Use of yoga in acute mental health inpatient settings: A systematic review

Abstract

Background

People with mental disorders accessing acute psychiatric inpatient care experience high levels of distress and acute symptoms. Yoga has been proposed as an intervention to support health and wellbeing in this context. This study aimed to synthesize the literature considering the effectiveness (including psychiatric, physical health, and service-level outcomes) and implementation (including participant experience, feasibility and safety data) of yoga in acute psychiatric inpatient settings.

Methods

We conducted a systematic review by searching Medline, CINAHL, PsycINFO, Embase, Clinicaltrials.gov, and PubMed Central as of April 2023. Any study presenting relevant empirical data was included. The population focus was people any age recruited in an inpatient psychiatric setting regardless of the primary psychiatric diagnosis, except for primary diagnoses of drug and alcohol disorders. Studies not focused on yoga as primary intervention, or not delivered in an inpatient psychiatric setting were excluded. No specific comparator or outcome focus was defined a priori. Quality appraisal was completed using the Cochrane Risk of Bias tool and Joanna Briggs Institute (JBI) checklists. Due to study heterogeneity, it was not appropriate to conduct a meta-analysis and a narrative synthesis was completed.

Results

15 studies (n = 2016) met the inclusion criteria, including four Randomised Controlled Trials (RCTs), seven pre/post studies, and four qualitative studies. Six studies had a comparison group, with three of them comparing against treatment as usual and three comparing against alternative interventions. Based on the limited available data, yoga appears to be feasible and acceptable in inpatient psychiatric settings. The main findings were subjective improvements in anxiety and positive participant experiences (relaxation; increased awareness of mind and body; feelings of connectedness with others; and spiritual wellbeing). One RCT found improvements in physical health, global functioning, and quality of life, which were sustained post-discharge. There were mixed results considering depressive and psychotic symptoms, as well as biological markers of stress. No study examined service-related implementation outcomes.

Conclusion

There is a limited evidence base for yoga conducted in inpatient mental health settings. The available evidence suggests that yoga is feasible and acceptable, without significant adverse events, with preliminary findings for anxiety reduction and positive qualitative experiences. Further research is required to determine the effectiveness on mental and physical health outcomes and what effect yoga program components have on outcomes (i.e., type, duration). Future research should also investigate the impact on service-related outcomes, such as length of stay and cost.