observed for PSS and for depression.

Despite short program exposure, acute changes in mental health indicators were

observed and continued after 2 weeks of treatment removal23.

An experimental study was conducted to assess the effect of yoga on stress

management in healthy adults. The sample was 16 studies. A systematic literature

search was performed to identify Randomized Controlled Trials (RCTs) and Clinical

Controlled Trials (CCTs) that assessed the effects of yoga on stress management in

healthy adults. Selected studies were classified according to the types of intervention,

duration, outcome measures, and results. The systematic review was based on eight

RCTs and CCTs that indicated a positive effect of yoga in reducing stress levels or

stress symptoms. Most of the studies had methodological problems. In that the

16

intervention duration was short and limited follow-up data was available. The results

revealed positive effects of yoga on stress reduction in healthy adult populations24.

An experimental study was conducted to examine the effectiveness of yoga in

enhancing emotional well-being and resilience to stress among university employees.

In a randomized controlled trial at a British university, they recruited 48 employees

and randomized them into either yoga or a control group. The yoga group was

offered six weeks of Dru Yoga, comprising one 60-minute class per week. These

classes were offered by a certified Dru Yoga instructor. The control group received

no intervention during this six-week study. Baseline and end-program measurements

of self-reported mood and well-being were self-assessed with the Profile of Mood

States - Bipolar (POMS-Bi) and the Inventory of Positive Psychological Attitudes

(IPPA). The results showed that there is significantly improved (p=0.004) POMS-Bi

and IPPA scores for the yoga compared to the control group for seven of eight

measures of mood and well-being. In comparison to the control group at baseline and

the end of the program, the yoga group reported increased life purpose and

satisfaction, and feelings of greater self-confidence during stressful situations. They

concluded that even a short program of yoga is effective for enhancing emotional

well-being and resilience to stress in the workplace25.

The above literature shows that there is a positive effect of yoga in reducing

stress during various situations. And also yoga is effective for enhancing the

emotional well-being and resilience to stress.

6.3. STATEMENT OF THE PROBLEM

17

A STUDY TO ASSESS THE EFFECTIVENESS OF YOGA THERAPY ON

STRESS AMONG PATIENTS WITH DEPRESSION ADMITTED IN A

SELECTED HOSPITAL AT BANGALORE.

6.4. OBJECTIVES OF THE PROBLEM

6.4.1. To assess the level of depression among patients admitted in a selected

hospital.

6.4.2. To assess the level of stress among patients with depression.

6.4.3. To assess the effectiveness of yoga therapy on reducing stress among

patients with depression.

6.4.4. To associate the level of stress with selected socio demographic variables

such as age, marital status, educational level, type of family, socio

economic status, religion and occupation

6.5. HYPOTHESIS

H1 : There will be a statistically significant difference in the level of stress

among the patients with depression before and after yoga therapy as measured by the

Ardell Wellness Stress Test at p <0.05.

H2: There will be a statistically significant association between socio-

demographic variables such as age, marital status ,educational level, type of family,

18

socio economic status and level of stress among the patients as measured by

Ardell Wellness Stress Test and Socio demographic profile at p <0.05.

6.6. RESEARCH VARIABLES

6.6.1. Independent variable: Yoga Therapy.

6.6.2.Dependent variable: Level of Stress.

6.7. OPERATIONAL DEFINITION

EFFECTIVENESS

In this study, effectiveness refers to reduction in the level of stress among patients

after Yoga Therapy as assessed by the Ardell Wellness Stress Test.

YOGA THERAPY

In this study, Yoga therapy refers to a standardized module of Yoga which consists

of Yogic Sukshma Vyayama, Suryanamaskara, Bhastrika Pranayama, ujjayi

Pranayama and Pranava Japa which will be administered for 40 minutes per day for

14 days to the patient.

STRESS

19

In this study stress refers to, the constant worry, tension, strain, hassles of daily

life,realor interpreted threat to physiological, psychological or behavioural response

and results in bodily or mental tension which will be measured by Ardell Wellness

Stress Test.

PATIENTS WITH DEPRESSION

In this study, patients with depression refers to people who are found to have mild

and moderatedepression as assessed by Hamilton Depression Rating Scale.Patients

with depression may have low mood, and aversion to activity that can affect their

thoughts, behaviour, feelings and physical well-being in which feelings of sadness,

anxiety, emptiness, hopelessness, misery, gloom, dejection ,worthlessness, guilt,

irritability or restlessness will be there.

6.8. ASSUMPTIONS

6.8.1. The patients with depression have certain amount of stress.

6.8.2. The yoga therapy has an effect on the level of stress among patients with

depression.

6.9. DELIMITATION

20

The study is limited only to patients with mild and moderatedepression admitted in a

selected hospital, Bangalore.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

Patients with mild and moderate depression in the selected hospital.

7.1.1. Research Design

A Quasi experimental design - Non randomized control group pre-test post-test

design.

Sl.

No:

Group Pre test Intervention Post test

1 Experimental group O1 X O2

2 Control group O1 - O2

7.1.2. Research Setting

21

The study will be conducted in Spandana Institute of Mental Health And Neuro

Science (SIMHANS) which consists of one main hospital with 50 beds and two

rehabilitative centers with 100 beds each.

7.1.3. Population

In this study, population areall the patients with depression admitted in a selected

hospital

7.2. METHOD OF DATA COLLECTION

7.2.1. Sampling Procedure

Non-Probability convenient sampling.

