Mental health

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Can yoga and breathing really help ‘cure’ depression?

Yoga and depression

Yoga and depression

“Taking yoga classes can help ease depressive symptoms, a new study says,” reports the Mail Online.

A small study from the US found yoga was associated with a clinically significant improvement in depression symptoms.

Researchers recruited 32 people with moderate to severe depression. They were allocated to either a low- or high-dose group for yoga. The high-dose group spent more time in classes and doing yoga and other exercises at home.

Average depression scores fell over the course of the 12-week study, with no differences seen between the two groups.

But the Mail failed to mention there was no comparison group, so it’s hard to assess the specific effect yoga had.

It could be the case that simply taking part in a regular group activity was beneficial. And, in some cases, symptoms may have improved anyway.

This study doesn’t add much to the evidence. The researchers say they plan another study with a walking group for comparison, which might help us see whether yoga is an effective therapy for depression.

The researchers say they don’t intend for yoga to be a substitute for the treatment of depression by trained healthcare professionals.

See your GP if you think you may have depression. Exercise for depression can be useful, but you may also benefit from other treatments.

Where did the story come from?

The study was carried out by researchers from Boston University School of Medicine, Harvard School of Medicine, Boston Medical Centre, McLean Hospital, Memorial Veterans Hospital, New York Medical College, Massachusetts General Hospital, and Columbia University, all in the US.

It was funded by grants from Boston University.

The study was published in the peer-reviewed Journal of Alternative and Complementary Medicine and is free to read online (PDF, 376kb).

The Mail Online story reports the facts of the study accurately, but inflates their importance, stating that the study “proves” yoga can “cure” depression, and saying the practice “could even be a replacement for antidepressant drugs”.

But the researchers don’t make such a claim themselves, and the story fails to point out that the lack of a comparison group means we can’t assume the reduction in depression was caused by yoga.

What kind of research was this?

This was a randomised dosing trial. This design is different from a traditional randomised controlled trial (RCT) as the intervention was the same in both groups but, as the name suggests, the dosage was different.

Usually, randomised studies include a control group, where people in that group don’t get the intervention, so researchers are able to judge how successful the intervention was.

However, in this study, the investigators looked at two groups who did different amounts of yoga. That means we can’t tell whether the improvements in their mental health were because of yoga or another reason.

What did the research involve?

Researchers screened 265 people with depression for the study, and eventually recruited 32 to take part in classes.

Half were randomly assigned to attend three 90-minute classes each week, with four 30-minute sessions at home. The other half were asked to attend two 90-minute classes, with three 30-minute sessions at home.

Everyone had their depression scores measured at the start, then after four weeks, eight weeks and 12 weeks. The researchers looked at average reductions in depression scores for the two groups.

Depression scores were measured by the Beck Depression Inventory, a self-completed 21-item questionnaire that scores depression symptoms as minimal (0-13), mild (14-19), moderate (20-28) or severe (29-63).

Researchers looked at whether changes in average depression scores differed between the two groups. They also considered whether the number of people with minimal symptom scores was different by the end of the study.

What were the basic results?

Both groups saw big drops in their average depression scores from the start to the end of the study:

in the high-dose group, the average score fell from 24.6 to 6, a drop of 18.6 points (95% confidence interval [CI] 22.3 to 14.9)

in the low-dose group, the average score fell from 27.7 to 10, a drop of 17.7 (95% CI 22.8 to 12.5)

This is the equivalent of a change from moderate depression to minimal depression symptoms. There was no difference between the groups in terms of how many people had only minimal symptoms at the end of the study.

One person dropped out of the study from each group. Nobody reported severe adverse effects from taking part in the classes, although 13 people reported muscle soreness.

How did the researchers interpret the results?

The researchers say their study “provides evidence that participation in an intervention composed of Iyengar yoga and coherent breathing is associated with a significant reduction in depressive symptoms for individuals with major depressive disorder.”

They note that people taking three classes a week said it “entailed a demanding time commitment” and concluded that, “Although the thrice-weekly classes (plus home practice) had significantly more subjects with BDI-II scores ?10 at week 12, the twice-weekly classes (plus home practice) may constitute a less burdensome but still effective way to gain the mood benefits from the intervention.”

