Effects of a yoga protocol in managing depression, anxiety, and stress among office workers during the COVID-19 pandemic: A cross-sectional study

look into the effectiveness of mind-body interventions such as yoga therapy as adjunct


Introduction
Studies conducted across the world during the last two years amidst the COVID-19 pandemic show an increase in the number of people with depression and anxiety (1). Reports suggest that people who had to engage in any type of work during the pandemic are more prone to experience mental health concerns (1-6).
Yoga, with its origin in ancient India, is a form of alternative medicine that implements mind-body practices. It is also an easily available, relatively inexpensive, and safe nonpharmacological form of practice and has been found to have physiological and mental health benefits (7-11). A substantial amount of research is currently being undertaken to look into the effectiveness of mind-body interventions such as yoga therapy as adjunct treatment in conditions such as depressive and anxiety disorders The COVID-19 pandemic is known to have caused serious negative effects on the health and mental wellbeing of people. Yoga is an easily available, relatively inexpensive, and safe non-pharmacological form of practice and has been found to have physiological and mental health benefits.

Aim
To look into the effects of yoga therapy in the reduction of symptoms of depression, anxiety, and stress among a cohort of office workers during the COVID-19 pandemic.

Methods
A descriptive cross-sectional study was conducted among office workers using a yoga protocol developed for this study. The validated DASS-42 scale was used to assess the levels of depression, anxiety, and stress before and after the intervention.

Results
A significant reduction was observed in the mean scores for depression (61.36%), anxiety (62.79%), and stress (62.63%) respectively among the 240 participants following the 30-day programme of yoga therapy.

Conclusions
Yoga therapy used in the above context appears to have helped in reducing depression, anxiety, and stress among office workers during the pandemic. Randomised controlled trials with larger sample sizes and better clinical method designs are needed to evaluate the level of evidence and effectiveness of yoga therapy in the treatment of above conditions. Keywords: yoga, stress, anxiety, depression, office workers (11)(12)(13)(14). Studies reveal that roughly 20% of those who suffer from mood disorders practise com-plementary therapies like yoga and aerobics (15).
The aim of this study was to investigate the effects of a 30-day yoga programme on depressive, anxiety, and stress levels among office workers during the COVID-19 pandemic.

Methodology
A cross-sectional design was used among a random sample of 300 adult participants who self-reported symptoms of depression, anxiety and stress. The participants were randomly selected from those who registered for yoga programmes at the Patanjali Yogpeeth, Haridwar, Uttarakhand, India. All participants were provided information prior to being recruited to the study https://doi.org/10.4038/sljpsyc.v14i1.8390 and only those who provided written informed consent were recruited. None of the participants had a history suggestive of any mental illness. During the study, they were not receiving any psychotropic, any specialised psychological treatments and or taking part or involved in meditation or yoga programmes. They were reviewed at baseline, at the start of the yoga protocol and at regular intervals for worsening of symptoms and for the need for psychotropics and or specialised psychological treatment.
A yoga programme was developed based on previously accepted protocols (16,17). All recruited participants underwent the prescribed yoga practice every day for 45-50 minutes each morning for 30 days continuously to manage depression, anxiety, and stress.
We used the validated English version of DASS-42 for this study to measure the pre and post-depression, anxiety and stress levels (18)(19). The ethical approval was obtained from the Ethics Review Committee of Patanjali Research Foundation (PAC/IEC/2022/11/37). The two-sample one-tailed z-test was applied at a 95% confidence interval to look into the effects of the yoga programme (20).

Results
Out of the 300 recruited participants, 240 participants completed the study. Of them, 56.25% of the patients were male. A significant association was found between the age group (Chi-square 19.83; p<0.0001) and marital status (Chi-square 34.32; p<0.0001) and their preexperimental DASS -42 scores ( Table 1). A significant reduction was observed in the mean scores for depression (61.36%), anxiety (62.79%), and stress (62.63%) respectively among the 240 participants following the 30-day programme of yoga therapy ( Figure 1).  Here ***p<0.001 denotes that the z statistics result was significant at 99% confidence interval.

Discussion
Our study found that yoga therapy has an effect in reducing the levels of depression, anxiety and stress among office workers who reported symptoms but didn't need specialised treatment for depression, anxiety, and stress. Previous research indicate that yoga may minimize stress levels by increasing the endorphin and gammaaminobutyric acid levels in the brain (21)(22). In addition, people who practice yoga have been found to have steadier levels of heart rate, respiratory rate, blood pressure, and cardiac output (23)(24). The present study has its unique feature as we focus solely on office workers who had concerns about losing their jobs, not getting new employment or reduction of monthly income associated with the COVID-19 pandemic. According to the best of our knowledge, this is the first study of this nature that involved a relatively large sample size of office workers in our setting.

Limitations
The inferences that have been drawn from the findings of this study are limited due to the lack of a control group. Furthermore, the participants came from a variety of professional backgrounds, which may have affected the DASS-42 scores differently depending on their responsibilities and other work-related issues.

Conclusions
Our study provides some evidence that mind-body relaxing exercises such as yoga practices have a positive response in reducing the severity of stress, anxiety, and depression. Further studies including randomized controlled trials in this area are recommended to establish the effectiveness of yoga therapy in the treatment of above conditions.

Statement of contribution
VA conceptualized the study. AG and RO conducted the study, SG conducted the analysis and wrote the manuscript. AB obtained the financial grant. All authors have approved the final version of the manuscript.

Declaration of interest
None declared.

Financial support
This research was supported by the Ministry of Ayush, Government of India, under Ayurswasthya Yojana-3988.