AYU (An International Quarterly Journal of Research in Ayurveda)

: 2016  |  Volume : 37  |  Issue : 1  |  Page : 22--25

Effect of Yoga on anxiety, depression and self-esteem in orphanage residents: A pilot study

Ravishankar Tejvani1, Kashinath G Metri1, Jyotsna Agrawal2, HR Nagendra1,  
1 Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
2 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Correspondence Address:
Kashinath G Metri
Assistant Professor, Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru - 560 019, Karnataka


Introduction: There has been an increase in a number of orphanages and children living in orphanages in last few years. The children living in orphanages often have psychological problems among which anxiety, depression, and low self-esteem are considered to be most prominent. Yoga is a noninvasive, cost-effective, and safe intervention among complementary and alternative medicine which is known to have a positive impact on psychological problems. Aims: The present pilot study intended to assess the effect of a two week Yoga intervention on anxiety, depression, and self-esteem of adolescents and young adults living in an orphanage. Materials and Methods: Adolescent and young adults participants who were the permanent residents of an orphanage (n = 34; males = 27, females = 7) between age ranges of 12–20 years underwent 2 week of Yoga intervention. Yoga intervention comprised Asana (Yogic postures), Pranayama (Yogic breathing practices), and Dharana-Dhyana (Yogic relaxation techniques) for 1 h daily over 15 days. Hospital anxiety and depression and Rosenberg self-esteem scale were administered at baseline and after the intervention to assess anxiety, depression, and self-esteem, respectively. Results: There was a significant reduction (P = 0.001) in anxiety, depression, and significant improvement in self-esteem (P = 0.001) at the end of 2 weeks Yoga intervention. Conclusions: This pilot study suggests that 2 weeks of Yoga practice potentially reduced anxiety and depression and improved self-esteem of orphanage adolescents and young adults. These findings need confirmation from studies with a larger sample size and randomized controlled design, which are implicated in the future.

How to cite this article:
Tejvani R, Metri KG, Agrawal J, Nagendra H R. Effect of Yoga on anxiety, depression and self-esteem in orphanage residents: A pilot study.AYU 2016;37:22-25

How to cite this URL:
Tejvani R, Metri KG, Agrawal J, Nagendra H R. Effect of Yoga on anxiety, depression and self-esteem in orphanage residents: A pilot study. AYU [serial online] 2016 [cited 2021 May 17 ];37:22-25
Available from: https://www.ayujournal.org/text.asp?2016/37/1/22/210947

Full Text


It takes a parent, family, and community to bring up a healthy child through love, nurturance, and gentle guidance. When children are neglected and abandoned or even abused, it may lead to a severe effect on them lasting till lifetime. Several studies have shown such effects of child abuse and neglect although the outcome may vary as a function of the interaction between specific genes and environmental conditions.[1] Children living in orphanages not only have to face challenges such as malnutrition, crowded living spaces, and lack of parental care which have been shown having a deleterious effect on development [2] but they may also have psychological difficulties such as loneliness, sense of abandonment, and difficulties in identity formation. One study from South Asia found behavioral problems in around 33% orphanage children.[3] In another comparative study between 52 adolescents living in an orphanage and 55 nonorphanage residents, it was reported that participants living in the orphanage had significantly higher anxiety, depression, negative self-concept, hostility, and Global Severity Index points than the control group.[4] Further, children living in orphanages often have low self-esteem.[5]

Yoga is one of the alternatives and complementary medicine interventions, which is noninvasive, safe, as well as cost-effective. It has found to be effective in many clinical health conditions such as hypertension, diabetes, asthma, Parkinson's disease,[6] as well as psychological problems such as anxiety [7] and depression.[8] In a study with school children, it was found that 10 days of residential Yoga program improved short-term and working memory.[9] In another study, 8 weeks of mindful awareness practice 30 min/session, 3 sessions/week showed a significant improvement in cognitive functions.[10]

However, none of the earlier studies have looked into the effects of a short termYoga intervention on anxiety, depression, and self-esteem in orphanage adolescents and young adults. Hence, this pilot study was conducted to explore this area.

 Materials and Methods

Thirty-four adolescents and young adults' residents of an orphanage Manav Mandir Gurukul, New Delhi, were enrolled in this study. The participants were from both the genders (boys = 27 and girls = 7) and in the age ranges of 12–20 years. Informed consent was obtained from both the participants and head of the orphanage home before the commencement of the study. Those participants not willing to participate in the study and those who had previous exposure to any form of Yoga were also excluded from the study. The study was approved by the Institutional Board of Directorate of distance education, Swami Vivekananda Yoga Anusandhana Samsthana University (no. 407/12-54; Dt. 16 February, 2015).