Conclusion

Many people report finding yoga and breathing exercises to be relaxing and helpful for their mental health. This study provides some evidence the practice might help people with symptoms of depression.

But flaws in the study mean we can’t be sure this is the case. The lack of a control group is the big problem.

For some people, depression simply gets better over time. For others, taking part in a class, being able to talk about their mental health, or getting out and doing some gentle physical exercise may improve their symptoms.

We don’t know whether yoga specifically made a difference because the study doesn’t tell us this.

Other problems include the study’s relatively small size. Also, the cut-off point of 10 on the depression score seems to have been randomly chosen, rather than being of any clinical significance.

The large number of people who dropped out of the study or lost touch with organisers before the study began (approximately 63) also points to the practical difficulty with the intervention.

Attending two or three yoga classes a week, plus three or four home practice sessions, may be difficult for many people with moderate to severe depression to fit into their lives.

And some people may have felt they were unable to cope with the experience of interacting with others in a group activity.

But it’s encouraging that most people in the study saw big improvements in their mental health over the 12-week period.

There are many treatments for depression, including antidepressant medicines and talking therapies, as well as relaxation therapies like yoga. An important first step is to talk to your GP.

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Is schizophrenia risk ‘around 80% genetic’?

Schizophrenia

Schizophrenia

“Genetics account for almost 80 per cent of a person’s risk of developing schizophrenia, according to new research,” the Mail Online reports. That is the main finding of a study looking at how often schizophrenia affected both twins of a pair, looking at identical and non-identical twins.

Schizophrenia is a serious mental health condition that can cause delusions and hallucinations. There is no single “cause” of schizophrenia. It is thought to result from a complex combination of both genetic and environmental factors.

The researchers looked at twins born in Denmark and found that if one identical twin had schizophrenia, the other twin (with the same genes) was also affected in about a third of cases. For non-identical twins, who only share on average half of their genes, this was true only in about 7% of cases. Based on these figures, the researchers calculated that 79% of the risk of developing schizophrenia was down to their genes.

While the findings suggest genes do play an important role in schizophrenia, this is only an estimate and the true picture is likely to be more complicated. Environmental factors clearly still have an influence on whether the person actually develops schizophrenia.

If you do have a history of schizophrenia in your family, this doesn’t mean you will automatically get the condition yourself. But it may be a good idea to avoid things that have been linked to the condition, such as drug use (particularly cannabis, cocaine, LSD or amphetamines).

 

Where did the story come from?

The study was carried out by researchers from the Center for Neuropsychiatric Schizophrenia Research at Copenhagen University Hospital in Denmark. Funding was provided by the Lundbeck Foundation Center of Excellence for Clinical Intervention and Neuropsychiatric Schizophrenia Research, and Lundbeck Foundation Initiative for Integrative Psychiatric Research.

The study was published in the peer-reviewed journal Biological Psychiatry, and is available to read for free online.

The Mail’s report that: “The findings suggest the genes we inherit play a far bigger role than previously believed and mean the seeds are sown before birth” isn’t strictly correct. The estimates from the current study are similar to those from some previous studies.

 

What kind of research was this?

This was a twin cohort study using data from the Danish Twin Register combined with the psychiatric registry, aiming to better quantify the extent to which schizophrenia risk may be explained by the genes we inherit. Previous studies have suggested that genes play an important role, but researchers wanted to use some updated statistical methods and newer data to come up with a more up-to-date estimate.

Both genetics and environmental factors are thought to play a role in the risk of schizophrenia. Twin studies are a standard way to estimate the extent to which genetics plays a role. Both identical and non-identical twins may be assumed to have the same environmental exposure. However, identical twins have 100% of their genes in common, while non-identical twins share only 50% on average.

Therefore if identical twins are more alike than non-identical twins, marked differences in health outcomes are likely to be down to genetics. Researchers used statistical methods to estimate what role genes play in the development of a particular characteristic (called “heritability”).

Previous studies show that schizophrenia affects both members of identical twins in 41% to 61% of cases, but only 0 to 28% in non-identical twins. A previous pooling of twin studies has suggested that the “heritability” of schizophrenia is 81%.

It is worth bearing in mind that this type of twin cohort study makes various assumptions to simplify the picture.

It assumes that genes and the environment do not interact. This assumption may result in over-estimating the impact of genes. For example, it could be the case that people with a specific genetic profile are more likely to use drugs. Drug use (an environmental risk factor), rather than the genes directly, could then increase the risk of schizophrenia.

