Abstract
BACKGROUND: Healthcare workers (HCWs) experienced elevated psychological distress during the COVID-19 pandemic. Culturally embedded, non-stigmatizing approaches may improve uptake of mental health support in this population. We aimed to evaluate the impact of Yoga, Bhagavad Gita learning, and their combination (Yoga+Gita) on psychological distress among HCWs. METHODS: We conducted a prospective, single-center, parallel-group randomized controlled trial at a secondary hospital in India. Eligible HCWs (>18 years, without pre-existing diagnosed mental health conditions) were randomized in a 1:1:1:1 ratio to: Yoga (daily 60-min sessions for one week), Gita (daily 60-min teaching of Bhagavad Gita Chapter 2 for one week), Yoga+Gita (30 min Yoga + 30 min Gita daily for one week), or Control (usual care). Psychological distress was assessed using the Generalized Anxiety Disorder-7 (GAD7) scale at baseline (B-GAD7), immediately post-intervention (IPI-GAD7), and 45 days post-intervention (DPI-GAD7). Participants were aware of group assignment, but data analysts were blinded. Group comparisons used Friedman and Kruskal-Wallis tests with Bonferroni-adjusted post-hoc analyses. We hypothesized that (1) all three interventions would reduce GAD-7 scores compared with control, (2) Gita would produce more durable effects than Yoga alone, and (3) the combined Yoga+Gita intervention would yield the greatest overall reduction in psychological distress. FINDINGS: Sixty-eight participants were enrolled (17 per group), with no losses to follow-up. B-GAD7 did not differ across groups (p = 0.908). Compared with Control, Yoga+Gita reduced anxiety immediately (p = 0.009), and Gita reduced anxiety at 45 days (p = 0.047). A clinically meaningful (≥4-point) GAD7 reduction at 45 days occurred in 17.6% (Yoga), 47.1% (Gita), 41.2% (Yoga+Gita), and 11.8% (Control) of the participants. Exploratory analyses suggested larger benefits among women and among those who continued practice. INTERPRETATION: Yoga and Gita-learning, particularly in combination, were associated with reductions in psychological distress among HCWs. TRIAL REGISTRATION: Prospectively registered with the CTRI (CTRI/2021/10/037365).