|
OJHAS Vol. 9, Issue 3:
(Jul - Sep, 2010) |
|
|
| Profile of Clients seeking Consultation
at Yoga Therapy Department: A Cross sectional Study |
|
Latha KS,
Associate Professor,
Department of Psychiatry, Kasturba Medical College & Hospital,
Manipal University, Manipal-576 104
Annapoorna K,
Senior Grade
Lecturer, Department of Yoga, K.M.C. Hospital, Manipal University,
Manipal- 576104. |
|
|
| |
|
|
|
|
|
|
Address For Correspondence |
Associate Professor,
Department of Psychiatry,
Kasturba Medical College & Hospital,
Manipal University, Manipal-576 104.
E-mail:
drlathaks@yahoo.com |
|
|
|
|
|
Latha KS, Annapoorna K. Profile of Clients seeking Consultation
at Yoga Therapy Department: A Cross sectional Study. Online J Health Allied Scs.
2010;9(3):11 |
|
|
|
|
Submitted: Jul 2, 2010;
Suggested revision: Jul 10, 2010; Resubmitted: Jul 15, 2010; Accepted:
Sep 5, 2010; Published: Oct 15, 2010 |
|
|
|
|
|
|
|
| |
|
| Abstract: |
|
It is estimated that between 10% and
30% of the general practice population are mentally or emotionally disturbed.
Physical complaints, multiple aches and pains are construed
as signs and symptoms of stress. Although yoga is considered as beneficial, any
hidden psychiatric morbidity may go undetected and thus untreated. Thus
the aim of this study was to obtain an estimate of hidden psychiatric
morbidity in clients seeking consultation at
the Department of Yoga. Fifty respondents
were administered Life Satisfaction Scale and General Health Questionnaire-12.
Majority were females, younger, graduates, married and also scored
above the cut off on GHQ, suggesting minor psychiatric disorder/distress;
reasons for consultation were related to being over weight, stress, aches and
pains, poor concentration. A significant number of persons reported of some
dissatisfaction in life. The perceived benefits were related to reducing
symptoms, stress, weight, relaxation and improvement in concentration and
memory.
Key Words: Yoga; Minor psychiatric
disorders; Stress; Tension; Relaxation; GHQ-12
|
|
India is a country with a population
of over 1 billion, and immense diversity in the languages spoken, levels
of literacy, and social and cultural practices. Organizing mental health
services for this predominantly rural population is indeed a daunting
task. Compounding with this problem are low budgetary resources, the
presence of competing and conflicting healing systems, scarcity of mental
health personnel, and the stigma of seeking help for problems related
to the mind.
People with minor mental morbidity form
the bulk of patients attending not only psychiatric services but all
primary care services. Such morbidity causes significant dysfunction
in the sufferer and needs active intervention. The prevalence of these
disorders has been found to be comparable in developed and developing
countries. People with minor mental health problems commonly present
with somatization phenomena. Srinivasan & Suresh (1) found that
patients with minor mental disorders could be detected at the primary
care level through somatic symptoms alone with a fair degree of validity.
The busy primary care physician could use such symptoms to screen probable
psychiatric morbidity and deal with it appropriately, avoiding the wasteful
use of scant medical resources. The phenomenon is more common where
literacy rates are low and in poorer countries, which has been attributed
to low psychologisation of symptoms and the lack of vocabulary to express
distress in emotional terms. However, reviewing the literature, most
of which derives from research in developed countries, does stress that
this phenomenon is universal. Indian patients do experience emotional
symptoms as well as somatic symptoms, but prefer to present the latter
as the predominant complaint in primary care. The suggestion that patients
prefer to present with somatic rather than psychological symptoms because
Indian languages lack the vocabulary to express emotional distress comes
from workers who may not have had the benefit of living experience with
regional languages and dialects, and has little foundation.
Depression or anxiety may manifest as
headaches, sleepless nights, constant tension, detachment, irritability,
loss of appetite or over eating, dryness of mouth, fear, self-blame,
lack of concentration, and lack of interest in any kind of activity.
Although chronic headaches may not be psychosomatic, they can be caused
by depression or anxiety.