Exclusion criteria

Participants with a history of any acute or chronic disease, recent surgery, or under any long-term antipsychotic medications were excluded from the study. Demographic details of the participants are mentioned in [Table 1].{Table 1}

Yoga module: Intervention

Asanas: Ardhakati Chakrasana (half waist pose), Pada Hastasana (hand feet pose), Vakrasana (diamond pose), Bhujangasana (cobra pose), Shalabhasana (locus pose), Vajrasana (diamond pose), etc.Pranayama: Nadishudhi Pranayama (alternate nostril breathing), Bhramari Pranayama (humming sound while exhalation), sectional breathing, etc., breathing practices – hands in and out breathing and ankle stretch breathingSuryanamaskara (twelve steps sun postures): Five rounds (increased day by day) – up to 12 roundsQRT – Quick Relaxation Technique and A-U-M and OM chantingDeep relaxation technique OM meditation.

Criteria for assessment

Both anxiety and depression were assessed at baseline and after 2 weeks of yoga intervention using Hospital Anxiety Depression Scale (HADS). While self-esteem was assessed using Rosenberg self-esteem scale.

Anxiety and depression

HADS [11] is a self-assessment scale, it is designed to assess the dimensions of anxiety and depression in nonpsychiatric participants in both hospital and community settings.[12] It is a validated and reliable tool to diagnose anxiety and depression in adolescents [13] and has been used for research in many surveys with the adolescent population.[14] It has got 14 items, which are divided into two subscales of seven items each, to measure the levels of anxiety and depression. Each item is rated on a scale from 0 (not at all) to 3 (very much). This is a popular and reliable scale, with Cronbach's alpha of 0.89.[15]


The Rosenberg self-esteem scale is a widely used self-report scale for evaluating individual self-esteem [16] on a global basis.[17] It has been used in many studies to assess self-esteem in the adolescent population.[18] It is a 10-item scale that measures global self-worth by measuring both positive and negative feelings about the self. All items are answered using a 4-point Likert scale.


All the participants underwent 2 weeks of Yoga intervention 1 h daily for 6 days/week. Yoga was taught by an expert Yoga instructor.

Data analysis

Data were analyzed using the SPSS version 10 (IBM SPSS data analytics, headquartered in Armonk, New York, United States). Data of all variables, except anxiety, were found to be not normally distributed by Kolmogorov–Smirnov test. Wilcoxon signed rank test was applied to see pre–post changes and paired sample t-test was applied to find pre–post difference in the anxiety level.

 Observations and Results

At the baseline, we observed that a total number of the participants having HADS anxiety and depression score above 11, suggestive of clinical anxiety and depression were 15 (42.82%) and 03 (8.5%), respectively. After 2 weeks of yoga intervention, these numbers fell down to 1 and 1, respectively. A significant reduction in a number of the participants having clinical anxiety (P < 0.001, −93.33%) and depression (P < 0.001, −66.66%) was observed at the end of the intervention [Table 2].{Table 2}

A significant reduction in depression (P < 0.001; −32.98%) and anxiety (P < 0.001; −32.95%) along with significant improvement in self-esteem (P < 0.001; +19.24%) was also observed at the end of 2 weeks [Table 3].{Table 3}


This study aimed to test the effect of short-term (2 weeks) Yoga intervention on anxiety, depression, and self-esteem in adolescent and young adult participants living in an orphanage. On post intervention, it is observed that a significant reduction in anxiety and depression along with a significant increase in self-esteem. Also a significant decrease in the number of the participants having clinical anxiety and depression after 2 weeks of Yoga intervention was observed. During the intervention phase, most of the participants were enthusiastic and motivated. Participants enjoyed the Yoga sessions, and no adverse effects of Yoga practice were reported.

In one of the earlier comparative studies between Yoga intervention and a control dance group with orphanage children having trauma-related distress, the participants showed significant improvements in symptoms after participation in an 8-week Yoga program as compared to controls.[19] Apart from this, Yoga is widely used in the adolescent population (nonorphanage) in many health-related conditions and one study with irritable bowel syndrome found 4 weeks of Yoga practice reduces anxiety, depression, pain, and functional disability.[20]

One possible mechanism behind these findings could be that Yoga improves autonomic functions through influencing neurohormonal mechanisms that suppress sympathetic activity through downregulation of the hypothalamic–pituitary–adrenal axis.[21] Reduced sympathetic activity leads to enhanced physical and mental relaxation. This may help in reducing anxiety, depression, and improve self-esteem. It has been reported that active participation in practice and increased physical activity may improve self-esteem [22] by improving perceived physical competence. Structured group physical activity program for the management of depression is a part of the treatment guidelines.

It is relevant to mention that in our study, we found the prevalence of anxiety is more than the prevalence of depression in this orphanage. One possible reason behind high anxiety levels in this age group may be related to worries about their career and uncertainty about future.

To the best of our knowledge, there are very few studies which have focused on the adolescent population living in orphanages. Therefore, in future, another study may be planned with the inclusion of a randomly assigned control group which can be given an intervention package of only physical exercise and relaxation by a trainer. This will control factors such as increased activity, as well as the interpersonal interaction, influencing the outcome. The blind objective behavioral rating can also be included as an outcome measure in future. Long-term follow-up may also be done to assess whether these children are able to sustain motivation to engage in Yoga once the intervention is over.

