Impact of Lavender Essential Oil Blends on Depression, Anxiety, and Stress among Iru lar Tribe in Tamil Nadu: Randomized Controlled Trial PDF Free Download
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ORIGINAL RESEARCH
worry, agitation, or restlessness—are frequently overlooked,
intensifying their emotional and physiological toll.6
In t r o d u c t I o n
Mental health concerns, particularly depression and anxiety, are
increasingly prevalent among older adults, with a heightened
impact on tribal populations.1 Aging individuals, including those
from indigenous communities, frequently contend with chronic
health conditions such as diabetes and cardiovascular diseases,
alongside physical impairments and cognitive decline. The resultant
loss of independence significantly affects their overall well-being.1,2
The population of interest in this trial comprised elderly
individuals (65–74 years) of the Irular tribe in Tamil Nadu, a
socioeconomically marginalized group with limited access to
conventional healthcare. In tribal settings, these challenges are
compounded by structural barriers, including limited healthcare
access, inadequate infrastructure, and deeply rooted cultural
stigmas surrounding mental health.3 The outmigration of younger
generations further exacerbates social isolation among elders,
weakening traditional support systems that have historically been
a source of stability. As these communal bonds erode, older adults
face an increased risk of loneliness, grief, and financial insecurity.4,5
Depression among tribal elders often goes undiagnosed due
to a lack of awareness and the cultural normalization of silent
endurance. Similarly, anxiety disorders—manifesting as persistent
1,2Department of Public Health Dentistry, Saveetha Dental College
and Hospitals, Saveetha Institute of Medical and Technical Sciences,
Chennai, Tamil Nadu, India
3Department of Orthodontics, Saveetha Dental College and Hospitals,
Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil
Nadu, India
4Department of Public Health Dentistry, Indira Gandhi Institute of
Dental Sciences, Puducherry, India
Corresponding Author: Lalitha Rani Chellappa, Department of Public
Health Dentistry, Saveetha Dental College and Hospitals, Saveetha
Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India,
Phone: +91 8668052146, e-mail: lalitharanibds28@gmail.com
How to cite this article: Boobalan S, Chellappa LR, Maliael MT, etal.
Impact of Lavender Essential Oil Blends on Depression, Anxiety, and
Stress among Irular Tribe in Tamil Nadu: Randomized Controlled Trial.
World J Dent 2025;16(8):756–762.
Source of support: Nil
Conflict of interest: None
Impact of Lavender Essential Oil Blends on Depression,
Anxiety, and Stress among Irular Tribe in Tamil Nadu:
Randomized Controlled Trial
Sivashankari Boobalan1, Lalitha Rani Chellappa2, Mathew Thomas Maliael3, Logesh Sidhu4
Received on: 16 August 2025; Accepted on: 15 September 2025; Published on: 14 October 2025
Ab s t r A c t
Aim: The present study aims to evaluate the impact of lavender essential oil blends on depression, anxiety, and stress among elderly individuals
of the Irular tribe in Tamil Nadu through a randomized controlled trial.
Materials and methods: A triple-blind, parallel-arm, randomized controlled trial was conducted targeting elderly individuals from the Irular tribe.
A total of 179 participants were randomized into seven groups, from A to G. Groups A–F had different commercially available lavender oil blends,
and group G was the control group with distilled water. Participants applied the assigned oil to pulse points and inhaled it nightly for 30 days. Data
were collected using a modified depression, anxiety, and stress scale (DASS) before the intervention and after 30 days, and statistical analysis was
performed using SPSS software. Paired t-tests, one-way analysis of variance (ANOVA), and post hoc analysis assessed the intervention’s effectiveness.
Results: A significant reduction in DASS scores was observed in all intervention groups except the control group. Group D demonstrated the
most pronounced reduction in DASS scores, corresponding to the blend comprising lavender, clary sage, patchouli, frankincense, and orange oils,
followed by groups B, C, E, A, and F. Group G, which is distilled water, showed no significant difference. Post hoc analysis confirmed statistically
significant differences between intervention and control groups (p < 0.001).
Conclusion: Inhalation aromatherapy with lavender essential oil blends effectively reduced depression, anxiety, and stress among elderly Irular
tribe members. Group G distilled water showed no significant change, and group D’s formulation exhibited the greatest efficacy, suggesting
an optimal combination of sedative and mood-enhancing essential oils.
