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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Effectiveness of Yoga on Quality of Life among Patients with Depression: A Randomised Controlled Trial
Correspondence Address :
Dr. Anuradha Yadav,
Senior Professor, Department of Physiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
E-mail: dr.anuradhayadav@yahoo.co.in
Introduction: Depression is the overriding reason for disability and its global prevalence has been increasing in recent decades. Depression is a substantial contributor to the global disease burden and a crucial determinant of quality of life and survival.
Aim: To determine the quality of life of patients with depression who received yoga intervention and compare it to patients who received conventional antidepressant medication (without yoga intervention) in terms of various domains.
Materials and Methods: This randomised controlled trial was conducted in Department of Physiology with the collaboration of the Department of Psychiatry at Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from November 2018 to February 2020. The study involved clinically diagnosed 60 patients with mild to moderate depression between the age groups of 18 to 45 years. The participants were split into two groups. The participants were split into two groups: interventional and control. The interventional group received a set of yoga exercises for three months in addition to conventional antidepressant treatment, while the control group received only conventional antidepressant treatment for the same duration. The World Health Organisation Quality of Life-BREF (WHOQOL-BREF) scale was used to assess the quality of life in both study groups at baseline, and after one month and three months. The unpaired Student’s t-test and repeated measures Analysis of Variance (ANOVA) were applied for two and more groups respectively. A p-value <0.05 was considered as statistically significant.
Results: The present study included 60 patients with depression; out of them 39 were male and 21 were females. A statistically significant difference was observed in WHOQOL-BREF scores between the interventional and control group in the physical (p-value<0.001) and psychological health (p-value<0.001) domain after three months of follow-up, but it was more improved among the interventional group. A significant difference was observed after one month in the interventional group in overall quality of life (p-value=0.004), physical (p-value<0.001), and psychological health domain (p-value=0.009) of quality of life. While in the control group, physical (p-value<0.001) and psychological health domain (p-value<0.001), as well as social relationships domain (p-value=0.015) significantly improved after three months of antidepressant treatment.
Conclusion: Three month of yoga practice improved the overall quality of life and all domains of quality of life. Whereas, three months of conventional antidepressant treatment improved only physical, psychological health and social relationship.
Antidepressant, Environment, Physical health, Psychological health, Social relationships, Yoga intervention
Depression is the overriding reason for disability and a major contributor to the disease burden across the world. In recent decades, the global prevalence of depression has risen (1). According to the World Health Organization (WHO), around 280 million people worldwide suffer with depression, with over 7,00,000 people dying each year as a result of it (2). Depression is a significant contributing factor to the quality of life and survival, accounting for about 50% of psychiatric consultations and 12% of all hospital admissions (1). It has been associated with an elevated risk of mortality, poorer outcome of treatment of physical disorders, and may negatively influence the Quality Of Life (QOL) (3). The pharmacological treatment prescribed for patients with depression indirectly affects the quality of life as medicinal treatment focuses on their symptoms (4). In recent clinical trials, measuring QOL has been recognized as an important add-on to objectify clinical effectiveness (5),(6).
The quality of life is defined by WHO as ‘individuals’ perception of their position in life in the perspective of the culture and value systems in which they live and with their goals, expectations, principles, and concerns’ (7). High levels of emotional stress can cause neurological and behavioural changes and negative life style practices, which has a negative effect on quality of life (8). Antidepressants improve only clinician-rated depression symptoms and did not exhibit improvement in overall well-being and QOL of patients (9). Numerous physical and mental practices and yoga relieve stress and improve QOL in patients with chronic disease (10),(11). Studies reported improvement in quality of life after intervention of yoga or Iyengar yoga in the breast cancer survivor, menopausal women and nonspecific chronic back pain (12),(13),(14).
Yoga practice emphasises the harmony of the mind and body to encourage a state of calmness and presence (15). The yoga intervention has been shown to improve physical health, mental health and psychological well-being, behavioural regulation, and interpersonal behavior, and thereby it may concurrently reduce a variety of psycho-pathological symptoms (16). However, studies on the effects of yoga have not primarily focussed on the depressed people’s quality of life. Many researchers have looked at the link between depression and QOL in elderly and middle-aged people around the world (17),(18), but there is a paucity of literature on QOL in depressed patients in India. Thus, this study aimed to determine the quality of life in patients with depression who received yoga intervention and compare it to patients who had conventional antidepressant treatment (without yoga intervention) in terms of various domains after three months of follow-up.