In summary, study results support the earlier findings about the efficacy of Yoga-based intervention in at-risk children and adolescents to significantly reduce anxiety and depression, even with a short-term intervention. More studies are required to explore the feasibility of scaling up such interventions as a preventive public mental measure.

Future studies should be carried out with larger sample size, proper randomization, and inclusion of an active control group. Duration of intervention should be increased and long-term effect should be studied. The intervention should also include counseling sessions and other components of Yoga such as Yama and Niyama. Assessment tools may include other robust objective variables such as heart rate variability, muscle strength, cognitive functions, mindfulness, and emotional states.


Two weeks of Yoga intervention may help in reducing anxiety and depression and may improve self-esteem in orphanage adolescents and young adults. However, further randomized controlled studies are required to confirm these findings. The limitations of this study were a short period of intervention and lack of a control group. However, as a pilot study, this research has brought new insights into the potential positive role of Yoga on psychological states in adolescents and young adults living in orphanages.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Cicchetti D, Rogosch FA. Gene × environment interaction and resilience: Effects of child maltreatment and serotonin, corticotropin releasing hormone, dopamine, and oxytocin genes. Dev Psychopathol 2012;24:411-27.
2Nikulina V, Widom CS, Brzustowicz LM. Child abuse and neglect, MAOA, and mental health outcomes: A prospective examination. Biol Psychiatry 2012;71:350-7.
3Lassi ZS, Mahmud S, Syed EU, Janjua NZ. Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: Comparison of children in an SOS village with those in conventional orphanages. Soc Psychiatry Psychiatr Epidemiol 2011;46:787-96.
4Kanbur N, Tüzün Z, Derman O. Psychiatric symptoms of adolescents reared in an orphanage in Ankara. Turk J Pediatr 2011;53:281-4.
5Fawzy N, Fouad A. Psychosocial and developmental status of orphanage children: Epidemiological study. Curr Psychiatry 2010;17:41-8.
6Colgrove Y, Sharma N, Kluding P, Potter D, Imming K, VandeHoef J, et al. Effect of Yoga on motor function in people with Parkinson's disease: A randomized, controlled pilot study. J Yoga Phys Ther 2012;2:1-11.
7Dhansoia V, Bhargav H, Metri K. Immediate effect of mind sound resonance technique on state anxiety and cognitive functions in patients suffering from generalized anxiety disorder: A self-controlled pilot study. Int J Yoga 2015;8:70-3.
8Woolery A, Myers H, Sternlieb B, Zeltzer L. A yoga intervention for young adults with elevated symptoms of depression. Altern Ther Health Med 2004;10:60-3.
9Hema BN, Kashinath GM, Nagendra HR. Effect of a 10 days yoga based program on short term and working memeory in school children. Ayurveda J Health 2015;13:37-39.
10Flook L, Smalley SL, Kitil MJ, Galla BM, Kaiser-Greenland S, Locke J, et al. Effects of mindful awareness practices on executive functions in elementary school children. J Appl Sch Psychol 2010;26:70-95.
11Rodgers J, Martin CR, Morse RC, Kendell K, Verrill M. An investigation into the psychometric properties of the hospital anxiety and depression scale in patients with breast cancer. Health Qual Life Outcomes 2005;3:41.
12Herrmann C. International experiences with the hospital anxiety and depression scale – A review of validation data and clinical results. J Psychosom Res 1997;42:17-41.
13White D, Leach C, Sims R, Atkinson M, Cottrell D. Validation of the hospital anxiety and depression scale for use with adolescents. Br J Psychiatry 1999;175:452-4.
14Jörngården A, Wettergen L, von Essen L. Measuring health-related quality of life in adolescents and young adults: Swedish normative data for the SF-36 and the HADS, and the influence of age, gender, and method of administration. Health Qual Life Outcomes 2006;4:91.
15Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of psychosomatic research. 2002 Feb 28;52:69-77.
16Gray-Little B, Williams VS, Hancock TD. An item response theory analysis of the Rosenberg self-esteem scale. Pers Soc Psychol Bull 1997;23:443-51.
17Hagborg WJ. The Rosenberg self-esteem scale and harter's self-perception profile for adolescents: A concurrent validity study. Psychol Sch1993;30:132-6.
18French SA, Story M, Perry CL. Self-esteem and obesity in children and adolescents: A literature review. Obes Res 1995;3:479-90.
19Culver KA, Whetten K, Boyd DL, O'Donnell K. Yoga to reduce trauma-related distress and emotional and behavioral difficulties among children living in orphanages in Haiti: A pilot study. J Altern Complement Med 2015;21:539-45.
20Kuttner L, Chambers CT, Hardial J, Israel DM, Jacobson K, Evans K. A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag 2006;11:217-23.
21Vempati RP, Telles S. Yoga-based guided relaxation reduces sympathetic activity judged from baseline levels. Psychol Rep 2002;90:487-94.
22Ekeland E, Heian F, Hagen KB, Abbott J, Nordheim L. Exercise to improve self-esteem in children and young people. Cochrane Database Syst Rev 2004; (1):CD003683.