Yoga v. health education for attentional processes relevant to major depressive disorder

The effectiveness of mindfulness yoga on patients with major depressive disorder: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Mindfulness yoga is a type of exercise that emphasizes the integration of mindfulness or meditation into yoga. The aim of this study was to determine the effectiveness of mindfulness yoga intervention on major depressive disorder (MDD) patients.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching nine databases, including PubMed, EMBASE, Web of Science, The Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), Wanfang Data knowledge service platform, Chinese Biomedical Literature Database (CBM), and China Science and Technology Journal Database (VIP) from inception to April 2023. Primary outcomes included the severity of depression. Secondary outcomes included anxiety and rumination.

RESULTS

Nine RCTs met our inclusion criteria (n = 581). The meta-analysis showed that mindfulness yoga significantly has a significant effect on depression (SMD = -0.53; 95%CI = -0.96 to -0.11; P < 0.05) among MDD patients. The only two RCTs involved also showed that mindfulness yoga could alleviate the anxiety level of MDD patients after intervention (SMD = -1.08; 95%CI = -1.64 to -0.52; P < 0.05). Meta-analysis did not reveal positive effects of the mindfulness yoga groups on rumination after intervention based on three RCTs (SMD = -0.33; 95%CI = -0.89 to 0.23; P > 0.05), but found a significant difference in the follow-up period based on two RCTs (MD = -7.42; 95%CI = -11.27 to -3.56; P < 0.05), compared with the control groups.

CONCLUSION

Although we were unable to provide conclusive evidence to support the effectiveness of mindfulness yoga in improving symptoms in MDD patients, we found the literature included in this study indicated that mindfulness yoga might have a potential benefit for MDD patients and should be a feasible, acceptable, and promising intervention.

Effectiveness of yoga for major depressive disorder: A systematic review and meta-analysis

Objective

Major depressive disorder (MDD) has a relapse rate that cannot be ignored and places a tremendous burden on the patient in the prevention and treatment process. Yoga, a combination of physical and mental exercises, is effective and acceptable for the adjunctive treatment of MDD. This study aimed to explore further the evidence of yoga's efficacy for patients with MDD.

Methods

PubMed, Embase, Cochrane library, PsycINFO, SinoMed, CNKI, Wanfang, and VIP databases from their inception to 13 October 2022 were searched by a pre-defined search strategy. RCTs of patients with MDD who met diagnostic criteria for yoga treatment were included. RoB2.0 was used to evaluate the quality of the literature. Improvement in depressive symptoms was assessed by the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAMD), or other scales were used as primary outcome indicators, and improvement in anxiety was assessed by the Hamilton Anxiety Scale (HAMA) and State-Trait Anxiety Inventory (STAI) scale as secondary outcome indicators. RR and Cohen's d at 95% CI were used as effect size estimates, and Q and I2 were used to evaluate the size of heterogeneity, with a p-value less than 0.05 indicating statistical significance.

Results

Thirty-four RCT studies, including 1,269 patients in the treatment group and 1,072 patients in the control group, 48.4% of whom were women, were included in the study. Compared to the control group, the BDI-II results yielded a moderate effect of yoga on the improvement of depressive symptoms (Cohen's d = -0.60; 95% CI: -1.00 to -0.21; p < 0.01), the HAMD results yielded a moderate improvement of yoga on the severity of depressive symptoms (Cohen's d = -0.64; 95% CI: -0.98 to -0.30; p < 0.01), and the STAI results can be concluded that yoga had a negligible effect on the improvement of the level of anxiety (Cohen's d = -0.26; 95% CI: -0.48 to -0.04; p = 0.02). No adverse events occurred in the yoga group during the treatment.

Conclusion

Yoga can improve depressive symptoms and anxiety in patients with MDD and has a safe and wide patient acceptance.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/], identifier [PROSPERO, CRD42022373282].

The effectiveness of mindfulness-based interventions for ruminative thinking: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To systematically evaluate the effectiveness of mindfulness-based interventions for ruminative thinking.

METHODS

Cochrane Library, Web of Science, Embase, EBSCO, PubMed and Science Direct databases were searched to include randomized controlled trials of mindfulness-based interventions for rumination that met the criteria. The Rumination scale was used as the primary outcome indicator, and the secondary outcome indicator included the Mindfulness scale. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Stata 16.0 software was used to perform meta-analysis, subgroup analysis, sensitivity analysis, meta-regression analysis and publication bias detection of the extracted data.

