International journal of nursing studies · 2025
Effect of horticultural activities on reducing depressive symptoms in community-dwelling adults: A systematic review and meta-analysis.
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Sin Po Yan, Li William Ho Cheung, Fan Myrian Sze Nga, Ng Shuk Ching, Choi Kai Chow
Аннотация
OBJECTIVE: To review and analyse randomised-controlled trials and controlled clinical trials on the effect of horticultural activities on alleviating depressive symptoms in community-dwelling adults.
ELIGIBILITY CRITERIA: We included randomised controlled trials and controlled clinical trials that reported depressive symptoms as an outcome. Only community-dwelling adults are included. Involved interventions were horticultural activities with direct interactions with real plants. Excluded interventions include complete virtual-reality-based interventions and passive involvement in a natural environment. The comparison group must not include any horticultural elements.
DATA SOURCES: On 12/9/2024, 14 databases were searched: Academic Search Ultimate, APA PsycInfo, British Nursing Index, CINAHL, CENTRAL, Educational Resources Information Center, Embase, Epistemonikos, Global Health, MEDLINE, Ovid Emcare, Ovid Nursing Database, Scopus, and Web of Science. Citation Search was performed.
RISK OF BIAS: The Risk of Bias-2 and the Risk-Of-Bias In Non-randomised Studies-of-Interventions tool were utilised.
RESULT SYNTHESIS: Data was synthesised using a random-effects meta-analyses model. Effect sizes were estimated as standardised mean differences.
RESULTS: The systematic review covered 30 studies and 2071 participants. The meta-analysis covered 25 studies and indicated that horticultural activities had an overall moderate effect on depressive symptoms (SMD - 0.67, 95 % CI -0.86 to -0.47, I2 54 %). Subgroup analyses revealed that horticultural therapy and therapeutic horticulture had no significant difference in effects (horticultural therapy: SMD -0.74, 95 % CI -1.35 to -0.14, I2 79 %; therapeutic horticulture: SMD - 0.62, 95 % CI -0.80 to -0.45, I2 27 %). The effect of horticultural activities in reducing depressive symptoms was moderate among younger adults (SMD - 0.59, 95 % CI -0.83 to -0.36, I2 43 %), and older adults (SMD - 0.73, 95 % CI -1.05 to -0.40, I2 61 %). The interventions conducted indoors and outdoors showed no significant difference (Indoor: SMD -0.55, 95 % Cl -0.87 to -0.23, I2 61 %; Outdoor: SMD - 0.62, 95 % Cl -0.83 to -0.42, I2 6 %). The effects of interventions once a week (SMD - 0.61, 95 % Cl -0.92 to -0.30, I2 68 %) were similar to those twice a week (SMD - 0.72, 95 % Cl -1.05 to -0.39, I2 37 %). The effective components of horticultural activities included plant care, horticultural artwork, harvesting, food consumption, sensory stimulation, and starting rituals.
DISCUSSION: Most studies have high risk of bias due to ethical requirements and the intervention nature. This review shows that depressive symptoms can be reduced through horticultural activities, such as plant care, horticultural artwork, harvesting, food consumption, sensory stimulation, and starting rituals. Implementing weekly horticultural activities can best achieve intervention results with less time investment.
ELIGIBILITY CRITERIA: We included randomised controlled trials and controlled clinical trials that reported depressive symptoms as an outcome. Only community-dwelling adults are included. Involved interventions were horticultural activities with direct interactions with real plants. Excluded interventions include complete virtual-reality-based interventions and passive involvement in a natural environment. The comparison group must not include any horticultural elements.
DATA SOURCES: On 12/9/2024, 14 databases were searched: Academic Search Ultimate, APA PsycInfo, British Nursing Index, CINAHL, CENTRAL, Educational Resources Information Center, Embase, Epistemonikos, Global Health, MEDLINE, Ovid Emcare, Ovid Nursing Database, Scopus, and Web of Science. Citation Search was performed.
RISK OF BIAS: The Risk of Bias-2 and the Risk-Of-Bias In Non-randomised Studies-of-Interventions tool were utilised.
RESULT SYNTHESIS: Data was synthesised using a random-effects meta-analyses model. Effect sizes were estimated as standardised mean differences.
RESULTS: The systematic review covered 30 studies and 2071 participants. The meta-analysis covered 25 studies and indicated that horticultural activities had an overall moderate effect on depressive symptoms (SMD - 0.67, 95 % CI -0.86 to -0.47, I2 54 %). Subgroup analyses revealed that horticultural therapy and therapeutic horticulture had no significant difference in effects (horticultural therapy: SMD -0.74, 95 % CI -1.35 to -0.14, I2 79 %; therapeutic horticulture: SMD - 0.62, 95 % CI -0.80 to -0.45, I2 27 %). The effect of horticultural activities in reducing depressive symptoms was moderate among younger adults (SMD - 0.59, 95 % CI -0.83 to -0.36, I2 43 %), and older adults (SMD - 0.73, 95 % CI -1.05 to -0.40, I2 61 %). The interventions conducted indoors and outdoors showed no significant difference (Indoor: SMD -0.55, 95 % Cl -0.87 to -0.23, I2 61 %; Outdoor: SMD - 0.62, 95 % Cl -0.83 to -0.42, I2 6 %). The effects of interventions once a week (SMD - 0.61, 95 % Cl -0.92 to -0.30, I2 68 %) were similar to those twice a week (SMD - 0.72, 95 % Cl -1.05 to -0.39, I2 37 %). The effective components of horticultural activities included plant care, horticultural artwork, harvesting, food consumption, sensory stimulation, and starting rituals.
DISCUSSION: Most studies have high risk of bias due to ethical requirements and the intervention nature. This review shows that depressive symptoms can be reduced through horticultural activities, such as plant care, horticultural artwork, harvesting, food consumption, sensory stimulation, and starting rituals. Implementing weekly horticultural activities can best achieve intervention results with less time investment.