Mental health problems currently are
said to constitute about eight per cent of the global burden of disease
and more than 15 per cent of adults in developing societies are estimated
to suffer from mental illness.(2) According to the new concept of measuring
disability called Disability Adjusted Life Years (DALY), mental disorders
constitute a significant part of total disability adjusted life years
(8.1%), more than the disability caused by several well recognized disorders
such as cancer (5.8%) and heart diseases (4.4%).(3)
Yoga is an ancient practice with Eastern
roots that involves both physical postures (asanas) and breathing
techniques (pranayama) , a practice of putting the body into different
postures while maintaining controlled breathing. It is a mind-body practice in complementary
and alternative medicine with origins in ancient Indian philosophy.
There is also a cognitive component focusing on meditation and concentration,
which is supposed to aid in achieving the goal of union between the self and the spiritual.
It is considered to be a discipline that challenges and calms the body, the
mind, and the spirit. Preliminary studies suggest that yoga may be beneficial in
the treatment of some chronic conditions such as asthma, anxiety, and stress
among others.
The aim of this
study is to evaluate the correlates of clients who seek consultation at the
department of yoga therapy for various reasons. It is premised that these
clients manifest with various somatic aches and pains, stress, tension and so on
which is likely to suggest that they are emotionally distressed which warrants
further evaluation.
Clients who were seeking consultation
at the department of yoga therapy of either sex irrespective of their
age, who were either referred from other medical specialties or who
attended the department on their own for some reason comprised the sample
of this study. Cases referred to the second author (AK) between August-September
2009 were taken. Those who sought consultation at the department of
Psychiatry were excluded. Clients who were willing to participate in
this study were only taken. There were 12 clients who refused to be
included. Confidentially was assured.
All the participants were briefed about
the study and told that participation was voluntary and that non participation
would not affect their treatment in any way. The proforma were given
and was asked to complete them immediately and hand it back filling
all the columns. They were asked to clarify with the investigator if
they had any doubts or questions.
The following were the assessments that
were used
1. Socio
Demographic Questionnaire of the client: Proforma devised to gather
information of the client-gender, age marital status, education, and occupation.
Also information about the client’s sources of referral, chief complaints,
reasons for consulting yoga department and perceived benefits from the yoga
therapy.
2. General Health Questionnaire (GHQ)-12: The GHQ is a well-known instrument used
extensively as a screening instrument for common mental disorders, in
addition to being a more general measure of psychiatric well being.
However, it is not a tool for indicating a specific diagnosis. It is
a measure of current mental health and since its development by Goldberg
in the 1970s (4) it has been extensively used in different settings
and different cultures. The questionnaire was originally developed as
a 60-item instrument but at present a range of shortened versions of
the questionnaire including the GHQ-30, the GHQ-28, the GHQ-20, and
the GHQ-12 is available. The scale asks whether the respondent has experienced
a particular symptom or behavior recently. Each item is rated on a four-point
scale (less than usual, no more than usual, rather more than usual,
or much more than usual); and for example when using the GHQ-12 it gives
a total score of 36 or 12 based on the selected scoring methods. GHQ-12
is a brief, simple, easy to complete, and its application in research
settings as a screening tool is well documented.(5) Scores vary by
study population. Scores about 11-12 are considered typical. Score >15
evidence of distress; Score >20 suggests severe problems and psychological
distress
3. Satisfaction with Life Scale: The Satisfaction with Life Scale was
developed by Ed Diener (6) to assess satisfaction with people's
lives as a whole. The SWLS is a short, 5-item instrument designed to
measure global cognitive judgments of one's lives. The scale usually
requires only about one minute of respondent time. There are five statements
that a client may agree or disagree with. Scoring is on a 1 - 7 scale
to indicate agreement/disagreement with each item.
The scale does
not assess satisfaction with specific life domains, such as health or finances,
but allows subjects to integrate and weigh these domains in whatever way they
choose. It takes only a few minutes to complete. The scores range from
5-35 and higher scores indicating higher satisfaction with life.
Data Analysis: The data was entered in SPSS and simple
statistics were carried out and the results were tabulated.
