Jessen Nanna Holt, Løvschall Claus, Skejø Sebastian Dyrup, Madsen Louise Sofia Sofia, Corazon Sus Sola, Maribo Thomas, Poulsen Dorthe Varning
Research Unit for General Practice, Aarhus, Aarhus, Denmark
DEFACTUM, Central Denmark Region, Denmark, Aarhus, Denmark.
BMJ Open. 2025 Jul 24;15(7):e098598. doi: 10.1136/bmjopen-2024-098598.
The use of natural environments and nature activities as elements in the treatment and rehabilitation of mental health challenges is gaining international attention. The objective of the present review was to summarise the knowledge on the effects of nature-based health interventions (NBHIs) targeting individuals diagnosed with anxiety, depression and/or experiencing stress.
Systematic review and meta-analyses. The quality and certainty of evidence were assessed using the SIGN and GRADE.
Searches were performed in Embase, MEDLINE, PsycINFO, CINAHL, Cochrane and Web of Science.
(1) NBHIs, (2) Individuals with a diagnosis of mild to moderate anxiety, depression and/or experiencing stress, (3) Age of participating individuals: 18-84 years, (4) Study designs: randomised controlled trials, cohort studies, case-control studies and case-series studies and (5) Publication date: 2000-2024.
Screening, quality appraisal and certainty of evidence, assessed using SIGN and GRADE, were performed by two independent reviewers, except title screening. Meta-analyses were performed using random-effect models.
Nineteen articles were included, of which 14 were included in the meta-analyses. The articles showed substantial variation in design, interventions, settings and risk of bias, limiting the certainty of evidence according to GRADE. Participating in NBHIs led to a small to large effect in mental health with standardised mean changes of -0.80 (95% CI= (-1.56; -0.04)), -0.87 (95% CI= (-1.18; -0.56)), -0.32 (95% CI= (-0.74; 0.09)) and 0.58 (95% CI= (0.39; 0.77)) for anxiety, depression and stress scores and overall mental health scores, respectively.
This is the first systematic review examining the effect of NBHIs exclusively on individuals diagnosed with anxiety, depression and/or experiencing stress. Our findings suggest small to large improvements after participating in NBHIs. However, methodological limitations to the included articles necessitate cautious interpretation.
CRD42024516270.
将自然环境和自然活动作为心理健康挑战治疗与康复的要素加以利用，正获得国际关注。本综述的目的是总结针对被诊断患有焦虑症、抑郁症和/或经历压力的个体的基于自然的健康干预措施（NBHIs）效果的相关知识。
系统综述和荟萃分析。使用苏格兰院校指南网络（SIGN）和推荐分级的评估、制定与评价（GRADE）对证据的质量和确定性进行评估。
在Embase、MEDLINE、PsycINFO、护理学与健康领域数据库（CINAHL）、考克兰图书馆和科学引文索引（Web of Science）中进行检索。
（1）基于自然的健康干预措施；（2）被诊断患有轻度至中度焦虑症、抑郁症和/或经历压力的个体；（3）参与个体的年龄：18 - 84岁；（4）研究设计：随机对照试验、队列研究、病例对照研究和病例系列研究；（5）出版日期：2000 - 2024年。
除标题筛选外，由两名独立评审员进行筛选、质量评估和证据确定性评估，使用SIGN和GRADE。荟萃分析采用随机效应模型。
纳入19篇文章，其中14篇纳入荟萃分析。这些文章在设计、干预措施、环境和偏倚风险方面存在很大差异，根据GRADE降低了证据的确定性。参与基于自然的健康干预措施对心理健康产生了小到中等程度的影响，焦虑、抑郁和压力评分以及整体心理健康评分的标准化平均变化分别为-0.80（95%置信区间=（-1.56；-0.04））、-0.87（95%置信区间=（-1.18；-0.56））、-0.32（95%置信区间=（-0.74；0.09））和0.58（95%置信区间=（0.39；0.77））。
这是第一项专门研究基于自然的健康干预措施对被诊断患有焦虑症、抑郁症和/或经历压力的个体影响的系统综述。我们的研究结果表明，参与基于自然的健康干预措施后有小到中等程度的改善。然而，纳入文章的方法学局限性需要谨慎解读。
国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42024516270。