7.2.2. Sample Size

Sample arepatients with depression and sample size is n=60, experimental

group(n=30) and control group (n=30).

7.2.3. Inclusion Criteria

7.2.3.1. Patients with mild and moderate depression admitted in a selected

hospital.

7.2.3.2.Both males and females between 20 - 65 years of age.

7.2.3.3.Patients who know English and/or Kannada.

7.2.4. Exclusion Criteria

22

7.2.4.1. Patients attending outpatient department.

7.2.4.2.Patients who are not willing.

7.2.4.3. Patients who have any mental retardation, antisocial personality and

co-morbid personality.

7.2.5. Tool Used For The Study

The tool consists of the following sections

Section A

Socio demographic data profile which includes age, sex, religion, marital status,

educational level, type of family, family income, number of children, socioeconomic

status

Section B

Hamilton depression rating scale to assess the level of depression(inclusion

criteria)

It is a questionnaire which contains 24 multiple choice question that can be used to

rate the severity of a patient's level of depression. The questionnaire rates the severity

of symptoms observed in depression such as low mood, insomnia, agitation,

anxiety and weight loss.

The Ardell wellness stress test to assess the level of stress.

23

It is a likert scale with 25 questions which is used to assess the level of stress. The

Ardell Wellness Stress Test now incorporates with 5 broad dimensions of wellness

such as the physical, social, professional, self or personal and the meaning and

purpose aspects of life satisfaction.

7.2.6. Data Collection Method

Formal permission will be obtained from the head of the institution.

After obtaining the informed consent from the patients who have depression

and assuring about the confidentiality of the information obtained, the

investigator will administer the questionnaire, to the patients to assess the

level of depression and level of stress, for about 30 minutes.

Based upon the result (mild and moderate- depression patients) the samples

will be taken and further divided into experimental group and control group

using Non-Probability Convenient Sampling.

The Yoga therapy consists of Yogic Sukshma Vyayama, Suryanamaskara,

Bhastrika Pranayama, Ujjayi pranayama and Pranava Japa which will be

administered for 40 minutes per day for 14 days to the experimental group

only.

After 14 days of intervention a post test will be conducted for both

experimental group and control group.

Pilot study will be conducted in a similar setting prior to the main study.

Intervention

24

The intervention consists of a standardized module of Yoga for depression

from NIMHANS which is validated and published. This module consists of Yogic

Sukshma Vyayama, Suryanamaskara, Bhastrika Pranayama, Ujjayi Pranayama and

Pranava Japa which will be administered for 40 minutes per day for 14 days to the

patient. In Yogic Sukshma Vyayama, different types of body exercises are giving and

Pranayama includes breathing exercises. Pranava japa includes A – Kara chanting, U

– Kara chanting, M – Kara chanting and AUM chanting. The researcher will undergo

a training program to be equipped in yoga therapy to the depressed patients.

7.2.7. Data Analysis Plan

The data collected will be analysed by using descriptive and inferential statistics.

Descriptive Statistics

Frequency and percentage distribution to analyse the demographic variables.

Mean and standard deviation to assess the level of stress.

Inferential Statistics

Statistical t test is used to compare the pre-test and post test scores for

statistical analysis.

Chi square test is used to determine the association between selected

demographic variables and level of stress.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION (OR)

INTERVENTION TO THE PATIENTS (OR) OTHER HUMAN

BEINGS?

25

Yes, Yoga therapy will be administered for patients with depression.

7.4. HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION?

Yes, the ethical clearance is obtained from the Institutional Ethical Review Board of

St. Philomena’s Hospital, Bangalore.(enclosed)

8. LIST OF REFERENCE

26

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mental disordersDSM-IV-TR. 4th ed. Washington, DC: American

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2011. p. 70

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depression among U.S. adults with diabetes. J diab care. 2007[cited 2007

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a rural city in southern Catalonia. J Psychiatr Ment health Nurs. 2011[ cited

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correlates in older adults in Ukraine. Int J Geriatr Psychiatry. 2011[cited

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http://www.ncbinlm .nih.gov/pubmed/depression.

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among patients with a single depressive episode.Psychopathology.2010[cited

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and treatment outcomes in patients with depressive disorders. J Affect disord.

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rural south eastern North Carolina. A school of nursing, university of North

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and association of depression, anxiety and medication in a Swedish

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depression. Alternative treatment in management of major depression.

2004.Available from: http://www.cdu.edu.au/teachingandlearning.

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exercises on people with depression: a systematic review. Br J Clin Psychol.

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Therapy With Hypnosis, and Psycho education for Long-Term Depressed

Mood: A Randomized Pilot Trial.J Clin Psychol. 2008[cited 2008 May 5];

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Nonclinical, Bi-Ethnic Sample of Adolescents. Hispanic health care

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24. Hartfiel N, Haven hand, Khalsa SB, Clarke G, Krayer A. The effectiveness

of yoga for the improvement of well-being and resilience to stress in the

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9218..

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9. Signature of the candidate :

10. Remarks of the Guide :

11. Name and Designation :

11.1 Guide : Mrs Pushpa D

11.2 Signature :

11.3 Co-Guide : Mrs Thamil Selvi D

11.4 Signature :

11.5 Head of the Department : Mrs Pushpa D

11.6. Signature :

12. 12.1. Remarks of the Chairman and Principal:

12.2. Signature :

31