Also, the results obtained are very dependent on the environment the twins are living in. So results would likely differ if the same study were carried out in different societies at different time points throughout history.

Finally, this type of study does not identify specific genes that may be involved in the risk of schizophrenia.

 

What did the research involve?

The Danish Twin Register, started in 1954, includes all twins born in Denmark. The Danish Psychiatric Central Research Register includes data on all psychiatric hospital admissions since 1969, and all outpatient visits since 1995. Diagnoses in the register are based on the long-established International Classification of Diseases (ICD), which is a way of classifying diseases according to standard criteria.

The researchers used data on 31,524 twin pairs born up to the year 2000, linked with the psychiatric registry data, and knew whether they were identical or not.

They identified the twins who had been diagnosed with schizophrenia or schizophrenia spectrum disorders (this means not fulfilling diagnostic criteria for schizophrenia, but having a disorder with similar characteristics).

They then looked at how many of these diagnoses affected both twins in a pair. They used statistical methods to estimate how much of a role genes played in the development of schizophrenia. One of the new features of the methods used was that they took into account how long each twin had been followed up.

The researchers’ results only apply to schizophrenia diagnosed up to the age of 40.

 

What were the basic results?

448 of the included twin pairs (about 1% of the sample) were affected by schizophrenia, and 788 were affected by schizophrenia spectrum disorders. Average age of diagnosis of these conditions was about 28 or 29 years.

The researchers found that if one identical twin was affected by schizophrenia or schizophrenia spectrum disorders, the chance of the second being affected was about a third. For non-identical twins, the chance was far lower – only 7% for schizophrenia and 9% for schizophrenia spectrum disorders.

The researchers estimated that in the population studied, about 78% of the “liability” for schizophrenia and 73% for schizophrenia spectrum disorders could come down to genetic factors. This means that a high proportion of the co-twins may be carrying genes that make them “vulnerable” to the condition, even if they haven’t developed it in this study.

 

How did the researchers interpret the results?

The researchers conclude: “The estimated 79% heritability of schizophrenia is congruent with previous reports and indicates a substantial genetic risk. The high genetic risk also applies to a broader [range of] schizophrenia spectrum disorders. The low [co-diagnosis] rate of 33% in [identical] twins demonstrates that illness vulnerability is not solely indicated by genetic factors.”

 

Conclusion

This study explores how much of the risk of developing schizophrenia or related disorders may be explained by genetics.

It shows that schizophrenia and related disorders are quite rare – affecting about 1% of the general population.

Their observed co-diagnosis rate in both twins – about a third for identical and less than 10% for non-identical twins – was lower than has been observed in other studies. This seems to suggest that while a high proportion of an individual’s susceptibility may come down to hereditary factors, environmental factors must still be play a substantial role.

This type of study makes a number of assumptions to simplify the picture, and these may not accurately portray reality. For example, it assumes that identical and non-identical twins would share similar environmental exposures.

However, this may not be the case. It also assumes that genes and the environment do not interact, but in reality, people with different genetic makeups may react to the same exposure in different ways.

Other reasons for the low co-diagnosis rate could be, as the researchers acknowledge, down to study methods. For example, some may have had different severity or presentation of illness influencing diagnosis. The study also does not have lifelong data for all of the twins. Though most people with schizophrenia are diagnosed before 40 years of age, longer follow-up times would be ideal.

One final point: estimates that come out of this type of study are dependent on the environment the twins are living in. So results would likely differ if the same study were carried out in very different societies, or at different time points throughout history. Though this study benefits from using a large population-wide registry, study members were all Danish residents. The findings may not apply to different populations, with different ethnic and cultural makeups.

The study will add to the large body of literature exploring the role of hereditary and environmental risk factors for schizophrenia. However, it certainly doesn’t mean we fully understand the causes of the condition, including the impact of environment on this condition.

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Sexual harassment in the workplace linked to depression

harassment

harassment

News that sexual harassment in the workplace can cause depression and work absence has hit the headlines after the results of a Danish study were published.

Researchers surveyed 7,603 employees from 1,041 organisations in Denmark, and asked them about symptoms of depression and whether they’d been subjected to sexual harassment from colleagues or customers or clients in the past 12 months. Overall, 4% of women and 0.3% of men reported harassment.