Clinical significance: This study demonstrates that lavender-based essential oil blends, particularly the group D formulation, can serve as a
safe, noninvasive, and cost-effective adjunct for reducing depression, anxiety, and stress among elderly tribal populations. The approach aligns
with traditional healing practices, making it culturally acceptable and feasible for integration into community-based geriatric mental health
programs, especially in resource-limited settings.
Keywords: Aromatherapy, DASS, Depression, Essential oil, Geriatric dentistry, Irular tribe, Lavender oil, Stress.
World Journal of Dentistry (2025): 10.5005/jp-journals-10015-2699
Impact of Lavender Oil on Depression, Anxiety, and Stress
World Journal of Dentistry, Volume 16 Issue 8 (August 2025) 757
for the full duration of the intervention. Participants were required to
be capable of following instructions and applying the essential oil
roll-on as directed. Individuals with serious systemic illnesses that could
influence study outcomes, those receiving psychiatric medications
for depression, anxiety, or stress, and participants with a history of
hypersensitivity to essential oils or intolerance to fragrances were
excluded. Additionally, elderly individuals with cognitive impairment
or physical limitations that hindered consistent use of the intervention
were not considered for inclusion.
Sample Size Calculation and Sampling
A total of 210 participants were randomized after screening 222
individuals for eligibility. They were allocated into seven groups
(A–G), with approximately 25–30 participants per group.
The required sample size was calculated using G*Power
software, based on the study by Ebrahimi etal.23 with 90% power
and a 95% confidence interval. A minimum of 25 participants per
group was required, resulting in an estimated sample size of 175.
Initially, a sample size estimation of around 250 participants was
considered for eligibility. To account for a 20% attrition rate, 210
participants were randomized after screening 222 individuals for
eligibility. Finally, 179 participants completed the study and were
distributed across seven groups: Groups A–G. Sampling was done
through the method of snowball sampling within the area and its
tribal settlements. The consolidated standards of reporting trials
(CONSORT) flowchart of the selection and data collection process
was explained in Figure 1.
Intervention Groups
The lavender oil blends were commercially procured, with group G
being the control group. The groups were as follows:
• Group A (Allorma Roll-on): Lavender oil, clary sage oil, almond
oil, sandalwood oil, ylang-ylang oil, and chamomile oil.
• Group B (Old Natural Antistress Roll-on): Lavender oil, chamomile
oil, malkangani oil, almond oil, lemon oil, rukhas oil, brahmi oil,
shankhpushpi oil, and mandukaparni oil.
• Group C (Secret Alchemist): Ylang-ylang oil, rose oil, sandalwood
oil, basil oil, and lavender oil.
• Group D (Dazze and Blussh Stress Away Roll-on): Almond
oil, orange oil, clary sage oil, lavender oil, patchouli oil, and
frankincense oil.
• Group E (Puretive De-stress Roll-on): Coconut oil, rosemary oil,
tea tree oil, peppermint oil, and lavender oil.
• Group F (Nua Balance Essential Oil Roll-on): Lavender oil, ylang-
ylang oil, orange oil, and rose oil.
• Group G (control): Distilled water.
Randomization and Blinding
To ensure balanced allocation, block randomization was utilized,
assigning 30 participants into seven groups (A–G). The random
allocation sequence was generated using SPSS syntax and Excel, and is
followed by the first author for participant assignment while ensuring
blinding. The assessor, participant, and statistician were blinded to the
intervention groups. For allocation concealment, every group received
the herbal oil in a white, plain plastic bottle with a lid as a roll-on.