Distribution of Sociodemographic Characteristics
of the Sample
|
Table 1: Distribution of Socio-demographic Parameters of the Sample |
| Parameters |
Frequency |
Percentage |
| Source of Referral |
| Direct |
34 |
68.00 |
| General Medicine |
3 |
6.00 |
| Orthopedics |
7 |
14.00 |
| OBG |
2 |
4.00 |
| Others |
4 |
8.00 |
| Gender |
| Male |
8 |
16.00 |
| Female |
42 |
84.00 |
| Age |
| <18 years |
4 |
8.00 |
| 19-20 years |
4 |
8.00 |
| 21-25 yrs |
10 |
20.00 |
| Up to 30 yrs |
6 |
12.00 |
| 31-40 yrs |
16 |
32.00 |
| > 41 yrs |
10 |
20.00 |
| Education |
| SSLC |
13 |
26.00 |
| Graduate |
30 |
60.00 |
| PG |
4 |
8.00 |
| Professional |
3 |
6.00 |
| Occupation |
| Student |
13 |
26.00 |
| Employed |
24 |
48.00 |
| Unemployed |
2 |
4.00 |
| Housewife |
11 |
22.00 |
| Marital status |
| Single |
22 |
44.00 |
| Married |
28 |
56.00 |
| Widowed |
- |
- |
Table 1 shows the demographic details
of the sample. As is evident majority i.e. 68% of the clients consulted
the Yoga department on their own directly and about 32% were referred
from other departments within the same hospital. There were about 7(14%)
who were referred from orthopedics mainly for the management of their
backache. [Figure 1]
Females out numbered males in
this study. There were forty two females against eight males. Twenty eight (56%)
were married as against 22(44%) who were single. There was no widow or widowers
in this group of clients.
The age of the clients seeking
yoga therapy in this study sample were usually younger about 24(48%) who were
below 30 years of age or in their middle age 31-40 years about 32%, persons
above 50 years were less.
Other socio-demographic variables revealed
that majority were graduates- 60% or completed their high school education-26%.
Among the sample 24(48%) were employed, 13(26%) students and 11(22%) were
housewives. [Figure 2]
 |
|
Figure 1 (left) and Figure 2 |
Distribution of GHQ & SLS Scores:
|
Table 2: Distribution of GHQ & SLS Scores |
| Parameters |
Frequency |
Percentage |
| G.H.Q.-12* |
| Typical score upto 12 |
32 |
64.00 |
| >15(evidence of distress) |
9 |
18.00 |
| >20(evidence of severe distress) |
9 |
18.00 |
| SLS** |
| 35-31-extremely satisfied |
3 |
6.00 |
| 26-30 satisfied |
14 |
28.00 |
| 21-25 slightly satisfied |
13 |
26.00 |
| 20-neutral |
4 |
8.00 |
| 15-19 slightly dissatisfied |
8 |
16.00 |
| 10-14 dissatisfied |
7 |
14.00 |
| 5-9 extremely dissatisfied |
1 |
2.00 |
| > 41 yrs |
1 |
2.00 |
| *GHQ-General Health Questionnaire
**SLS-Satisfaction with Life Scale |
 |
Figure 3: Distribution of GHQ across the sample
|
 |
|
Figure 4: Distribution of Satisfaction with
Life among Clients |
The General Health Questionnaire was
administered to screen for minor psychiatric morbidity in this set of
clients seeking consultation in the Yoga Department of this General
Hospital which is situated in a catchment area catering to the health
needs of 3-4 districts of the state besides getting patients from the
neighboring district of Uttara Kannada, Shimoga, Kodagu and the state of Kerala.
Thirty two (64%) scored up to 12 which is considered a typical score among the
normal population which is not a significant score and having some mild
negligible discomfort. Eighteen (36%) clients scored above the stipulated cut
off, about nine had evidence of distress and another nine qualifying for severe
distress. This finding pointed that probably this subset of clients were
suffering from some minor psychiatric morbidity such as anxiety or depression,
warranting further assessments to find out the exact nature of the problem.