This randomised controlled trial was conducted in Department of Physiology with the collaboration of the Department of Psychiatry at Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from November 2018 to February 2020. The study was undertaken after obtaining permission from the Departmental Research Committee (DRC), Institutional Clinical Trial Screening Committee (CTSC), Ethics Committee (EC), and written consent from the participants. University approval number (No. F7 Research/ RUHS/ 2018/ 16480) and Institutional Ethics Committee approval number (No. 3951 MC/ EC/2018). Clinically diagnosed patients of depression who were on stable medical treatment (for at least one month), recruited from the Psychiatry Outpatient Department after taking written informed consent from patients.
Sample size: Sample size was calculated at 95% confidence level, 0.05 alpha error and at 80% study power 30 for each group.
Inclusion criteria: Patients with mild to moderate levels of depression were recruited in the study that was diagnosed by using the Hamilton Depression Rating Scale (HDRS) (19). A total 60 patients of depression between the ages of 18-45 years of both genders were included in the present study.
Exclusion criteria: Patients with severe mental and medical co-morbidities, those who were already practicing yoga or were receiving any cognitive behavioural therapy or psychotherapy, who had a history of alcohol consumption or smoking, or who used any other addictive substance, and those who were non corporative during the study, all were excluded from the study.
A total of 87 participants were screened and out of them seven participants were excluded from the study, only 80 participants who met the inclusion criteria were included in the study after obtaining written informed consent. But only 60 participants were recruited and others were excluded. Randomisation was done by using chit box method (Table/Fig 1). The participants were randomly assigned into:
• Interventional group (n=30): For 3 months, patients received yoga intervention while continuing to get the same medical treatment.
• Control group (n=30): Patients received same conventional antidepressant treatment for the same time frame.
Procedure
The study included 60 patients with depression using Hamilton Depression Rating Scale (HDRS) (19):
• Mild depression (8-13)
• Moderate depression (14-18)
The test procedure had been explained to all of the participants, and it was recommended that they maintain their lifestyle during the intervention program. The group that underwent yoga intervention was asked to practice a set of yogic exercises (Asana), Pranayama, and Dhyana one hour daily, for at least 5 days per week under the supervision of a trained yoga instructor. In both study groups, QOL was measured at baseline, after one month and three months.
The following yoga practices were advised to perform during the study period:
• Specific postures (Asanas): Suryanamaskara, Shashankasan (for 15 min)
• Breathing exercises (Pranayamas): Kapalbhati, Deerg-Swas-Preksha, Anulom-vilom, Bhramari, Omkar Chanting (for 20 min)
• Meditation (Dhyana): (for 20 min)
World health organization quality of life-BREF: Quality of life was measured with the World Health Organization Quality of Life-BREF (WHOQOL-BREF) (7), a short version of the WHOQOL-100 questionnaire. The WHOQOL-BREF questionnaire is a validated self-assessment questionnaire designed for use in clinical trials and consists of 26 items assessing the Quality Of Life (QOL) of the subjects in four domains:
• Domain 1: Physical health (7 items),
• Domain 2: Psychological health (6 items),
• Domain 3: Social relationships (3 items)
• Domain 4: Environment (8 items)
General evaluative aspect (overall Quality of Life and General Health: 2 items).
Each questionnaire item is answered on a five-point Likert scale. The total scores were calculated; a higher score indicated a good quality of life and vice-versa. The calculated raw scores in each domain transformed into the score of 0-100 scale comparable with WHOQOL-100.
Statistical Analysis
The data was entered into a spreadsheet (Microsoft Excel 2007). Quantitative data were expressed in mean and standard deviation, while qualitative data was expressed in percentage and proportion. Quantitative data was further analysed by unpaired student t-test and for multiple variables repeated-measure Analysis of Variance (ANOVA) was applied. The tests were conducted in Statistical Package for Social Sciences (SPSS) version 20.0 with a confidence interval of 95% and an alpha error of 0.05. A p-value <0.05 was considered statistically significant.
The baseline mean±SD of HDRS score for interventional and control groups were 14.97±1.65 and 14.43±2.46 (p-value=0.328), respectively and compatible at the baseline level. The socio-demographic characteristics of research participants are shown in (Table/Fig 2).
The present study found that overall quality of life and general health in the patients with depression improved among the interventional group (p-value<0.001), while in the control group, no significant improvement was observed. A statistically significant difference was observed in WHOQOL-BREF scores between the interventional and control group in the physical and psychological health domain after three months of follow-up. But the statistically significant improvement in WHOQOL-BREF scores was more among the interventional group than the control group after three months. Whereas, the social relationships and environment domain were only statistically improved among the interventional group (Table/Fig 3).
The present study found that overall quality of life in the patients with depression improved even after one month among the interventional group (p-value<0.05). A significant difference was observed only after one month in the interventional group as all duration showed a significant change in the physical and psychological health domain of quality of life. Whereas, a statistically significant improvement in the social relationships and environment domain was observed after three months (0 to 3 months and 1 to 3 months), as shown in (Table/Fig 4).
