Article

The Relationship Between Outdoor Recreation and Depression Among Individuals With Disabilities

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Abstract

The purpose of this study is to identify the relationship between outdoor recreation participation and depressive symptoms among individuals with disabilities. The current paper compares three outdoor recreation predictors (dichotomized participation, participation index score, and participation frequencies) to two depression dependents (dichotomized current major depression and raw depression index score). Results reveal a negative relationship between outdoor recreation participation and depression, outdoor recreation participants had lower overall depression scores than nonparticipants, and lower depression scores were related to more frequent outdoor recreation participation. Future experimental studies are needed in order to fully understand the causal relationship between outdoor recreation and depression among different subgroups of individuals with disabilities.

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... Favorable associations have been found not only between gardening activities and depression itself [34], but also factors related to depression risk such as stress [35] and social cohesion or interaction [36]. However, most studies that examine the relationship between gardening and depression either specifically target groups of gardeners [34,36] or specifically vulnerable groups of society, such as those already diagnosed with depression or other mental health disorders [37][38][39], people with disabilities [40,41], refugees [42] or the elderly [43,44]. Often, studies involve interventions, such as horticultural therapy, that have defined treatment goals and are specifically designed to treat people with depression or other health issues [35,[37][38][39]44,45]. ...
... This is not the same as 'typical' gardening, which involves gardening in or around one's own home or in community or allotment gardens, usually without the structure of guided activities or intentional therapy. To our knowledge, few cross-sectional studies have examined the relationship between gardening behavior and depression risk in a general urban population (but see e.g., [43] with a focus on allotment gardeners and [40] that focuses on people with disabilities but does not preferentially target gardeners). ...
... While mental health benefits of targeted gardening programs, such as horticultural therapy, are extensively studied [37][38][39]41,44], there are few studies examining gardening behavior and depression risk more generally. In the few cross-sectional studies that have examined, this relationship differs from ours, as they targeted populations with disabilities [40], specific groups of gardeners [34], or did not examine depression risk per se but rather mental health or well-being more generally [36,66]. Finally, studies examining aspects of gardening behavior and migration history are diverse and include research on potential benefits of gardening for people with a migration history [42,80], attitudes towards gardening [79], effects of gardening intervention projects [42,53] and even species composition of gardens in relation to migration history [64]. ...
Article
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As the world’s population becomes more urbanized, there is an associated decrease in nature exposure and a rise in noncommunicable diseases, including depression. Previous cross-sectional studies examining urban nature exposure and depression have reported favorable associations. However, many of these studies rely primarily on nature exposure metrics that measure the intensity of nature exposure, while other dimensions of urban nature exposure remain understudied. Therefore, in a cross-sectional, questionnaire-based case study targeting a general urban population (n = 282), we examined the relationship between two less commonly studied urban nature exposure variables (i.e., gardening behavior and greenspace visit frequency) and depression risk while also considering sociocultural background (multivariate logistic regression model). Results indicated that being a gardener was significantly associated with a reduced odds of being at risk of depression and that having a family migration history, but not a self-migration history, was associated with increased odds of being at risk of depression. In the examination of neighborhood socialization frequency and depression risk, we did not determine any significant association. The results of this study, therefore, highlight the importance of considering both people’s sociocultural backgrounds and urban nature exposure in more detail to help plan for and support healthier cities in the future.
... It was noteworthy that generally there remained insufficient research regarding the impact of GE on physiological health markers, and even less with specific modes such as gardening (Wilson & Christensen, 2011) or undertaken in natural settings (Pretty et al, 2007). Notable research included a study on 'forest bathing' 6 , that produced empirical evidence for lowered resting heart rate, blood pressure, sympathetic nerve activity and concentrations of cortisol, with greater parasympathetic nerve activity, compared to urban environments (Park et al,6 Forest bathing refers to 'bathing' or immersion in forest environments. ...
... Therefore, my own GE research has either enhanced, or pioneered, research with specific groups and contexts. It is, however, important to acknowledge that since the start of the last decade, the field has expanded rapidly: GE studies involving horticultural, gardening and those recovering from strokes (Barello et al, 2016;Patil et al, 2019), people with disabilities (Wilson & Christensen, 2011), people with mild to chronic mental health conditions (Bragg & Atkins, 2016;Kim & Park, 2018), schizophrenia patients (Liu et al, 2014), immigrant families (Hordyk et al, 2015) and people within different stages of rehabilitation (TCV, 2016). A few studies have also attempted to evaluate the different impacts on wellbeing resulting from exercise by comparing different environmental settings, including indoor, urban, park, river, beach, and coast, as identified by Rogersen et al (2016) and White et al (2015). ...
Thesis
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In recent years there has been considerable reporting of a range of physical and psycho-social benefits derived from ‘green exercise’, a term which describes a myriad of nature-based activities, including gardening, walking, climbing, and running in natural surroundings. Extant literature has largely focused upon exploring these benefits in respect of specific physical and psycho-social health and wellbeing outcomes, including positive impacts upon mood states, enhanced social connectedness, and improvements in recovery rates for patients in physical rehabilitation programmes. However, numerous gaps existed within the research beyond a focus on outcome measures: firstly, articulating the essential influences (mechanisms and processes) potentially driving these impacts. Secondly, insufficient qualitative investigations, particularly longitudinal ones. Third, a lack of innovation in researching green exercise, especially in respect of ethnographic studies. Fourth, and relatedly fifth, a need for more granular focused research upon specific population groups and settings, and utilising specific modes of green exercise - gardening, horticulture, and conservation activity - that had hitherto been under-investigated. The work consists of findings from six published papers that not only confirm that green exercise promotes positive enhancements to physical and psycho-social health and wellbeing for participants, but also offers possible explanations as to why and how these are derived, drawing upon relevant theories and concepts. The investigations were based upon a pragmatic overarching research approach employing ethnography to research participant experiences within four distinct contexts: a purpose-built garden within a medium secure NHS unit; a conservation project in an urban park; a woodland project outside formal mental health service provision; and a corporate health setting. Combined, these small-scale ‘case studies’ of GE offer important insight into the value of GE for specific groups and contexts and enable the development of a suggested socio-ecological model that emphasises a ‘green transformative ripple effect’ can be achieved delivering benefits not only for individuals, but also at group and community level. The latter is further evidenced through local ‘social impact’, demonstrating potential for the adoption of green exercise initiatives by practitioners and policymakers involved in social prescribing and community development as part of a more comprehensive health improvement strategy within communities.
... Outdoor recreation was investigated in a study, revealing a negative correlation with depression. Participants, comparing to nonparticipants, had lower overall depression scores, showing that the more an individual participate in outdoor recreation activities, the more it exhibited lower depression scores (Wilson & Christensen, 2012). Outdoorrelated activities do not differ in terms of improvement in mood states when compared to other exercise methodologies. ...
... The decrease in CON and TEN among males, and FAT and DEP among females may have connections with their social relationship, and physical and psychological health respectively as found in a previous study (Sichiri et al, 2016 Wilson and Christensen (2012) found out. This increasing DEP scores among males may have links on previous findings (Lee, McMahan & Scott, 2015) regarding the competitive inclination of male birders in a novice skill set. ...