Intervention
After randomization, participants were instructed to apply the
essential oil roll-on to the bilateral pulse points, specifically behind
the ears and on both wrists, each night at bedtime. Additionally,
Aromatherapy is gaining recognition as a culturally adaptable
and complementary approach to addressing mental health
concerns among elderly tribal populations.7–9 This therapeutic
practice utilizes plant-derived essential oils to enhance both
emotional and physical well-being. The benefits of aromatherapy
are primarily delivered through inhalation and topical application,
each engaging distinct physiological pathways.10
The bioactive compounds penetrate the skin, enter the
circulatory system, and influence physiological functions
by modulating hormone levels, enzymatic activity, and
neurotransmitter balance.11,12 The integration of aromatherapy
within tribal communities aligns seamlessly with their traditional
healing practices, which emphasize the use of natural remedies
and plant-based treatments.13,14
A key process in this approach is sublimation, wherein essential
oil compounds transition directly from a solid state to vapor without
passing through a liquid phase. This method facilitates the efficient
release of therapeutic compounds, optimizing their absorption and
effectiveness.15,16 By leveraging traditional botanical knowledge
and sustainable extraction techniques, aromatherapy can serve as
a culturally attuned intervention for improving mental well-being
in tribal elders.17,18
Essential oils such as lavender, bergamot, rose, and ylang-ylang
are well-documented for their calming and mood-enhancing
properties.19 However, incorporating locally available medicinal
plants into aromatherapy can enhance its cultural relevance and
acceptance within tribal communities.20
For elderly individuals in tribal settings, integrating this practice
into community health programs or elder care initiatives can provide
a holistic approach to mental health support.21 By utilizing locally
relevant practices, aromatherapy can enhance the accessibility and
acceptability of mental health support in these settings.22
Elderly tribal populations face a high burden of depression,
anxiety, and stress, compounded by limited healthcare access and
cultural stigma. Aromatherapy offers a safe, low-cost, and culturally
acceptable alternative, yet evidence among indigenous groups is
scarce. The population of interest in this study comprised elderly
individuals (65–74 years) belonging to the Irular tribe in Tamil
Nadu, a socioeconomically marginalized community with limited
access to conventional healthcare. Therefore, this study aims to
assess the effectiveness of inhalation aromatherapy using various
combinations of lavender oil in alleviating depression, anxiety, and
stress among elderly individuals of this community.
MAt e r I A l s A n d Me t h o d s
Study Design
The study employed a triple-blind, parallel-arm, randomized
controlled trial design. It was conducted between April and
December 2024, targeting tribal populations with medical records
at selected community health centers in the rural region of Tiruttani,
in Tamil Nadu, India, targeting elderly individuals of the Irular
tribe. Ethical clearance of the study was obtained prior from the
Institutional Scientific Review Board with an ethical number of
SRB/SDC/PG-1825/24/PHD/214. The tribes were identified through
community leaders, and written consent for the study was obtained
from all the participants, and anonymity was maintained.
Eligibility Criteria
The study included elderly members of the Irular tribe aged 65–74 years
who were residing in the study area, willing to participate, and available
Impact of Lavender Oil on Depression, Anxiety, and Stress
World Journal of Dentistry, Volume 16 Issue 8 (August 2025)
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Statistical Analysis
The data collected by the modified DASS were tabulated with
Microsoft Excel and analyzed by SPSS software version 27. The
normality of the data was analyzed by the Shapiro–Wilk test, and
the data were found to be parametric. To assess the difference
in the DASS scores before and after the intervention, a paired t-
test was used. To assess the difference in the scores between the
groups, one-way analysis of variance (ANOVA) was done at baseline
and after the intervention. Post hoc tests were done to assess the
intergroup comparisons, and the significance level (p-value) was
kept at less than 0.05.
re s u lt s
A total of 222 individuals were assessed for eligibility, of whom
210 were randomized into seven groups. Following attrition, 179
participants completed the study and were included in the final
analysis. The participant recruitment and allocation process is
summarized in the CONSORT flowchart (Fig. 1).
The mean age of participants varied across groups, ranging
from 68.78 ± 4.85 years in group A to 72.63 ± 2.96 years in group
C. Of the total participants, 97 (54.2%) were males and 82 (45.8%)
were females. Group B had the highest proportion of males (18/25;
72.0%), while group F had the lowest (10/25; 40.0%). Conversely,
females predominated in group F (15/25; 60.0%) and were equally
represented in group C (13/26; 50.0%). Regarding marital status,
120 participants (67.0%) reported having a spouse, with the highest
proportion in group C (22/26; 84.6%) and the lowest in group G
they were asked to inhale the aroma of the oils from their wrists
once before sleep. The study was carried out for 30 nights, and they
were instructed to use the oil every day for 30 nights.