People who reported harassment from customers or clients scored 2.05 points higher on a 50-point depression score than those reporting no harassment. People reporting harassment from colleagues scored 2.45 points higher.

The findings generally support the understanding that sexual harassment can have harmful effects on mental health – regardless of who it comes from.

But this study has many limitations:

The one-off assessment can’t show that harassment preceded depression symptoms.

We don’t know how meaningful the small score difference was and who’d actually diagnosed the employees with depression.

The prevalence of harassment may be inaccurate – people being harassed may not have felt comfortable reporting this, or may not have completed the work survey at all.

This study can only show a link between sexual harassment and depression. It can’t prove that sexual harassment causes depression, no matter how plausible it seems.

Where does the study come from?

The study was conducted by researchers from the National Research Centre for the Working Environment, the University of Southern Denmark and the University of Copenhagen, all in Denmark.

No sources of funding were reported and the authors declared no conflicts of interest.

The study was published in the peer-reviewed journal BMC Public Health, and is available to read free online.

The media generally reported the study’s findings accurately, but the news stories could benefit from addressing the many limitations of what we can conclude from the results of this research.

What kind of research was this?

This cross-sectional study looked at the relationship between employees reporting having been sexually harassed by clients or customers, or workplace colleagues, and symptoms of depression.

Previous research has shown that sexual harassment can have harmful effects on mental health, including depression and anxiety.

Most past research is said to have focused on harassment in the workplace coming from colleagues or supervisors, with little attention given to clients or customers. This was therefore the specific focus of this study.

But the main limitation of the design of this study is that because it’s a one-off assessment, it can’t prove the harassment preceded the depression and is the single direct cause of these symptoms, however plausible that might be. It can only show a link.

What did the researchers do?

The study obtained data from two sources: the Work Environment and Health in Denmark cohort study (WEHD) and the Work Environment Activities in Danish Workplaces Study (WEADW).

The WEHD invites a random sample of employed adults (aged 18 to 64) to take part in a postal or internet-based questionnaire on their health and work environment every two years.

The current study involves 7,603 people who responded in 2012 (covering 1,041 work organisations). They represent half of all people invited to participate in the surveys.

The WEADW invited individual organisations and their employees to take part in the survey.

The study included 1,053 organisations and 8,409 employees within these organisations. Again, these represented about half of the organisations and half of the employees invited to take part.

Sexual harassment in the workplace was assessed by asking: “Have you been exposed to sexual harassment at your workplace during the last 12 months?”. People who responded yes were then asked who the perpetrator was.

The researchers grouped the responses as harassment from clients or customers, or from others in the workplace like colleagues, supervisors or subordinates.

Depression symptoms were assessed using the Major Depression Inventory (MDI), which includes 12 questions that cover the standard diagnostic criteria for depression.

The final score ranges from 0 to 50, with a higher score showing more symptoms of depression.

The researchers split responses into probable depression or not, using a cut-off of above or below 20, which was established in prior research.

They also asked if there were psychological workplace initiatives, such as health insurance to cover treatment by psychologists, or whether the workplace performed a psychosocial assessment.

The researchers looked at the relationship between these factors, adjusting for age, gender and the nature of the workplace (for example, healthcare, industry or construction) as potential confounders.

The final sample from the two surveys combined included 7,603 adults who completed all relevant questions, from 1,041 organisations.

What were the basic results?

The average age of participants was 46. Healthcare work was the most common occupational group (29%), closely followed by “knowledge work” (25%), then industry and the private sector.

The proportion of people who reported sexual harassment was low: 4.1% of women, 0.3% of men, or 2.4% of respondents overall.

People working in health or care were most likely to report sexual harassment from clients or customers, rather than colleagues.

Average depression scores were 2.05 points higher (95% confidence interval [CI] 0.98 to 3.12) for people exposed to sexual harassment from clients or customers compared with those reporting no sexual harassment.

Depression scores were 2.45 points higher (95% CI 0.57 to 4.34) when people had been sexually harassed by their colleagues.

The risk of what the researchers called “clinical depression” wasn’t significantly higher for people exposed to harassment from clients or customers. The risk of “clinical depression” was significant when people were harassed by their colleagues.