However this issue was not addressed as it was not within the scope of this
study. [Figure3]
The Satisfaction with Life was
assessed in these clients and results revealed that about 60% reported of some
satisfaction in life whereas 32% reported of some degree of dissatisfaction. The
dimension of the problem might be different in each person which may be
pertaining to their health, health of relatives, finances, interpersonal
problems or dissatisfaction with the living situation and so on. However in this
study these issues were not evaluated. It is well established that life stress
can manifest with anxiety or depressive or somatic (physical) symptoms. [Figure
4]
|
Table 3: Distribution of reasons for consultation and other related problems
of the clients |
| Parameters |
Frequency |
Percentage |
| Reasons for consultation
Yoga Dept |
| Improve general health/well being |
4 |
8.00 |
| Weight reduction |
14 |
28.00 |
| Improve memory, concentration |
7 |
14.00 |
| Aches & pains |
14 |
28.00 |
| Hypertension |
2 |
4.00 |
| Tension/stress |
4 |
8.00 |
| Acidity/GI symptoms |
3 |
6.00 |
| Insomnia |
2 |
4.00 |
| Anger Control |
1 |
2.00 |
| Constipation |
1 |
2.00 |
| Manifestations |
| Single |
40 |
80.00 |
| Two |
8 |
16.00 |
| More than 2 |
2 |
4.00 |
| Presence of Physical
illness |
| Present |
25 |
50.00 |
| Absent |
25 |
50.00 |
| Other related problems |
| Migraine |
4 |
8.00 |
| Hypertension |
4 |
8.00 |
| Infertility |
3 |
6.00 |
| Job stress |
1 |
2.00 |
| Asthma |
2 |
4.00 |
| Skin allergy |
1 |
2.00 |
| Respiratory allergy |
1 |
2.00 |
| *Some of them reported more than 1
reason for consultation |
 Figure 5: Distribution of Reasons for consultation
|
The reasons for consulting at
the department, presence of physical disorders, chief complaints or
manifestations and the perceived benefits by clients were assessed. As depicted
in the Table 3 & Table 4 the major reasons for consulting were over weight
14(28%); Aches and pains 14(28%); stress and tension 4(8%); poor memory and
concentration 7(14%) or to improve general health/physical fitness 4(8%). Other
reasons such as acidity, insomnia, hypertension, and anger control were reported
but less common. The common pain symptoms reported by many clients were
headache, stomach pain, body aches, and pain in the limbs and so on. There were
40 i.e. 80% who reported of just one complaint and 10(20%) reported more than
one complaint. There were about 50% who reported of the presence of some
physical problem such as migraine-4 ; hypertension -4; asthma-2, skin and
respiratory allergies and also infertility-3.Others reported of symptoms of
hyperacidity, sinusitis and so on, besides symptoms suggestive of tension
headache-5(10%). [Figure 5]
|
Table
4: Distribution
of chief complaints reported by the clients |
| Chief
Complaints reported |
Frequency |
% |
| Aches & pains |
11 |
22.00 |
| Stress & tension |
8 |
16.00 |
| Overweight |
13 |
26.00 |
| Muscular problem |
1 |
2.00 |
| General health(Fatigue) |
6 |
12.00 |
| Hypertension |
4 |
8.00 |
| Acidity |
3 |
6.00 |
| Problems in memory
& concentration |
7 |
14.00 |
| Skin allergy |
1 |
2.00 |
| Migraine |
4 |
8.00 |
| Insomnia |
2 |
4.00 |
| Infertility |
3 |
6.00 |
| Respiratory allergies |
2 |
4.00 |
| Depression |
1 |
2.00 |
| Asthma |
2 |
4.00 |
| Anger control |
1 |
2.00 |
| 10 clients reported more than 1 complaint |
| |
|
Table
5: Distribution of Clients' Perceived Benefits of Yoga |
|
Parameters |
Frequency |
% |
| Weight
reduction/control |
12 |
24.00 |
| Symptom reduction |
7 |
14.00 |
| Well being/fitness |
10 |
20.00 |
| Relaxation |
11 |
22.00 |
| Improvement in memory/concentration |
7 |
14.00 |
| Hypertension control |
4 |
8.00 |
| Asthma control |
2 |
4.00 |
| Increase in confidence |
1 |
2.00 |
| Don’t know |
3 |
6.00 |
| 4 clients reported more than 1 benefit |
|
|
 |
|
Figure 6:
Distribution of Clients Perceived Benefits of Yoga |
The perceived benefits reported by the
clients were physical well being or fitness- 10(20%); relaxation- 11(22%);
symptom reduction- 7(14%); improvement in memory and concentration 7(14%);
weight reduction- 12(24%); control of hypertension 4(8%); asthma control-4(8%)
and other allergies.[Figure 6]
Yoga is one of the common methods
used as mind–body therapy(7) and being promoted as a complementary and alternative
therapy, its clinical application has greatly
increased over the past 3 decades.(8) Yoga
is much talked about as a health practice and is almost a fad in the
modern world, where extravagant claims are made about its ability to
resolve almost every illness of the mind and body.