RESULTS

A total of 61 studies with 4229 patients were included. Meta-analysis results revealed a significant intervention effect on ruminative thinking (SMD = -0.534, 95 % CI = [-0.675, -0.394], z = -7.449, P < 0.001). However, there was no significant difference between mindfulness-based interventions and CBT (SMD = 0.009, 95%CI = [-0.239, 0.258], z = 0.073, P = 0.941). Meta-analysis showed that mindfulness-based interventions significantly enhanced the level of mindfulness (SMD = 0.495, 95 % CI = [0.343, 0.647], z = 6.388, P < 0.001), while it was not significant compared to CBT (SMD = 0.158, 95%CI = [-0.087, 0.403], z = 1.266, P = 0.205). The two subgroups with >65 % (SMD = -0.534, 95%CI = [-0.681, -0.386], z = -7.081, P < 0.001) and 80 % (SMD = -0.462, 95%CI = [-0.590, -0.334], z = -7.071, P < 0.001) of females showed significant improvement in ruminative thinking. There were significant intervention effects for depression, students, cancer, healthy adults, and clinical patients. Significant intervention effects were demonstrated for various participant ages and intervention periods.

CONCLUSION

This study confirmed the feasibility of mindfulness-based interventions in improving ruminative thinking and enhancing the level of mindfulness. However, the effectiveness of mindfulness-based interventions was not significant compared to CBT. The two subgroups with a higher proportion of females showed a more significant improvement in ruminative thinking, whereas there were no significant differences in participant characteristics, age, and the duration of intervention.

Effect of physical exercise on sleep quality of college students: Chain intermediary effect of mindfulness and ruminative thinking

The Physical Exercise Rating Scale, Mindfulness Attention Awareness Scale (MAAS), Ruminative Thinking Scale (RRS), and Pittsburgh Sleep Quality Index (PSQI) are used to conduct the questionnaire among a sample of 1,006 college students (average age = 19.95 years, SD = 1.86 years) to figure out whether there is any correlation between physical exercise and sleep quality in college students as well as how the mechanism of mindfulness and ruminative thinking plays a role in them. For data analysis, the Harman single-factor test was used; for the common method deviation test, Pearson's correlation analysis, and the mediating effect tested by using the bootstrap method were carried out. Results: (1) Overall, 34% (PSQI ≥ 8) of college students' sleep quality is poor. (2) The PSQI is positively correlated with ruminative thinking, while both are negatively correlated with the level of physical exercise and mindfulness; the level of physical exercise is positively correlated with the level of mindfulness. (3) Physical exercise can significantly negatively predict sleep quality (β = -0.08, P < 0.05), significantly positively predict mindfulness (β = 0.12, P < 0.001), and significantly negatively predict ruminative thinking (β = -0.07, P < 0.05). When participate in physical exercise, mindfulness, and ruminative thinking enter the regression equation at the same time, only mindfulness and ruminative thinking can predict sleep quality(β = -0.15, P < 0.001) significantly negatively predicted sleep quality and ruminative thinking (β = 0.22, P < 0.001) significantly positively predicted sleep quality, while physical exercise (β = -0.04, P > 0.05) had no significant predictive effect on sleep quality. (4) After controlling for age and gender, physical exercise appears to have an impact on sleep quality of college students through the independent intermediary role of mindfulness and ruminative thinking and the chain intermediary role of mindfulness and ruminative thinking, with a total mediating effect value of -0.007. This study reveals the relationship between physical exercise and sleep quality, as well as its mechanism, thus guiding college students to actively participate in physical exercise. It also provides corresponding suggestions to improve sleep quality as well as physical and mental health in college students.

An analysis of business students’ stressors and their coping strategies in the post-pandemic era

The COVID-19 pandemic has brought a dramatic change in teaching–learning practices in higher education across the world. The post-pandemic era with a new shift of teaching–learning phase raises the concern of students' psychological well-being, especially the novice, i.e., first-year undergraduate students, as first-year students often struggle to adjust to the new environment of higher institutions, thereby depressive symptoms are more prevalent among them. In this regard, a qualitative study was conducted followed by a dyadic approach to explore the symptoms of students’ psychological stressors, their causes, and provide essential remedies for coping with such behaviors in the post-pandemic era. The findings show that students’ stressors were commonly reported due to the academic workload, institutional regulations, lack of resources, and financial constraints. Regarding indications, unusual behavior, lack of confidence, improper sleep, and lack of motivation were identified as the primary symptoms of students’ stress. However, participants reported a lack of understanding regarding stress-related matters. Yet, students and faculty members try to adopt several strategies for reducing such stressors. By examining the perceived psychological stress, indications, and coping behaviors, this study enriches the literature by bridging pragmatic and theoretical gaps regarding students’ stressors of business management. Furthermore, the study mainly suggests that adequate institutional support should be provided to deal with students’ problems that cause stress. Also, universities should organize workshops or seminars to cultivate psychological health awareness among students and faculty members.