But the researchers didn’t define what they meant by “clinical depression”.

Any psychological workplace initiatives reported had no effect on the links between sexual harassment and depression.

What do the researchers conclude?

The researchers concluded: “The association between sexual harassment and depressive symptoms differed for employees harassed by clients or customers and those harassed by colleagues, supervisors or subordinates.

“The results underline the importance of investigating sexual harassment from clients or customers and sexual harassment by colleagues, supervisors or subordinates as distinct types of harassment.

“We found no modification of the association between sexual harassment by clients or customers and depressive symptoms by any of the examined psychosocial workplace initiatives.”

Conclusions

This study in general supports the understanding that sexual harassment can have harmful effects on mental health – regardless of whether it comes from clients or colleagues.

It’s also perhaps unsurprising that health or care workers were more likely to report sexual harassment from clients or customers, as they generally have more close interaction with members of the public than many other professions.

The researchers also pointed out that sexual harassment by clients or customers should not be normalised or ignored by employers.

This study has advantages in its large sample size and thorough assessments, and will provide a valuable contribution to research in this area.

But as a piece of evidence, it still can’t prove that sexual harassment directly causes depression, no matter how likely this may seem.

The study had many limitations, including:

This is a cross-sectional assessment, and participants were asked about symptoms of depression at the same time as they were questioned about harassment. It’s not possible to determine the direction of the relationship and know whether harassment preceded depression symptoms.

The people involved aren’t necessarily representative of all employees. Only half of eligible employees responded to the two surveys in the study. There may be differences in those who chose to respond and those who did not. People who are being harassed in their workplace may be less likely to want to complete a survey on their workplace. And some of the responses may be inaccurate as people may not feel comfortable saying they’re being harassed – especially who by. Overall, the number of people currently being harassed in the workplace could be much higher than the percentage reported here.

The study only asked about harassment in the past 12 months. It didn’t look at previous harassment situations that have now been resolved. Lifetime harassment exposure in the workplace is unknown and could be higher.

The study isn’t able to delve into how long the harassment has been going on, or the nature of the harassment. These things could give a better indication of how it’s linked with depression symptoms.

The depression diagnoses aren’t clear. The main finding was that people who’d been harassed were a few points higher on the 50-point depression score. It’s difficult to say how much of an effect this difference would have on the person’s health and wellbeing. The researchers looked at the effect on risk of “clinical depression”, but it’s not clear what they meant by this.

We can’t read too much into the risk relationships identified because of several factors: the potentially non-representative sample, the small proportion of employees who reported harassment, and the uncertain diagnoses of depression symptoms.

The study surveyed people from Denmark. This means the findings may not easily be applied to the UK or other countries.

Nevertheless, these limitations don’t undermine the importance of these findings.

Anyone experiencing workplace harassment in any form, whether from clients or customers or colleagues, should feel able to report it.

It’s also important to seek help from a health professional if you’re experiencing symptoms of depression.

Read more about how to look after your mental health.

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Many teenagers reporting symptoms of depression

Many teenagers reporting symptoms of depression

Many teenagers reporting symptoms of depression

Summary

“One in four British girls hit by depression at 14 as experts blame increase in cyber bullying and academic pressure,” says the Sun after a large study found 24% of 14-year-old girls in the UK report symptoms of depression.

The Millenium Cohort Study followed more than 19,000 children born in the UK in 2000 to 2001. Parents completed surveys when the children were aged 3, 5, 7, 11 and 14 about any emotional difficulties they were having. At age 14, the children also completed a short questionnaire about their mental health.

Levels of anxiety and depressive symptoms were similar for girls and boys up to the age of 11. At age 14, parents reported 12% of boys and 18% of girls had emotional problems. But when the 14-year-olds themselves were asked about their mental health, 9% of boys and 24% of girls reported depressive symptoms.

Though the statistics are worrying, it is important to note that these were responses to questionnaires and not formal diagnoses of depression so the real figures are likely to be lower. However, it is still of concern that so many children are struggling with emotional problems.

If you have concerns about yourself or a child, see your GP as there are many effective treatments available including talking therapies.

Find more information and advice for young people on mental health problems.

Where did the story come from?

The study was carried out by researchers from University College London, and was funded by the Economic and Social Research Council and the Government.