The current study on the characteristics
of clients seeking consultation in the yoga therapy department in a tertiary care facility in India
has shown that
the clients are predominantly
females, are young below 30 years of age and
are either graduates or secondary
school educated. The reason for female predominance in
the present study may
be due to the fact that the yoga instructor
is a female, with the male
clients being seen by the male instructors. However it has also been a general
observation that the females prefer this mode of alternative treatment than
their male counterparts.
Stigma associated with
mental illness is more frequently reported in the general community
than among professionals. A growing
body of data derived from field-surveys indicates that
many people with psychiatric disorders seek no professional
help in any kind of health facility. Psychic symptoms, unlike somatic
symptoms, are construed as socially disadvantageous. Thus, somatization
of psychiatric disorders is widespread in Asia. This increases the barriers to seek help and
contributes to the stigmatization of the mentally ill. This also might
have been one of the reasons in the present study to consult the yoga
therapy department.
High rates of medically unexplained symptoms
have been observed in many non-western countries and in ethnic minorities
of industrialized countries.(9) It was also observed in our sample
that many manifested vague somatic symptoms. Anxiety and depression
are the two leading mental health
conditions seen in any setting. They are often under diagnosed
and under treated in this setting.
Kleinman(10) noted that in non-Western
societies feelings of sadness, worthlessness and guilt were less common,
while somatic complaints such as feeling tired, stomach-aches and headaches
were more common. He also noted that the association of culturally salient
somatic language of complaints with depression and anxiety has been
recorded for clinical samples in a variety of countries such as Saudi
Arabia, Iraq, India and Hong Kong. These somatic symptoms have been
reported to include symptoms such as dizziness, tiredness, fatigue,
headaches, and abdominal pain.(10-12)
There is considerable evidence (4,5,11,12) to suggest that many patients with significant psychiatric illness
attending their general practitioner or other systems of medicine are
unrecognized as such. In 1970 Goldberg and Blackwell (4) coined the
term 'hidden psychiatric morbidity' and found that these patients were
distinguished by their attitude to their illness and by usually presenting
a physical symptom to the general practitioner. In this study about
a third of the sample scored above the cut off on GHQ, suggesting minor
psychiatric morbidity. The general health questionnaire a self-reporting
screening questionnaire which identifies individuals who have a high probability
of suffering from psychological illness.(15,16)
Many clients with vague multiple bodily symptoms may find their way
to the practice of yoga.
Scientific evidence has accumulated during
the last 15 years establishing that subsyndromal depression (SD). SD
symptoms have a high prevalence in the general population and in clinically
depressed patient cohorts studied cross-sectionally or followed longitudinally.
The clinical relevance and public health importance of SD symptoms are
associated with a significant and pervasive impairment of psychosocial function
when compared to no depressive symptoms.
Although DSM-IV acknowledged the clinical
significance of some subthreshold forms such as minor depression (MinD)
and recurrent brief depression (RBD), clinicians continued to struggle
with the concept of "subthreshold" depression. A substantial
number of patients continued to present with depressive symptoms that
still did not satisfy any DSM-IV diagnosis. Generally, these patients
failed to complain of anhedonia and depressed mood, a criterion that
DSM-IV mandates for any diagnosis of depression. Therefore, researchers
reexamined the question of whether this cluster of depressive symptoms,
in the absence of anhedonia and depressed mood, was clinically significant.
Some researchers labeled this cluster of symptoms, "subsyndromal
symptomatic depression" (SSD).
In the current study, the persons who
complained of poor concentration were all students and usually in adolescents
it is known that due to various distractions and the tensions of growing
up and the environmental stresses like peer pressure and parental expectations
they are likely to be distracted. These people may seek help in yoga hoping that
it
helps them focus, improve and sustain their concentration.
Three of the clients attending yoga reported
that they were not aware of the benefits and consulted as some of their
friends had recommended. There has been much publicity in the lay press,
in the print media as well as in the electronic media about the beneficial
effects of yoga in various physical as well as psychological conditions
and there are channels which telecast the step-to-step practice of yoga.