Article
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Aim.Theprimary purpose of the study was to know how birdwatching as a form of physical activity immediately affects the mood states of senior high school students, and figure out how effective birdwatching in moods improvement during physical education classes and other purposes. Researchers also aimed to investigate differences when compared to walking alone, and if gender affects these mood state differences. Methods.Participants were forty-three (N=43) physically healthy students, clustered into Walking (W) and Birdwatching (Bw) groups, with treatments scoping walking session and walking with birdwatching respectively. Respondentsaccomplished the Abbreviated POMS questionnaire for 5 minutes, before and after interventions. Results.It is found that the pre-and post-profile of Bw group exhibited significant reduction in Tension (TEN), Confusion (CON) and Fatigue (FAT) using the paired T test. However, using the Wilcoxon test, TEN and CON reductions were found significant. While the TMD mean score of Bw group exhibited reducing before-and-after movement, W group showed significant reduction in all 5 negative mood states after intervention. Analyzing effects on males and females, it is found that reduction in TEN is strong regardless of gender, while males exhibited significant decrease in CON using paired T test in the Bw group. Conclusions.Results showed a significant decrease in TEN, CON and FAT scores among Bw Group in a senior high school physical education setting. Despite no significant change, TMD scores decreased after the 20-minute birdwatching activity with walk. Results of W group also validates previous investigations with significant decrease in all negative mood states and TMD.
... Indeed, previous studies have shown that gardening increases individual's life satisfaction, vigor, psychological wellbeing, positive affects, sense of community, and cognitive function (Gigliotti and Jarrott, 2005; Gonzalez et al., 2010; van den Berg et al., 2010; Wakefield et al., 2007; Wichrowski et al., 2005; Wood et al., in press). Reductions in stress, anger, fatigue, and depression and anxiety symptoms have also been documented (Rodiek, 2002; Wichrowski et al., 2005; Wilson and Christensen, 2011; Wood et al., in press). In consequence, engagement with gardening has increasingly been recognised as not only a cost-effective health intervention (Clatworthy et al., 2013), but also a treatment or occupational therapy for those with psychological health issues, so-called " horticultural therapy " (Gonzalez et al., 2010; 2011a). ...
... depression severity, life satisfaction, cognitive function) persisted at 3-months' follow up after the therapy, indicating that gardening has a persisting influence on health. Of the 22 case studies, 7 studies focused on daily gardening and found that those who participated had better health than did non-gardeners, such as reductions in stress and BMI, as well as increases in general health and life satisfaction (Park et al., 2009; Sommerfeld et al., 2010; van den Berg et al., 2010; Waliczek et al., 2005; Wilson and Christensen, 2011; Wood et al., in press; Zick et al., 2013). The strength of these studies is that they found no significant difference in the characteristics or socio-economic status of gardeners and non-gardeners, or controlled for these factors. ...
Article
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There is increasing evidence that gardening provides substantial human health benefits. However, no formal statistical assessment has been conducted to test this assertion. Here, we present the results of a meta-analysis of research examining the effects of gardening, including horticultural therapy, on health. We performed a literature search to collect studies that compared health outcomes in control (before participating in gardening or non-gardeners) and treatment groups (after participating in gardening or gardeners) in January 2016. The mean difference in health outcomes between the two groups was calculated for each study, and then the weighted effect size determined both across all and sets of subgroup studies. 22 case studies (published after 2001) were included in the meta-analysis, which comprised 74 comparisons between control and treatment groups. Most studies came from the United States, followed by Europe, Asia, and the Middle East. Studies reported a wide range of health outcomes, such as reductions in depression, anxiety and body mass index, as well as increases in life satisfaction, quality of life and sense of community. Meta-analytic estimates showed a significant positive effect of gardening on the health outcomes both for all and sets of subgroup studies, whilst effect sizes differed among eight subgroups. Although Egger's test indicated the presence of publication bias, significant positive effects of gardening remained after adjusting for this using trim and fill analysis. This study has provided robust evidence for the positive effects of gardening on health. A regular dose of gardening can improve public health.
... The literature exploring the health benefits of activity in nature is indeed growing in commonality (e.g., bird, 2007;Annerstedt & Wahrborg, 2011;Selhub & Logan, 2012) and is sated with studies emphasising the positive effects of active leisure on health. excluding the work by Wilson and Christensen (2012) who explored the effect of outdoor recreation on depression in persons with disabilities, Sugerman's (2001) exploration of inclusive outdoor education and work exploring the mental health benefits of therapeutic gardening (e.g., Parr, 2007), specific evidence concerning disability and nature is sparse. Conradson's (2005) work highlights that the benefits of natural environment experiences are not intrinsic, and rather are contingent on a range of relational and social factors. ...
... Notwithstanding the recent interests in nature and health (Alberta Parks, 2014;Annerstedt & Wahrborg, 2011), and some examination of the impact of outdoor recreation on mood symptoms for adults with disabilities (Wilson & Christensen, 2012), research in general has been slow to address the mental health benefits associated with nature-based interventions particular to adults with disabilities and their caregivers. Findings of this study show promise and provide a platform for future study and point the direction to specific questions such as 'do nature experiences impact caregivers and persons with disabilities differently, and how do these impacts affect the helper/helped relationship?' ...
Article
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The benefits of green space and nature experiences are increasingly being recognised and translated into public health policy and practice. Alongside this trend, inclusion of all people into parks and nature has been an important area of parks and recreation practice. Nature inclusion for those with disabilities, youth, seniors and immigrants has become a focus of Alberta in Western Canada. This study was designed to examine the influence of two such government supported nature interventions, including day trips and a more extensive weekend or week-long nature experience, on mental well-being outcomes. It is a mixed methods pilot study (N = 37) with baseline and post-intervention measures of quality of life using the standard Quality of Life Inventory (QOLI) alongside other qualitative accounts. Quantitative findings, while not statistically significant, show a positive trend towards improved depression markers, greater health satisfaction, improved social relationships (in particular, love and friendship), as well as satisfaction with a sense of community and experiences of helping. In addition to comments within the QOLI, qualitative data were elicited through reflective writing during the nature interventions. Three dominant qualitative themes of inclusive nature experiences were found: ‘Sensory Activation’, ‘Reimagined Social Relations’ and ‘Reinvented Self’.
... For example, exposure to urban nature has been associated with stress reduction and mental recovery (Hedblom et al., 2019;Ward Thompson et al., 2012), lower depression risk (Cox et al., 2017;Jakstis & Fischer, 2021;Lee & Lee, 2019) and with increased physical activity (Astell-Burt et al., 2014;Knobel et al., 2021). Similarly, the frequency of both urban green and blue space visits and outdoor recreation have been associated with positive health effects (Cox et al., 2018;Wilson & Christensen, 2012). This emphasis on the benefits of specifically urban nature for people is increasingly important, as most of the world's population (United Nations, 2019), including 75% of Europeans (The World Bank, n.d.), currently live in urban areas. ...