The physical and psychological health domains, as well as social relationships domain in the control group, improved after three months (0 to 3 months and 1 to 3 months) of antidepressant treatment with a significant difference, whereas statistically no improvement was observed in the environment domain of quality of life (Table/Fig 5).
A statistically high significant (p-value=0.001) improvement was observed in all domains of quality of life in terms of mean change (0 to 3 months) among the interventional group than the control group, which showed that quality of life improves more with yoga intervention (Table/Fig 6).
The percentage distribution of all domains shows a similar pattern in both study groups. There was a significant improvement in all the four domains of QOL followed by the yoga intervention in terms of mean change percentage as depicted in (Table/Fig 7).
The present study was conducted on 60 patients of depression with a mild and moderate level of severity. In this study, it was discovered that overall quality of life in patients with depression improved only after one month of yoga intervention (p-value<0.05), but there was no significant improvement in the control group. Yoga practice improved all domains (physical, psychological, social relationships, and environment) of quality of life, while conventional antidepressant treatment improved only physical, psychological and social relationship after three months. Yoga improved physical and physiological health earlier than social relationships and environment domain. After three months mean change in all domains significantly rised among the interventional group than the control group subjects, but the percentage distribution of all domains remained same in both study groups.
The physical health domain deals with features such as mobility, fatigue, pain, sleep, and work capacity while the psychological health domain deals with questions relating to feelings, self-esteem, spirituality, thinking, learning, memory, etc. The social relationships domain has questions relating to problems with interpersonal relationships, social support, etc and the environment domain deals with problems relating to financial resources, physical safety, and adaptability to the physical environment such as pollution, noise, and climate (20), (21).
Previous study conducted by Tekur P et al., reported the usefulness of one-week intensive residential integrated yoga in improving QOL with all four domains in patients with chronic low back pain (22). Since, it was a highly controlled setting, where patients stayed away from their normal duties, a significant difference in QOL was observed after one week (22). Hariprasad VR et al., in the elderly showed improvement in all domains of QOL with 6 months of yoga (23). QOL in Dental Professionals improved with 6 weeks of integrated yoga and breathing techniques sessions (24). Patil NJ et al., conducted a randomized trial on the nursing population with chronic low back pain and observed a significant improvement in physical, psychological, and social domains of WHOQOL-BREF, whereas the environmental domain did not show significant improvement (25). The present study supports the findings as shown below (Table/Fig 8) (17),(18),(20),(26),(27),(28),(29),(30).
Regular practice of yoga improves depression and can lead to a significant increase in serotonin levels and a decrease in the levels of monoamine oxidase, an enzyme that breaks down neurotransmitters and cortical (31). Exercise induces neurogenesis which modulates synaptic plasticity. It increases several growth factors relevant for maintaining optimal functioning of the brain and also has been associated with changes in regional brain volume and integrity. The effects induced by these exercises have been simulated in healthy humans and clinical populations and they show increased brain volume in grey and white matter regions, increased white matter integrity in frontal and temporal lobes, increase in Brain-Derived Neurotrophic Factor (BDNF), reduction in symptoms of depression, and improvement in cognitive functioning in young and old (32). This study was a randomized control design, with an economical approach and active supervision for the control group as well as the interventional group for three months were the strengths of this study.
Limitation(s)
The limitation of the study was its small sample size.
Yoga improves one's overall quality of life. Interventional group had much better physical and psychological health after three months of yoga than the control group. Yoga intervention promoted physical and psychological wellbeing faster (just after one month of yoga intervention), but it took a little longer (three months) to enhance social interaction and the environmental domain. When comparing the interventional group to the control group after three months, the mean change in all areas of quality of life was considerably greater in the interventional group subjects. Yoga improved mostly all domains of quality of life of a depressed person in a short span of time. So, yoga must be promoted as an alternative therapy with medication for good, quick results; as yoga heals the body and mind naturally. The present research highlights the importance to create awareness and encourage the practice of yoga among depressed persons.
However, future studies are required on a larger population to fortify current understanding about the beneficial effect of yoga intervention on quality of life in patients of depression.
Authors are thankful to the Department of Psychiatry, SMS Hospital, Jaipur for timely guidance and provision of patients. Authors also grateful to all patients for their time and valuable support to complete this research within time.
DOI: 10.7860/JCDR/2022/56068.16754
Date of Submission: Mar 04, 2022
Date of Peer Review: Apr 13, 2022
Date of Acceptance: Jun 02, 2022
Date of Publishing: Aug 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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