It was published by the Centre for Longitudinal Studies, an Economic and Social Research Council resource centre based at University College London and is free to read online (PDF, 554kb).

In general, the media reported the research accurately, although few explained that the children had not been formally diagnosed with depression and had only reported some symptoms in a questionnaire.

What kind of research was this?

This was a cohort study in which children born in the millennium were followed up over 14 years through questionnaires given to both parents and the children themselves.

This type of observational study is good for looking at patterns of illness in the population. However, it relies on people agreeing to take part so can be subject to selection bias whereby only people with an interest in the topic complete the survey.

What did the research involve?

The Millenium Cohort Study recruited the parents of 19,517 children born in 2000 to 2001 from England, Scotland, Wales and Northern Ireland.

When the children were aged 9 months, 3, 5, 7, 11 and 14 years, the parents answered questionnaires about their physical, emotional, social, cognitive and behavioural development. They also provided details about their family relationships, economic status and family life.

When the children were aged 3 and above, the questionnaires included the Strengths and Difficulties Questionnaire which includes parental concerns about behaviour problems, hyperactivity and bullying, and gives a score out of 10, with higher scores indicating greater problems.

When the children were aged 14, they completed the Short Mood and Feelings Questionnaire. This consists of 13 statements. Children are asked if they felt the statements were true, sometimes true or not true reflections of how they felt in the previous two weeks:

I felt miserable or unhappy.

I didn’t enjoy anything at all.

I felt so tired I just sat around and did nothing.

I was very restless.

I felt I was no good anymore.

I cried a lot.

I found it hard to think properly or concentrate.

I hated myself.

I was a bad person.

I felt lonely.

I thought nobody really loved me.

I thought I could never be as good as other kids.

I did everything wrong.

What were the basic results?

Average scores on the Strengths and Difficulties Questionnaire (0 to 10) completed by parents were low overall (a lower score indicating lesser problems):

Behaviour problems were more likely at the age of 3, with a score of just below 3, which then reduced and stayed around 1.

Emotional symptoms gradually increased from 1 to just over 2 by the age of 14.

Hyperactivity was the biggest problem, scoring around 3 at all ages.

Peer problems scored between 1 and 2 at all ages.

The proportion of children reported to have emotional problems by their parents increased with age:

at the age of 3, it was 8%

by 11, this had risen to 12%

at 14, it was still 12% for boys but had increased to 18% for girls

The proportion of children reported to have behaviour problems varied with age:

at the age of 3, 20% of boys and 17% of girls

at 5, 11% of boys and 7% of girls – at 14, 15% of boys and 11% of girls

According to the Short Mood and Feelings Questionnaire completed by 14-year-old children:

24% of girls reported high levels of depressive symptoms

9% of boys reported high levels of depressive symptoms

Ethnicity and household income results indicate that children from all backgrounds and socioeconomic status can suffer from symptoms of depression:

Prevalence for girls ranged from 9% of Black African and 15% of Bangladeshi background to 25% of white and 27% of mixed race.

Mixed-race boys were also more likely to have symptoms of depression, at 13% compared to 3% of those of Indian ethnicity.

18% of girls from the highest income bracket, 23% from the lowest and up to 27% of those from the second lowest bracket had symptoms of depression.

12% of boys in the second lowest bracket going down to 6% in the highest bracket had depression symptoms.

How did the researchers interpret the results?

The researchers concluded that “children’s perspectives about their mental health may be different from their parents”. They say this “highlights the importance of obtaining young people’s own perspective of their mental ill-health, alongside other perspectives”.

Conclusion

This large cohort study highlights high levels of depressive symptoms in children and adolescents.

It is however important to note that these are symptoms – we don’t know how many of the children would be diagnosed with depression.

When parents complete the Short Mood and Feelings Questionnaire, it is estimated that it will accurately identify 75% of children with depression and 73% of children without depression. But it is less accurate when children complete it. Recent research suggests that it can identify 60% of children with depression and 61% of children without depression.

Despite these limitations, the fact that so many children report symptoms is of concern. Various experts in the media have suggested reasons, ranging from greater awareness of mental health issues and therefore increased reporting, to greater pressure from social media. Further research is needed to identify the causes.

It is important to seek help early for children with emotional problems and your GP is the best place to start. You can also contact the charity Young Minds that offers information and help to both young people and their parents or carers.