Article
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In light of global climate change and the biodiversity crisis, making cities more resilient through an adjusted design of urban green and blue spaces is crucial. Nature‐based solutions help address these challenges while providing opportunities for nature experiences, and providing cultural ecosystem services that support public health. The COVID‐19 pandemic and its associated stressors highlighted the interrelated socio‐ecological services provided by nature‐based solutions like urban green and blue spaces. This pan‐European study therefore aimed to enhance the socio‐ecological understanding of green and blue spaces to support their design and management. Using an online survey, green and blue space preferences, usage, and pandemic‐related changes in greenspace visit and outdoor recreation frequencies were examined. Greenspace visit and outdoor recreation frequencies were associated with respondents’ (N = 584 from 15 countries) geographical location, dominant type of neighbourhood greenspace and greenspace availability during the pandemic, but not greenspace perceptions or sociodemographic background. Greenspace visit and outdoor recreation frequencies were generally high; however, Southern Europeans reported lower greenspace visit and outdoor recreation frequencies both before and during the pandemic than Northern Europeans. Many Southern Europeans also reported having few neighbourhood greenspaces and low greenspace availability during the pandemic. The most common outdoor recreational activity among respondents before the pandemic was walking or running with the most frequently stated purpose of time spent outdoors being restorative in nature (i.e. relaxing or calming down). Most Europeans had positive perceptions of green and blue spaces with preferences for structurally diverse and natural or unmanaged green elements. This highlights the importance of accessible green and blue spaces both in everyday life and during times of crisis. Stakeholders, their preferences, and regional and cultural differences should be included in the co‐design of urban green and blue spaces to maximize their potential for both people and nature. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog.
... Apart from that, the implemented TH program showed a significant effect on reducing internalizing behavioral problems (sadness, depression, anxiety, withdrawal) in EG participants. A positive influence of various horticultural interventions on certain manifestations of internalizing disorders, primarily depression and anxiety, was confirmed in both typical population (Beyer et al., 2014;Gonzalez, Hartig, Patil, Martinsen, & Kirkevold, 2011;Kamioka et al., 2014;Nicholas et al., 2019), and in persons with disabilities (Wilson & Christensen, 2011). ...
Article
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Therapeutic horticulture (TH) is a non-invasive support treatment in which participants enhance their well-being through active or passive involvement in plant and plant-related activities. Positive effects of TH are mainly noticed in children and youth with intellectual disability (ID), while the effects of TH on adults with ID have not been extensively studied. The aim of this study was to determine the impacts of TH on psycho-social aspects of functioning in adults with moderate ID in institutional settings. The sample included 68 adults with moderate ID of both genders. The participants were divided into an experimental group (N=33), that participated in a designed ten-week program TH, and a control group (N=35). The Social Skills Rating System – SSRS (Gresham & Eliot, 1990) was used to assess social skills and behavioral problems and Self-Efficacy for Gardening Scale was designed for assessing self-efficacy. We compared the results before and after the intervention. The obtained results showed a significant decrease in different forms of problem behaviors, and an improvement of social skills and self-efficacy in experimental group. Results of this study provide the empirical proof for positive effects of TH on the improvement of the psychosocial well-being of adults with moderate ID in institutional settings. However, further research is necessary.
... Previous studies reported that mobility in cities with higher SES decreased faster than cities with lower SES following lockdown 35,36 . As the social distancing policies went on, residents in high SES districts seem to have more trouble engaging in recreational or outdoor activities 36 , which help in reducing concerns and worries 37 . In contrast, there was no association between district-level SES and increase in stress, and this result could be affected by stress resilience 38 . ...
Article
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Mental health has been a major public health concerns during the COVID-19 pandemic. This study investigated the effects of COVID-19 on mental health and whether individual and regional characteristics are associated with the changes in mental health. We estimated district-specific changes in the prevalence of moderate stress, extreme stress, and depression before and during the COVID-19 pandemic after adjusting for the time trend of mental health outcomes. Then, a meta-regression was conducted to examine the associations between district-level characteristics and changes in mental health due to the pandemic. The prevalence of moderate stress, extreme stress, and depression increased during the pandemic and the increases were more prominent in districts with high population density and in individuals aged 19–59 years, with a high education level, and with high household income. The % with reduced physical activity due to the pandemic were positively associated with increases in stress; while, the % that have mutual trust among neighbors and the number of sports facilities were negatively associated with increases in stress. Local tax per person had a positive association with increase in depression. Our study provides epidemiological evidence into the mental health consequences of the pandemic, which can inform the priority of resource allocation for managing mental health.
... Situating disability as possibly cured or at least alleviated/rehabilitated through experiences within nature is not a new supposition. Rather it echoes prior environmental education research, which suggested that environmental education might be best suited for people with disabilities as it can lesson disabilities, such as Wilson and Christensen (2012) who suggested that experiences in nature may alleviate disabled individuals' depression. Or that depression and madness in individuals is lessoned through experiences in nature in the outdoors (Frances, 2006;Townsend, 2006). ...
Article
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In this article, I call for a cripping of environmental education as a necessary move in shifting away from the field’s current conceptions of disability as defect and deficiency, and towards disrupting the structures and processes that operate as normalizing technologies within ableism/sanism. Through an examination of the ways that the field of environmental education has/has not engaged critical disability politics, I illuminate how disability is not often included within environmental education literature. When it is, it is often through the use of disability as metaphor or through recommendations for best practices in accommodating disabilities. More often though within environmental education, disability has operated as a hidden curriculum, underpinning much of the field’s curricular, pedagogical, and even philosophical foundations. Through a cripping of the field these compulsory able-bodied/able-minded assumptions are made apparent. I suggest that by centering crip bodies and minds through cripistemologies, we might enable new ways of knowing, being in, connecting to, and understanding the natural world.
...  Nature-based tourism and outdoor recreation. A prominent theme within this category is the recognition that spending time in nature and participating in outdoor recreation activities is connected to better health and an increased sense of well-being (e.g., Beringer, 2004;Roggenbuck & Driver, 2000;Wilson & Christensen, 2012). McAvoy et al. (1989) found that both persons with disabilities and those without who participated in a national wilderness trip program had similar positive experiences. ...
Technical Report
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This report offers a brief overview of international research on accessible tourism with a focus on nature-based tourism, based on a search in the scientific database Scopus. In this report, we reviewed 342 scientific publications, and the identified themes with the largest numbers of publications were accessible transportation, accommodation and tourist attractions together with experiences, motivations and constraints/barriers for people with disabilities in tourism settings. Research publications appear to mainly discuss accessible tourism from the perspective of the consumer, while far lesser attention has been paid towards the perspective of the tourism supplier. Findings from the literature review show that a majority of the identified publications were published between 2010 and 2019, indicating an enhanced academic interest relating to accessible tourism. However, within the overall topic of tourism for people with disabilities, accessible nature-based tourism appears to be a rather marginalized field of study.
... Outdoor recreation activities contribute positively to both physical and mental health [1][2][3]. Outdoor recreation helps maintain lower body fat percentages and lead to lower blood pressure and cholesterol level [4,5] while also helping stress management and reducing anxiety or depression [6][7][8][9]. Nearly half of Americans aged six and older participate in various types of outdoor recreation activities such as hiking, camping, and fishing, among many others [10]. ...
