Burnout among healthcare professionals is increasingly recognized as a critical factor affecting their well-being and the quality of the services they provide. Relaxation techniques are well-known measures to improve mental wellbeing. Indian doctors studied the role of Raj Yoga Meditation (RYM) versus Stress Management Counseling (SMC) in managing burnout in healthcare professionals.
It is well known that healthcare professionals are particularly susceptible to stress and other psychological symptoms. Nowadays, meditation and relaxation techniques are considered helpful in coping with psychosocial problems. Breathing techniques such as yogasana and pranayama help to reduce palpitations, regulate breathing patterns and eliminate toxins, thereby improving the condition of the body. Raj Yoga (RYM) is a meditation technique that has been shown to be clinically beneficial for conditions such as coronary heart disease, tension headaches, depression and anxiety in patients undergoing coronary bypass surgery, as well as substance abuse and diabetes.
Professor Dr. Mohit Dayal Gupta of the Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India, and his colleagues conducted a prospective observational study examining mental health problems such as burnout in healthcare workers and assessing the impact of RYM versus stress management counseling (SMC) among healthcare workers in India [1]. The study also aimed to analyze 12-lead ECG data using artificial intelligence-based machine learning (ML) algorithms to assess the impact of RYM versus SMC on heart rate variability in this population.
Significant reduction in burnout and depression with RYM
The healthcare professionals were assigned to two groups: RYM (n=100) or SMC (n=102). Patients in the RYM group received instruction in a structured Raj yoga module from a qualified Raj yoga teacher in groups of five for three months, offline for one week and then online for up to 30 minutes daily. A social media group was set up to ensure adherence by study participants, and regular twice-daily notifications were sent and phone calls were made as needed. In the SMC arm, the coach advised and taught stress management steps (including perspective change, positivity, digital “detox”, sleep hygiene) in offline mode for 30 minutes on one day, after which he received feedback daily for one week and then once a week for three months. All participants also received weekly reminders and video/audio calls to ensure proper implementation and adherence.
All participants underwent a psychological examination (Depression Anxiety Stress Scale-21, DASS-21) and an examination aimed at burnout syndrome (Mini-Z questionnaire) at the beginning of the study, after 4 weeks and after 12 weeks, and a 12-lead ECG was performed. Based on the answer to question 3 of the Mini-Z questionnaire, the participants were classified as either “at risk of burnout” or “satisfied”.
The 12-week RYM practice led to a significant decrease in the DASS-21 score (-45.00 at baseline vs. -24.2 after 12 weeks, p<0.001) and burnout in question no. 3 of the Mini-Z questionnaire (1.87 at baseline vs. 1.34 after 12 weeks, p<0.001). However, no significant decrease in DASS-21 and burnout scores was observed in the SMC group after 12 weeks of follow-up. There was also no correlation between DASS-21 and burnout scores and gender, age, marital status, education and family type between the two groups.
Improved burnout values indicate a healthier heart condition
For the ECG data, the performance of the random forest (RF) classifiers
- a) with ultrashort HRV features (classifier-1) and
- b) compared with time series analysis features (classifier-2).
The evaluation metrics were calculated separately for 30% test data from visit 3 and for the combined data from visit 1 and 2. The classifier based on time series analysis features performed better than the ML classification model based on ultrashort heart rate variability (HRV) features. The performance of classifier 2 was very good on all metrics, including precision, recall, F1 score and accuracy, on the test data from visit 3 compared to visits 1 and 2 combined.
The results showed that the mean and median probability of not having burnout improved significantly from visit 1 to visit 3 for the RYM group and decreased for the SMC group with both classifiers. The improvement in burnout status indicated a healthier cardiac status of subjects in the RYM group despite workload, while no such improvement was observed in the SMC group. According to Professor Gupta and colleagues, these results indicate that RYM is a potential tool for improving the mental health of healthcare workers.
A significant reduction in burnout in the RYM vs. the SMC group and an increase in satisfaction from the first visit at the beginning of the study to the third follow-up visit after 12 weeks shows that integrating non-pharmacological lifestyle interventions such as yoga into the routine of healthcare workers can significantly improve their mental health, the Indian authors conclude. This could help to ensure that high-quality patient care continues to be provided. As a caveat, they note that this was an open-label study in a single center and with a limited sample size. The effect of RYM was only demonstrated over a short observation period of 3 months, so a longer follow-up period is needed to observe the effect in the long term.
Literature:
- Gupta MD, et al.: Psychological problems and burnout among healthcare workers: Impact of non-pharmacological lifestyle interventions. Indian Heart Journal 2024; doi: 10.1016/j.ihj.2024.11.245.
HAUSARZT PRAXIS 2024; 19(12): 40