Participants and their families received clear instructions on the
proper use of the oils, as they were responsible for administering
them at home. Additionally, researchers advised them to store
the essential oils and distilled water at room temperature, away
from direct sunlight. To promote adherence to the intervention,
participants received a daily reminder via text message each
evening.
Data Collection
Demographic data were collected from the selected health
center while assessing for eligibility. The individual demographic
questionnaire gathered information on age, gender, educational
background, presence of spouse, and housing. This questionnaire
was administered by the researcher at baseline, before the study
commenced.
To assess the stress and anxiety levels of the participants, the
modified depression, anxiety, and stress scale (DASS) was used. It
is a 12-item questionnaire with four scores ranging from 0, which
denotes did not apply to me at all, to a score of 3, which denotes
applied to me very much, or most of the time. The questionnaire
was a prevalidated one developed by Halford.24 The questionnaire
was not self-administered. It was translated into the local language
of Tamil for the participants by the researcher and the team.
In this study, participants were assessed at baseline before the
intervention and after 30 days of intervention.
Fig. 1: CONSORT flowchart of the study process
Impact of Lavender Oil on Depression, Anxiety, and Stress
World Journal of Dentistry, Volume 16 Issue 8 (August 2025) 759
pronounced improvement, showing a reduction from 29.70 ± 2.23
to 8.18 ± 1.54. In contrast, group G showed no significant reduction
(p = 0.095) (Table2 and Fig. 2).
One-way ANOVA revealed no significant difference in baseline
DASS scores across the groups. However, there was a highly
significant difference in postintervention scores (F = 581.584,
p < 0.001) (Table 3). Post hoc analysis using Bonferroni correction
indicated that postintervention scores in group G were significantly
higher than those in all other groups (p < 0.001). Additionally, group
D exhibited significantly lower scores than groups A, B, C, and E (p <
0.001), suggesting a superior intervention effect in group D (Table4).
The findings indicate that inhalation aromatherapy using lavender-
based essential oil blends significantly reduced depression, anxiety,
and stress among elderly individuals of the Irular tribe, with the
group D formulation demonstrating the greatest efficacy compared
to other blends and the control group.
(15/25; 60.0%). Most participants (145/179; 81%) resided in owned
homes, while 34 (19%) reported living in rented accommodation.
Educational levels varied, with illiteracy most common in group E
(20/26; 76.9%), while higher education (graduate and above) was
least represented across all groups (11/179; 6.1%) (Table1).
At baseline, the DASS scores were comparably high across all
groups, ranging from 23.00 ± 2.38 in group A to 30.12 ± 2.13 in group
F. Following the 30-day aromatherapy intervention, significant
improvements were observed in all groups receiving essential
oil blends (groups A–F), whereas the control group showed no
significant change. Postintervention mean DASS scores reduced to
12.08 ± 1.68 in group A, 11.80 ± 1.26 in group B, 12.15 ± 0.97 in group
C, 8.18 ± 1.54 in group D, 12.27 ± 1.37 in group E, and 13.20 ± 1.08
in group F, compared to 28.80 ± 1.68 in the control group (group
G). Paired t-tests confirmed statistically significant reductions in
groups A–F (p < 0.001 for all), with group D demonstrating the most
Table 1: Demographic details of the study participants
Group A
(n = 25)
Group B
(n = 25)
Group C
(n = 26)
Group D
(n = 27)
Group E
(n = 26)
Group F
(n = 25)
Group G
(n = 25)
Age Mean ± SD 68.78 ± 4.85 68.89 ± 4.89 72.63 ± 2.96 69.52 ± 6.21 69.85 ± 3.94 70.85 ± 4.23 69.23 ± 3.83
Gender Males 15 18 13 12 15 10 14
Females 10 7 13 15 11 15 11
Spouse
presence
Yes 12 15 22 20 18 18 15
No 13 10 4 7 8 7 10
Housing Owned 20 22 20 22 21 19 21
Rental 5 3 6 5 5 6 4
Education Illiterate 11 12 15 17 20 17 18
Schooling 13 12 10 8 4 5 6
Graduate and
above
1 11223 1
Table 2: Paired t-test showing significant differences in the DASS scores after the intervention in groups A to F
Paired t-test Mean Std. deviation t-value p-value
Pair 1 Group A before 23.0000 2.38048 21.707 0.000
Group A after 12.0800 1.68127
Pair 2 Group B before 28.4800 3.25474 22.718 0.000
Group B after 11.8000 1.25831
Pair 3 Group C before 29.2308 2.53468 30.953 0.000
Group C after 12.1538 0.96715
Pair 4 Group D before 29.7037 2.23288 51.886 0.000
Group D after 8.1852 1.54514
Pair 5 Group E before 29.3077 2.24088 44.577 0.000
Group E after 12.2692 1.37281
Pair 6 Group F before 30.1200 2.12760 33.200 0.000
Group F after 13.2000 1.08012
Pair 7 Group G before 29.1600 1.90788 1.737 0.861
Group G after 28.8000 1.68325
Table 3: One-way ANOVA showing significant differences in the DASS scores postintervention
DASS scores postintervention Sum of squares df Mean square F Sig.