Article
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This paper uses over 30 million individual-level trips in federal recreation locations to investigate the impact of short-term temperature shocks on outdoor recreation activities. Our results show that in the short term, a 1◦C temperature increase during the last 6 months increases the total trip duration by 1.197 days (or a 4.12% increase) and the total number of trips by 0.472 (or a 5.44% increase) at the zipcode-month level. The positive effect is primarily driven by the increased number of trips and more in- state travel. We find that the impact of temperature on the number of recreation trips generally increases under a higher temperature. When the monthly temperature is below < 5◦C, the temperature increase will reduce the number of trips as individuals in low-temperature regions is likely to reduce travel demand when the temperature gets warmer.
... Previous studies reported that mobility in cities with higher SES decreased faster than cities with lower SES following lockdown 35,36 . As the social distancing policies went on, residents in high SES districts seem to have more trouble engaging in recreational or outdoor activities 36 , which help in reducing concerns and worries 37 . In contrast, there was no association between district-level SES and increase in stress, and this result could be affected by stress resilience 38 . ...
Preprint
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Mental health has been a major public health concerns during the COVID-19 pandemic. This study investigated the effects of COVID-19 on mental health and whether individual and regional characteristics are associated with the changes in mental health. We estimated district-specific changes in the prevalence of moderate stress, extreme stress, and depression before and during the COVID-19 pandemic after adjusting for the time trend of mental health outcomes. Then, a meta-regression was conducted to examine the associations between district-level characteristics and changes in mental health due to the pandemic. The prevalence of moderate stress, extreme stress, and depression increased during the pandemic and the increases were more prominent in districts with high population density and in individuals aged 19–59 years, with a high education level, and with high household income. The % with reduced physical activity due to the pandemic were positively associated with increases in stress; while, the % that have mutual trust among neighbors and the number of sports facilities were negatively associated with increases in stress. Local tax per person had a positive association with increase in depression. Our study provides epidemiological evidence into the mental health consequences of the pandemic, which can inform the priority of resource allocation for managing mental health.
... Recreation in natural environments can be a way to restore people's adaptive resources, in order to better fight physical and social stressors (Hartig et al., 2014). Research conducted during recent decades has demonstrated how therapeutic horticulture activities can have a positive impact on the rehabilitation of people and the reduction of the recovery period (Bengtsson and Grahn, 2014), especially tested for health outcomes as mental disorders as depression (Gonzalez et al., 2009(Gonzalez et al., , 2010(Gonzalez et al., , 2011Kam and Siu, 2010;Wilson and Christensen, 2011;Ghanbari et al., 2015;Wood et al., 2016). Depression encompasses a large range of phenomena, from relatively normal emotional reactions to severe affective disorders, being among the most common forms of mental disorders across all regions of the world (Ferrari et al., 2013a, b, c). ...
... Also, these results were supported by Kessler et al., (34) on his study which presented that 64.3% have fully or intermitted impaired work functioning and agreed with Novick et al., (35) who illustrated that 52% of depressed patients had pain symptoms that affecting work performance and worsening QOL. These results were also broadly consistent with the results of Wilson (36) who indicated that there was a negative relationship between activity participation and recreation and depression. ...
... Specifically, such activities can benefit movement symmetry, muscle strength, vestibular function, and hand-eye coordination in older adults and individuals with disabilities. Well-documented psychological benefits of horticultural activities in older adults include improved concentration and decreased negative emotions (e.g., fear of poverty) [41][42][43][44][45][46][47][48][49][50][51][52][53][54]. The benefits of these activities also extend to enhanced personal life satisfaction and mental health. ...
Article
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This study investigated the effects of an 8-week horticultural activity intervention on attitudes toward aging, sense of hope, and hand–eye coordination in 88 older adults in residential care facilities. In the experimental group, the mean score for “attitudes toward aging” increased from 3.81 before the intervention to 4.74 points after the intervention (standard deviation SD = 0.24 and 0.27, respectively), and the control group dropped from 3.75 to 3.70 (standard deviations, respectively SD = 0.27 and 0.28). The mean score for “sense of hope” increased from 3.28 before the intervention to 3.81 points after the intervention (SD = 0.49 and 0.26, respectively). In contrast to the control group, the mean score gradually declined from 3.26 to 3.16 points (standard deviation SD = 0.54 and 0.48, respectively). In the test of hand–eye coordination, the time required to complete the cup stacking test significantly decreased from 33.56 to 25.38 s in the experimental group but did not significantly change in the control group. Generalized estimating equation analysis revealed a significant interaction between group and time (p < 0.001). The data trends revealed significant differences in outcomes between the experimental group and the control group. At 3 months after the end of the study, the effect size in the experimental group remained higher than that in the control group.
... Similarly, we found that increased time spent outdoors correlated with a reduction in depression (but not anxiety) risk, and those who spent more than an hour a day outdoors had approximately half the risk of depression as those who spent no time outdoors. This association of depression with time outdoors echoes prior research on associations with time spent outdoors and its impact on mental health (37,38). Our finding that both larger living space and increased time spent outdoors correlate with a reduction in mental health burden may have actionable implications for public health initiatives and decisions regarding access to outdoor recreation areas during stay-at-home or shelter-inplace orders. ...
Article
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Pandemic coronavirus disease 2019 (COVID-19) may lead to significant mental health stresses, potentially with modifiable risk factors. We performed an internet-based cross-sectional survey of an age-, sex-, and race-stratified representative sample from the US general population. Degrees of anxiety, depression, and loneliness were assessed using the 7-item Generalized Anxiety Disorder-7 scale (GAD-7), the 9-item Patient Health Questionnaire, and the 8-item UCLA Loneliness Scale, respectively. Unadjusted and multivariable logistic regression analyses were performed to determine associations with baseline demographic characteristics. A total of 1,005 finished surveys were returned of the 1,020 started, yielding a completion rate of 98.5% in the survey panel. The mean (standard deviation) age of the respondents was 45 (16) years, and 494 (48.8%) were male. Overall, 264 subjects (26.8%) met the criteria for an anxiety disorder based on a GAD-7 cutoff of 10; a cutoff of 7 yielded 416 subjects (41.4%), meeting the clinical criteria for anxiety. On multivariable analysis, male sex (odds ratio [OR] = 0.65, 95% confidence interval [CI] [0.49, 0.87]), identification as Black (OR = 0.49, 95% CI [0.31, 0.77]), and living in a larger home (OR = 0.46, 95% CI [0.24, 0.88]) were associated with a decreased odds of meeting the anxiety criteria. Rural location (OR 1.39, 95% CI [1.03, 1.89]), loneliness (OR 4.92, 95% CI [3.18, 7.62]), and history of hospitalization (OR = 2.04, 95% CI [1.38, 3.03]) were associated with increased odds of meeting the anxiety criteria. Two hundred thirty-two subjects (23.6%) met the criteria for clinical depression. On multivariable analysis, male sex (OR = 0.71, 95% CI [0.53, 0.95]), identifying as Black (OR = 0.62, 95% CI [0.40, 0.97]), increased time outdoors (OR = 0.51, 95% CI [0.29, 0.92]), and living in a larger home (OR = 0.35, 95% CI [0.18, 0.69]) were associated with decreased odds of meeting depression criteria. Having lost a job (OR = 1.64, 95% CI [1.05, 2.54]), loneliness (OR = 10.42, 95% CI [6.26, 17.36]), and history of hospitalization (OR = 2.42, 95% CI [1.62, 3.62]) were associated with an increased odds of meeting depression criteria. Income, media consumption, and religiosity were not associated with mental health outcomes. Anxiety and depression are common in the US general population in the context of the COVID-19 pandemic and are associated with potentially modifiable factors.