Many institutes as well as hospitals have started regularly to run departments
of yoga therapy and there have been satisfactory liaison from other
medical specialties. In almost all common medical conditions yoga
asanas, meditation
as well as pranayama has been recommended
as an adjuvant therapy. In many stress management programmes as well as courses,
yoga is advocated as a stress buster.
Yoga is also
being promoted as a form of cognitive behavioural therapy, involving many activities, including the exercise
of mental control, physical movements and posture, and regulation of
breathing.(17) Although the role of yoga and its beneficial effects
on short term basis has been reported, it has not been convincingly established.
This may be related to the multiplicity of forms of yogic practice in
vogue, and the difficulty of standardizing them in terms of dosage.
It is a fertile field for research, as this health practice is in tune
with the religious and philosophical outlook of much of Indian society.
Evidence for their efficacy according to Western scientific requirements
is not yet forthcoming, but the growing interest of scientists in these
disciplines is encouraging formal research into traditional psychiatric
therapies. Motivation and compliance may also be issues that require
consideration before recommendation of a programme such as yoga. Grover
et al (17) investigated whether the benefits of yoga were related
to a person’s initial attitude towards yoga. They found that initial
attitude to yoga did not predict the extent of benefits from the yoga.
They also noted that participants’ attitudes towards yoga became more
positive the longer they attended classes.
The choice of
suitable yoga practices for a particular trainee is dependent on general health,
personality, values and motivations, family life, job, time available, living
conditions, previous experience, and positive or negative expectations among
others. The "prescriptions" of yoga practices for various diseases, even if
useful as general information, should be considered with this reservation.
- Srinivasan TN, Suresh
TR. Non-specific symptom screening
method: detection of non-psychotic morbidity based on non-specific symptoms. Gen Hosp Psychiat. 1991;13:106-114.
- Desjarlais R, Eisenberg
L, Good B, Kleinman A. World Mental Health : Problems and Priorities
in Low-Income Countries. New York: Oxford University Press, 1995.
- WHO, World Bank. World
Development Report: Investing in Health. New York: Oxford University
Press. 1993
- Goldberg DP, Blackwell B.
Psychiatric illness in general practice. A detailed study using a new
method of case identification. BMJ 1970;1:439-443
- Goldberg DP, Huxley P. Mental
illness in the community: the pathway to psychiatric care. London: Tavistock,
1980.
- Diener E, Emmons RA,
Larson RJ, Griffin S. The satisfaction with life scale.
J Person Ass. 1985;49:71-75
- Barnes PM, Powell-Griner E,
McFann K, Nahin RL. Complementary and alternative medicine use among
adults: United States, 2002. Advance
Data. 2004;343:1–20.
- Khalsa SB. Yoga as a therapeutic
intervention: a bibliometric analysis of published research studies.
Ind J Physio & Pharmaco. 2004;48(3):269–85
- Sethi BB, Nathawat SS, Gupta
SC. Depression in India. J Soc Psychol, 1973;91(1):3–13
- Kleinman A. Rethinking
Psychiatry: from Cultural Category to Personal Experience. New York:
Free Press.1988
- Cheung FM. An overview
of psychopathology in Hong Kong with special reference to somatic presentation.
In Tseng W, Wu D (Eds.), Chinese culture and mental health 1985. Orlando:
Academic Press Inc. pp. 287–304
- Youngmann R, Minuchin-Itzigsohn
S, Miriam B.
Manifestations of Emotional Distress among Ethiopian Immigrants in Israel:
Patient and Clinician Perspectives Transcult
Psychiat. 1999;36(1):45-63
- Marks J, Goldberg DP, Hillier
VE. Determinants of the ability of general practitioners to detect psychiatric
illness. Psychol Med 1979;9:337-353.
- Goldberg DP, Steele JJ, Johnson
A et al. Ability of primary care physicians to make accurate rating
of psychiatric symptoms. Arch Gen Psychiat
1982;39:829-833.
- Overton GW, Wise TN. Psychiatric
diagnosis in family practice: is the general health questionnaire an
effective screening instrument? South Med
J,, 1980;73:763-764
- Goldberg D. Identifying psychiatric
illness among general medical patients. BMJ. 1985;291:161-162
- Grover P, Varma VK, Pershad D et al. Role of yoga in the treatment of neurotic disorders:
current status and future directions. Ind J Psych 1994;36:153-162.
|