Between groups 6784.536 6 1130.756 581.584 0.000
Within groups 334.414 172 1.944
Total 7118.950 178
Impact of Lavender Oil on Depression, Anxiety, and Stress
World Journal of Dentistry, Volume 16 Issue 8 (August 2025)
760
social isolation, and cultural stigma. As a marginalized group relying
on natural remedies, aromatherapy is both culturally acceptable and
feasible, offering a low-cost, noninvasive strategy for community
health programs.
Aromatherapy has been increasingly recognized as a
complementary therapy for psychological well-being, with
several essential oils demonstrating anxiolytic and antidepressant
properties. Lavender oil, in particular, has been shown to modulate
the limbic system and autonomic nervous activity, thereby reducing
stress and anxiety levels.25 Clary sage and patchouli contribute to
mood stabilization, while frankincense and citrus oils such as orange
enhance emotional balance through the serotonergic pathway.
Previous studies have documented the effectiveness of lavender-
based aromatherapy in alleviating depressive symptoms among
elderly women and patients undergoing medical treatment.26
In the present study, among the formulations tested, Dazze
and Blussh Stress Away Roll-on (group D) exhibited the greatest
efficacy, likely due to its carefully selected combination of essential
oils. Lavender oil and clary sage oil are widely recognized for their
calming and anxiolytic properties, significantly reducing stress and
anxiety. Patchouli oil and frankincense oil contribute to emotional
stabilization, while orange oil enhances mood by stimulating
serotonin production, which was proven in a study done in
Mexico.17 Additionally, almond oil serves as an effective carrier oil,
improving absorption and efficacy. Compared to other groups, this
unique formulation appears to have provided a synergistic effect,
explaining its superior results in stress reduction.
These findings emphasize the potential of essential oil-based
interventions in psychological stress management. The exceptional
performance of Dazze and Blussh Stress Away Roll-on suggests that
an optimal blend of sedative (lavender and clary sage), grounding
dI s c u s s I o n
The statistical analyses confirmed the effectiveness of the
intervention in reducing psychological distress. Paired t-tests
showed significant score reductions in all groups, with group D
(Dazze and Blussh Stress Away Roll-on) achieving the greatest
improvement, while the control group showed minimal change.
Demographic factors influenced outcomes; for instance, group
E’s high proportion of illiterate participants may have limited
comprehension, whereas group D’s balanced gender distribution
and greater marital stability likely provided added support. The
Irular tribe was chosen as they face a disproportionate burden of
untreated mental health concerns due to poor healthcare access,
Fig. 2: Mean DASS scores postintervention among the study groups
Table 4: Post hoc test showing differences between the groups in the DASS scores after the intervention
DASS scores
postintervention (I) groups (J) groups Mean difference (I − J) Sig.
Post hoc Group A Group B 0.28000 1.000
Group C −0.07385 1.000
Group D 3.89481*0.000*
Group E −0.18923 1.000
Group F −1.12000 0.106
Group G −16.72000*0.000*
Group B Group C −0.35385 1.000
Group D 3.61481*0.000*
Group E −0.46923 1.000
Group F −1.40000*0.010*
Group G −17.00000*0.000*
Group C Group D 3.96866*0.000*
Group E −0.11538 1.000
Group F −1.04615 0.170
Group G −16.64615*0.000*
Group D Group E −4.08405*0.000*
Group F -5.01481*0.000*
Group G −20.61481*0.000*
Group E Group F −0.93077 0.383
Group G −16.53077*0.000*
Group F Group G −15.60000*0.000*
* Denotes significance (p-value) level is less than 0.05
Impact of Lavender Oil on Depression, Anxiety, and Stress
World Journal of Dentistry, Volume 16 Issue 8 (August 2025) 761
for integration into real-world community health programs.