... Subsequently, gardening activities have been widely studied as potential methods of restoration from stress and negative mood, or as therapeutic interventions (e.g., horticultural therapy) for people suffering mental health-related difficulties (e.g., [38][39][40]). Significant reductions in stress, fatigue and depressive symptoms in the context of gardening activities have also been reported [41,42]. Recent meta-analytic research documents considerable evidence for the positive effects of gardening on both physical and mental health, after adjusting for publication bias [43]. ...
Article
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The financial and health burdens of stress associated with increased urbanization have led to a demand for mental health enhancement strategies. While some extant literature details mental health benefits of community gardening, a coherent narrative on the construct of resilience and its relationship with the mental health benefits of community gardening is lacking. The present study examined the relationship between community gardening and a number of mental health benefits, in the forms of subjective well-being, stress, resilience potentials, and resilience factors (self-esteem, optimism, and openness). A total of 111 residents in Singapore completed a survey. Results from Multivariate Analysis of Covariance (MANCOVA) and Pearson's correlation analyses show that, after controlling for age and levels of connection to nature, community gardeners reported significantly higher levels of subjective well-being than individual/home gardeners and non-gardeners, indicating that engagement in community gardening may be superior to individual/home gardening or non-gardening outdoor activities. Community gardeners reported higher levels of resilience and optimism than the non-gardening control group. These novel results indicate some potential for mental health benefits in urban environments, specifically in terms of subjective well-being and resilience. These findings have implications for future research in clinical psychology, mental health promotion, and policy.
... Recreation also contributes an individual, community and nations welfare [7] and can reduce depression [8]. Recreation also includes the development of knowledge, skills, knowledge, and attitudes. ...
... Physiological, psychological and social benefits of participating in outdoor recreation are well established in literature (e.g., [17][18][19][20][21][22][23]). Outdoor recreation participation is related to lower depression scores among individuals with disabilities [24] and among individuals over 65 years of age [25]. It reduces the stress level [21] and annoyances resulting from city noise [18,26] and gives a feeling of peace and tranquility [27,28]. ...
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Although outdoor recreation participation has been studied extensively, little research has come from less developed regions of the world. This paper examined outdoor recreation participation and its predictors in Istanbul, an increasingly urbanized and populated megacity, in Turkey. The results show that nearly half of the people interviewed in this study had claimed to visit a nature area at least once a week or more often, nearly three-quarters invested a travel time to these areas of between 30 min to 2 h, about two-thirds spent more than 2 h at the area, and about one-third was engaged in leisurely walking. The frequency of visits was almost the single predictor of travel time. Visit frequencies were predicted by the travel time and visit length. Activity type and traveling longer than 2 h predicted the length of visits. Recreational activity type was predicted by visit length and travel time. Socio-demographic variables were associated with only a few outdoor participation variables. The findings imply that the residents have limited contact with nature and limited opportunity to benefit from such interaction.
... Studies were also heavily represented by small sample sizes, with eight of the 13 studies including 20 participants or less, which is appropriate for many qualitative approaches. (2015), Ewert (1988) Butler-Collins (2017), Christensen, Wilson, and Holt (2013), Gathright, Yamada, and Morita (2006), Korpela et al. (2014), Li et al. (2012), Mang (1985), Morrow, Rodriguez, and King (2017), Vella, Milligan, and Bennett (2013), Weng and Chiang (2014), Wilson and Christensen (2012), Wolsko and Lindberg (2013), Zebrack, Kwak, and Sundstrom (2017) Natural Green-Spaces 8 Irani (1996), Jakubec et al. (2016) Buchecker and Degenhardt (2015) Hartig, Kaiser, and Strumse (2007), Harris (1996) Table Formatting (Stern, Powell, and Hill 2014). *Some sources operationalized nature-based recreation in multiple ways. ...
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The demand for mental health services around the world has risen dramatically. Many researchers and practitioners are looking for alternative mental health treatments, including nature-based recreation. However, reviews examining nature-based recreation’s therapeutic effectiveness are limited. The purpose of this study was to conduct a systematic review of available research regarding the potential mental-health benefits of nature-based recreation. Following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines, a global standard established to ensure consistency and quality in literature reviews, a systematic search generated 51 articles for review. Most articles (n = 46, 90%) observed at least one positive association between nature-based recreation and mental health, including improvements in affect, cognition, restoration, and well-being, and decreases in anxiety and depression symptoms. Trends regarding the setting, population, methodology, and theoretical orientation of existing research, as well as recommendations for future research, are discussed in this review.
... Moreover, a growing body of research focusing specifically upon how gardening and horticultural activity may promote positive impacts on mental illhealth has emerged in recent years (Fieldhouse, 2003;Rappe et al, 2008;Wilson & Christensen, 2011). For example, a study by Gonzalez, Hartig, Patil, Martinsen (2009), suggested a restorative effect underpinned changes in depression severity and perceived attentional capacity outcomes for clinically depressed adults as a result of a therapeutic horticultural program. ...
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An increasingly robust evidence base supports the therapeutic value of nature on mental health and wellbeing. The rise in reported mental ill-health across the world has major implications for the effective use of healthcare budgets, as well as economic consequences. Health practitioners may need to consider going beyond traditional mental health service provision and look to more widespread engagement with community-based interventions. This is especially important given that the structured nature of service provision may present significant challenges for some people with mental ill-health (MIND, 2016). Thus, this study explored the experiences of volunteers with mental health problems attending an unorthodox center in a woodland setting within the North West of England, which seeks to promote health and wellbeing through green exercise. An ethnographic approach, involving the use of fieldwork diaries and photographs, explored the center’s informal and unique physical and socio-cultural environment. Formally researching as outsiders on participants was deemed incongruent with the empowering ethos of the center. Following a six-week relationship building period, in which the researchers immersed themselves in the practical activities, individual fieldwork interviews were conducted with each of the volunteers (n=11). Transcribed data revealed three key themes underpinning the self-reported positive impacts on personal mental health and wellbeing. The importance of the physical and social environment was paramount, whereby volunteers recognized the restorative effects of the natural environment, but also stressed the flexible, informal and ‘no nonsense’ ethos of the center, combined with the social support, as major factors in delivering positive health outcomes. The clear sense of purpose and meaning underpinning activity choice/participation, and the feeling of togetherness this fostered, were also major influences. Using existing skills and developing new ones demonstrated the power of occupational engagement in enhancing enjoyment, achievement and overall contribution. Recognition of the influence of the context and structure of services on people’s ability to engage in therapeutic activities is therefore crucial in order to enable people to access support in their mental health recovery. Key words: mental ill-health; natural environment; mental wellbeing; green exercise, occupation; volunteers.
... However, a growing number of quantitative studies involving diverse populations and a host of different gardening and horticultural activities have, in general, reported improvements in mental health status of study subjects (Clatworthy et al., 2013). More specifically, studies have reported reductions in anxiety (Lee et al., 2004;Kam and Siu, 2010;Gonzalez et al., 2011b), depression (Gonzalez et al., 2011a;Wilson and Christensen, 2011), negative mood state (Wichrowski et al., 2005;Kam and Siu, 2010;Van Den Berg and Custers, 2011), and perceived stress (Kam and Siu, 2010;Yun and Choi, 2010;Kotozaki et al 2015). As foreseen by Kaplan in her seminal study (1973), interactions with or immersion in nature and natural areas can similarly lead to reductions in anxiety, depression, mood state disorders, and perceived stress, as well as improvements in self-esteem, directed attention, and cognition (Berman et al., 2008;Annerstedt and Wahrborg, 2011;Coon et al., 2011;Keniger et al., 2013). ...
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Plants provide people with vital resources necessary to sustain life. Nutrition, vitamins, calories, oxygen, fuel, and medicinal phytochemicals are just a few of the life-supporting plant products, but does our relationship with plants transcend these physical and biochemical products? This review synthesizes some of the extant literature on people-plant interactions, and relates key findings relevant to space exploration and the psychosocial and neurocognitive benefits of plants and nature in daily life. Here, a case is made in support of utilizing plant-mediated therapeutic benefits to mitigate potential psychosocial and neurocognitive decrements associated with long-duration space missions, especially for missions that seek to explore increasingly distant places where ground-based support is limited.
... Chronic illness can lead to depression, which can worsen a person's overall health (Moussavi et al., 2007). Research has found gardening can help to reduce depression in individuals with disabilities and increase overall life satisfaction (Waliczek et al., 2005;Wilson and Christensen, 2011). ...
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In the last quarter century, the epidemic of overweight and obese Americans has increased strikingly. This, in turn, has caused a substantial rise in the risk of cardiovascular diseases, cholesterol, hypertension, osteoarthritis, stroke, type II diabetes, specific forms of cancer, and other diseases. The main purpose of this research was to investigate the influence of gardening activities on activity levels, body mass index (BMI), allergies, and reported overall health of gardeners and nongardeners. The sample population was drawn from two sources: an online survey and an identical paper-pencil formatted survey, which was distributed to church, garden, and community service groups within Texas and parts of the midwestern United States. A total of 1015 people participated in the study. Results from this study indicated nongardeners were less physically active when compared with gardeners. However, frequency of gardening did not have a statistically significant impact on gardeners’ BMI. There was also no difference in BMI between gardeners and nongardeners. Gardeners indicated having more frequently reoccurring symptoms for “ear infection/ear ache,” “high cholesterol,” “kidney stone,” “gallstones,” and “arthritis,” indicating gardening may be being used as a distraction therapy, helping gardeners to cope with pain and remain active when other forms of exercise may not be an option. There was no statistically significant difference in incidence of allergies between gardeners and nongardeners. © 2016, American Society for Horticultural Science. All rights reserved.
... Moreover, a growing body of research focusing specifically upon how gardening and horticultural activity may promote positive impacts on mental illhealth has emerged in recent years (Fieldhouse, 2003;Rappe et al, 2008;Wilson & Christensen, 2011). For example, a study by Gonzalez, Hartig, Patil, Martinsen (2009), suggested a restorative effect underpinned changes in depression severity and perceived attentional capacity outcomes for clinically depressed adults as a result of a therapeutic horticultural program. ...
... Bird, 2007 andLouv, 2012) with numerous studies emphasizing the positive effects of nature on health (Selhub & Logan, 2012;Hartig, 2008). Excluding the work by Wilson and Christensen (2012) who explored the effect of outdoor recreation on depression in persons with disabilities, and work exploring the mental health benefits of therapeutic gardening (e.g. Parr, 2007); however, there is a paucity of literature specific to nature inclusion, disability, caregiving and mental well-being. ...
Chapter
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Purpose - The benefits of green space and nature are increasingly recognized and translated into public health policy and practice. Alongside this trend, inclusion of all people into parks and nature has been an important area of parks and recreation practice. Nature inclusion for those with disabilities, youth, seniors and immigrants has become a focus of Alberta Parks in collaboration with the Ministry of Tourism Parks and Recreation in Western Canada. This study was designed to examine the experiences of participants in two such governmentsupported inclusive nature activities, including day trips and more extensive week-end or week-long nature experiences for adults with disabilities and caregivers.
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The purpose of this qualitative study was to explore perceived constraints of structured outdoor recreation experiences for students attending a Historically Black College/University (HBCU). Data were collected from four focus group sessions. Grounded Theory was used to analyze the data and from an analysis of data, four themes emerged: 1. Family impact, 2. Companionship, 3. Social media and technology, and 4. HBCU and Black American cultures. This study confirmed the importance of social companionship and the need for relevant marketing strategies as motivators for Black student participation in outdoor recreation activities at this HBCU. A common thread among the groups, was the perception of Whiteness in outdoor spaces and its negative impact on outdoor recreation involvement.
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The literature presents consistent results concerning the positive effect of restorative environments on the recovery of psychophysiological stress and attention fatigue. However, there is a need for studies addressing specific population groups. This study developed a systematic review to identify the main findings about the effect of restorative environments in people with disabilities. The scarcity of publications was verified, as well as the lack of research in developing countries. Some studies showed the occurrence of restoration in people with disabilities. We suggest the development of experimental research taking into account other senses, such as hearing and touch.
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The report is part of the project Accessible and inclusive nature-based tourism, more information about the project can be found here: https://www.miun.se/Forskning/forskningsprojekt/pagaende-forskningsprojekt/tillgangliga-och-inkluderande-naturmiljoer/. The purpose of the project has been to increase accessibility among nature-based tourism companies and public organizations that work to develop tourism and outdoor recreation for people with disabilities.
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In recent years, children’s use of mobile phones has grown rapidly, which might lead to an increase in mental stress and negatively affect their health. Despite increasing evidence that horticultural activity can provide significant health benefits, few scientific evidence-based studies are currently available regarding these benefits to children’s health and wellbeing in schools. Therefore, this study aims to determine the potential benefits of horticultural activity for children from both psychological and physiological perspectives. Twenty-six elementary school students (mean age, 8.12 ± 0.21 years) were asked to perform a plant-related task and a mobile game task for 5 min. During both tasks, physiological sensors were used to measure the participants’ heart rate variability, skin conductance, and skin temperature. Additionally, the participants’ emotional responses were assessed using semantic differential and State–Trait Anxiety Inventory tests immediately after each task. Results revealed that, compared with the mobile game task, participants’ health statuses were positively correlated with the horticultural task, including a considerable decrease in skin conductance and sympathetic nervous activity, together with a marginal increase in parasympathetic nervous activity. Such responses suggested that horticultural activity increased relaxation and decreased feelings of stress. Furthermore, the horticultural activity was associated with a substantial increment in comfort, naturalness, relaxation, and cheerfulness feelings, as well as a significant reduction in depression and a reduction in total anxiety levels. Given these positive benefits, horticultural activity may provide a great contribution to children’s healthy life at school, prompt psychological relaxation and minimize mental stress relative to smartphone games.