Furthermore, adherence was strengthened through daily reminders
and structured follow-up, which improved the consistency of the
intervention.
This study has several limitations, including reliance on self-
reported DASS scores, short-term assessment, and potential
demographic variability, all of which may affect the reliability
of the findings. A placebo effect and inconsistent application of
the roll-on may also have influenced outcomes. Future research
should include long-term studies, objective physiological
markers, and comparisons with established stress management
methods. Personalizing formulations and expanding the sample
to more diverse populations could improve the effectiveness and
generalizability of essential oil-based interventions.
co n c lu s I o n
This study examined the effects of inhalation aromatherapy using
lavender and chamomile essential oils on depression, anxiety,
and stress levels of elderly individuals of the Irular tribe. The
formulation in group D, which was Dazze and Blussh Stress Away
Roll-on with blends of almond oil, orange oil, clary sage oil, lavender
oil, patchouli oil, and frankincense oil, was the most effective
in promoting emotional well-being. The 30-day intervention
demonstrated a significant reduction in depression, anxiety, and
stress scores, with the effects persisting after the intervention and
at the 1-month follow-up.
Future studies should include longer follow-up to assess
sustained effects and incorporate objective measures such as
cortisol levels or heart rate variability. Expanding research to
other tribal and rural populations across India would enhance
generalizability. Exploring blends with locally available medicinal
plants and evaluating integration into primary health programs
can further establish aromatherapy as a feasible, culturally relevant
adjunct for geriatric mental healthcare.
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effectively alleviate symptoms of depression, anxiety, and stress.
Supporting these results, research by Ko etal., in South
Korea, among institutionalized elderly demonstrated that a 7-day
inhalation aromatherapy regimen using lavender essential oil
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A study conducted by Tang and Tse27 in China among
community-dwelling elderly found that inhalation aromatherapy
using a blend of lavender and bergamot essential oils significantly
reduced anxiety levels in older adults living in the community.
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effectiveness of inhalation lavender aromatherapy in lowering
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of the present study.28
However, research by Seifi et al.29 in Iran among inpatients
undergoing coronary artery bypass graft surgery reported that
lavender essential oil aromatherapy did not have a significant
impact on anxiety levels in patients undergoing coronary artery
bypass graft surgery. This discrepancy may be attributed to
differences in the nature of anxiety experienced by community-
dwelling older adults compared to surgical patients, as well as
variations in the intervention protocols. Seifi and colleagues
administered two drops of 2% lavender essential oil for 20 minutes
on the 2nd and 3rd days postsurgery, which may have influenced
the study outcomes.
Ebrahimi et al.23 reported in a study conducted in Iran that
aromatherapy inhalation with chamomile and lavender essential
oils decreased anxiety, depression, and stress levels in community-
dwelling older adults. A 30-day intervention showed a notable
reduction in depression, anxiety, and stress levels, both immediately
after the program and 1 month later. This study found that inhalation
aromatherapy using lavender and chamomile essential oils was
effective in lowering these mental health concerns and enhancing
overall well-being in older adults living in the community. However,
given the limited research available in this area, further studies are
recommended to explore and validate these findings.
The study establishes lavender-based essential oil blends as
an effective, noninvasive, and low-cost adjunct for managing
depression, anxiety, and stress in elderly tribal populations.
Its cultural acceptability and ease of home-based use support
integration into community and primary healthcare programs,
offering a scalable complementary strategy for geriatric mental
health care in resource-limited settings.
This trial possesses several strengths. The focus on a
marginalized tribal population addressed a critical gap in research
by targeting a community with limited access to mental health
care. Unlike studies assessing a single essential oil, this research
compared multiple blends, enabling the identification of the most
effective formulation. The chosen intervention was noninvasive,
low-cost, and culturally acceptable, supporting its potential
Impact of Lavender Oil on Depression, Anxiety, and Stress
World Journal of Dentistry, Volume 16 Issue 8 (August 2025)
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