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There is growing attention to findand popularize untypical forms of therapy which should help patients in hospitals, occupational facilities and clinics. The main aim of the article is to show the differences between horticultural therapy as a form of therapy and work in a garden, which can also provide therapeutic results. Comparison of different determinants was a method to outline that proper understanding of the differences may be beneficialboth for theoreticians and practitioners who use nature in order to improve their patients’ health. However, it is useful for future teachers and could play a role in the teacher education process. As a conclusion, it has been established that source literature scientificreports focus rather on potential recipients or benefitswhich come from this form of therapy, whereas basic differences between gardening and horticultural therapy have been rarely mentioned. Analysis has helped to observe that there are many factors which differentiate therapeutic work in the garden from work in the garden which can bring therapeutic effects. Performing such an analysis seems to be significantin connection with the growing popularity of centers which offer this kind of therapy, and with the emergent dilemmas concerning how it differs from gardening and whether the therapy is worth the money invested in it.
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Long-term care facilities seek ways to enhance the quality of life for residents. Cycling Without Age (CWA), a new international cycling program, is gaining momentum for older adults. This study explored resident riders’ and trishaw pilots’ lived experience of their participation in the CWA program using a qualitative approach at a long-term care facility in the United States. Researchers conducted 27 face-to-face, semi-structured interviews with riders and pilots. For resident riders, the three themes identified included (a) breath of fresh air; (b) wave, chat, and remember; and (c) sit back and relax. Two themes were identified for the pilots: (a) change in frame of mind, and (b) mental and physical rewards. CWA can be as a new strategy for person-centered care. The CWA program provides nursing an opportunity to advocate, recommend, and obtain an order for residents to participate in the program.
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Background: There is a growing interest in research investigating the association between green space (GS) and mental health and wellbeing (HWB), in order to understand the underlying mechanisms. Accordingly, there is a need to map the literature and create an overview of the research. Methods: A scoping review approach was used to map literature on GS, including context and co-exposures (the GS exposome), and their associations with mental HWB. The review considers mental HWB definitions and measurements and how GS is characterized. Furthermore, the review aims to identify knowledge gaps and make recommendations for future research. Results: We identified a great diversity in study designs, definitions, outcome measures, consideration of the totality of the GS exposome, and reporting of results. Around 70% of the 263 reviewed studies reported a positive association between some aspect of GS and HWB. However, there is a limited amount of research using randomized controlled crossover trails (RCTs) and mixed methods and an abundance of qualitative subjective research. Conclusions: The discords between study designs, definitions, and the reporting of results makes it difficult to aggregate the evidence and identify any potential causal mechanisms. We propose key points to consider when defining and quantifying GS and make recommendations for reporting on research investigating GS and mental HWB. This review highlights a need for large well-designed RCTs that reliably measure the GS exposome in relation to mental HWB.
Conference Paper
This exploratory research project explores the mobility challenges of outdoor navigation and way-finding, through the lens of the person with a disability. Obstacles in social participation and human interaction with technology within the urban environment are salient issues driving this research study about mobility and accessibility when navigating urban parks. People with disabilities, specifically those with mobility limitations, such as people in motorized wheelchairs, have particular needs that must be addressed to maximize social participation within in the urban environment and involvement in leisure activities. This study examines the physical environment and social activities that occur in a typical leisure filled day at the park, what obstacles hamper navigation, and what issues emerge from the perspective of the person with the disability. The study data collection proceeds from a constructivist perspective using a participatory approach (Living Lab), wherein researchers and participants collaborated together to create the activity and also to assess its success post activity. Data collection tools included walkabouts, recording conversation in real time, and discussions both before and after the research activity. The study is presented with examples, and the emergent issues help reveal opportunities for potential ways to both respond to mobility challenges and integrate way-finding, as a means for future development of mobility and navigational tools for better accessibility and enjoyment of social activities within the urban park environment.
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ADDITIONAL INDEX WORDS. depressive symptoms, elderly, plants, nature, out-doors, institutional care, human issues in horticulture SUMMARY. Depression is a major health problem among the elderly. Its prevalence is high among those in long-term care. Exposure to the garden environment may alleviate depressive symptoms, but there is little research evidence to confi rm this hypothesis. In this study we investigated the perceived effects and meanings related to garden visits among older individuals living in long-term care and assessed whether there are associations between experi-ences from garden visits and self-rated depression. Data were gathered by surveying 30 elderly people living in Kustaankartano, a nursing home and service center for elderly people in Helsinki, Finland. Prevalence of self-rated depression was high; 46% of the participants were depressed. Both being in the garden and seeing it from the balcony and observing nature were of great signifi cance for most of the participants. For more than half of the participants, visiting the garden improved mood, quality of sleep, and ability to concentrate; it generated feelings of recovery and promoted peace of mind. Affective effects of visiting the garden tended to be more pronounced among the depressed than among those not depressed. The depressed did not consider social interaction and participation in social activities very important for their well-being. Depression tended to be related to perception of the residents that they experienced hindrances and distresses associated with visiting the garden. Although there were indica-tive differences between the depressed and nondepressed participants in garden experiences, the results suggest that visiting the garden may affect the subjective well-being of both groups positively.
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Objective. —A consensus conference on the reasons for the undertreatment of depression was organized by the National Depressive and Manic Depressive Association (NDMDA) on January 17-18, 1996. The target audience included health policymakers, clinicians, patients and their families, and the public at large. Six key questions were addressed: (1) Is depression undertreated in the community and in the clinic? (2) What is the economic cost to society of depression? (3) What have been the efforts in the past to redress undertreatment and how successful have they been? (4) What are the reasons for the gap between our knowledge of the diagnosis and treatment of depression and actual treatment received in this country? (5) What can we do to narrow this gap? (6) What can we do immediately to narrow this gap?
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Despite recent interest in healing gardens and therapeutic landscapes at residential care facilities, few empirical studies have measured health outcomes in elderly populations. This study explored methods for assessing psychological and physiological outcomes associated with natural environments. Seventeen residents ranging from 71 to 98 years of age (mean 84.7) engaged in the same activities at an outdoor horticultural garden or indoor classroom. Before and after the experience, subjects were assessed for positive and negative mood, anxiety, and salivary cortisol. No significant change was found in mood or anxiety level. Cortisol was significantly lower in the garden environment compared with the indoor settings, indicating greater reduction in stress level. This pilot study supports previous research finding health-related outcomes associated with brief exposure to natural environments.
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Children growing up in the inner city are at risk of academic underachievement, juvenile delinquency, teenage pregnancy, and other important negative outcomes. Avoiding these outcomes requires self-discipline. Self-discipline, in turn, may draw on directed attention, a limited resource that can be renewed through contact with nature. This study examined the relationship between near-home nature and three forms of self-discipline in 169 inner city girls and boys randomly assigned to 12 architecturally identical high-rise buildings with varying levels of nearby nature. Parent ratings of the naturalness of the view from home were used to predict children's performance on tests of concentration, impulse inhibition, and delay of gratification. Regressions indicated that, on average, the more natural a girl's view from home, the better her performance at each of these forms of self-discipline. For girls, view accounted for 20% of the variance in scores on the combined self-discipline index. For boys, who typically spend less time playing in and around their homes, view from home showed no relationship to performance on any measure. These findings suggest that, for girls, green space immediately outside the home can help them lead more effective, self-disciplined lives. For boys, perhaps more distant green spaces are equally important.
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Depression and anxiety are prevalent among adults with disabilities. However, little is known regarding the geographic variability of depression and anxiety among adults with disabilities in the United States. We estimated prevalence of current depression, lifetime diagnoses of depression (LD), and lifetime diagnoses of anxiety (LA) among adults with disabilities by state, metropolitan and micropolitan statistical area (MMSA), and county. We analyzed Behavioral Risk Factor Surveillance System data from 2006 for 41 states and territories, 74 MMSAs, and 112 counties. Stratified analyses by sociodemographic and health status variables were performed for the 10 MMSAs with the highest estimates of current depression, LD, and LA, respectively. Current depressive symptoms were assessed with the Patient Health Questionnaire-8. Estimates of current depression, LD, and LA among adults with disabilities varied substantially by state, MMSA, and county. Current depression estimates ranged from 14.7% in North Dakota to 30.1% in Mississippi; from 8.4% in San Francisco-Oakland-Fremont, CA, to 36.2% in Jacksonville, FL; and from 12.3% in Cumberland County, ME, to 44% in Orleans Parish, LA. There was major variation within some states (e.g., prevalence of current depression was 8.4% in San Francisco-Oakland-Fremont, CA compared to 25.5% in Los Angeles-Long Beach-Glendale, CA). In the 10 MMSAs with the highest estimates, estimates varied by age, gender, socioeconomic status, and health status. Public and mental health agencies may find these estimates useful for program planning purposes to address depression and anxiety among adults with disabilities.
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This study aimed to assess changes in psychological distress and social participation in adults diagnosed with clinical depression during and after participating in a therapeutic horticulture programme, and to investigate if the changes covaried with levels of group cohesiveness during the intervention. An intervention with a single-group design was repeated with different samples in successive years (pooled n = 46). In each year, five groups of 3-7 participants went through the intervention. Data were collected before, twice during, and immediately after a 12-week therapeutic horticulture programme, as well as at 3-months' follow up. Mental health assessments included the Beck Depression Inventory, the State Subscale of Spielberger State-Trait Anxiety Inventory, the Positive Affect Scale from the Positive and Negative Affect Scale, the Perceived Stress Scale, and the Therapeutic Factors Inventory-Cohesiveness Scale. The analysis of the pooled data confirmed significant beneficial change in all mental health variables during the intervention. Change from baseline in depression severity persisted at 3-months' follow up. Increased social activity after the intervention was reported for 38% of the participants. The groups quickly established strong cohesiveness, and this continued to increase during the intervention. The average level of group cohesiveness correlated positively, but not significantly, with change in all mental health outcome variables.
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Two studies with single-group design (Study 1 N = 18, Study 2 N = 28) addressed whether horticultural activities ameliorate depression severity and existential issues. Measures were obtained before and after a 12-week therapeutic horticulture program and at 3-month follow-up. In both studies, depression severity declined significantly during the intervention and remained low at the follow-up. In both studies the existential outcomes did not change significantly; however, the change that did occur during the intervention correlated (rho > .43) with change in depression severity. Participants' open-ended accounts described the therapeutic horticulture experience as meaningful and influential for their view of life.
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This paper is a report of a study conducted to assess change in depression severity, perceived attentional capacity and rumination (brooding) in individuals with clinical depression during a therapeutic horticulture programme and to investigate if the changes were mediated by experiences of being away and fascination. Individuals with clinical depression suffer from distortion of attention and rumination. Interventions can help to disrupt maladaptive rumination and promote restoration of depleted attentional capacity. A single-group study was conducted with a convenience sample of 28 people with clinical depression in 2009. Data were collected before, twice during, and immediately after a 12-week therapeutic horticulture programme, and at 3-month follow-up. Assessment instruments were the Beck Depression Inventory, Attentional Function Index, Brooding Scale, and Being Away and Fascination subscales from the Perceived Restorativeness Scale. Mean Beck Depression Inventory scores declined by 4.5 points during the intervention (F = 5.49, P = 0.002). The decline was clinically relevant for 50% of participants. Attentional Function Index scores increased (F = 4.14, P = 0.009), while Brooding scores decreased (F = 4.51, P = 0.015). The changes in Beck Depression Inventory and Attentional Function Index scores were mediated by increases in Being Away and Fascination, and decline in Beck Depression Inventory scores was also mediated by decline in Brooding. Participants maintained their improvements in Beck Depression Inventory scores at 3-month follow-up. Being away and fascination appear to work as active components in a therapeutic horticulture intervention for clinical depression.
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Although depressive symptoms in older persons are common, their association with disability burden is not well understood. The authors evaluated the association between level of depressive symptoms and severity of subsequent disability over time and determined whether this relationship differed by sex. Participants included 754 community-living persons aged 70 years or older who underwent monthly assessments of disability in four essential activities of daily living for up to 117 months. Disability was categorized each month as none, mild, and severe. Depressive symptoms, assessed every 18 months, were categorized as low (referent group), moderate, and high. Multinomial logit models invoking Generalized Estimating Equation were used to calculate odds ratios and 95% confidence intervals. Moderate (odds ratio = 1.30; 95% confidence interval: 1.18-1.43) and high (odds ratio = 1.68; 95% confidence interval: 1.50-1.88) depressive symptoms were associated with mild disability, whereas only high depressive symptoms were associated with severe disability (odds ratio = 2.05; 95% confidence interval: 1.76-2.39). Depressive symptoms were associated with disability burden in both men and women, with modest differences by sex; men had an increased likelihood of experiencing severe disability at both moderate and high levels of depressive symptoms, whereas only high depressive symptoms were associated with severe disability in women. Levels of depressive symptoms below the threshold for subsyndromal depression are associated with increased disability burden in older persons. Identifying and treating varying levels of depressive symptoms in older persons may ultimately help to reduce the burden of disability in this population.
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In the treatment of Major Depressive Disorder (MDD), Behavioral Activation Therapy (BA)has emerged in recent years as an efficacious intervention. Derived from a component analysis of CBT, it offered at once a parsimonious explanation for the active ingredient of CBT, while demonstrating clinical efficacy as a separate treatment. Since the original investigation by Jacobson and colleagues in 1996, several well-controlled studies have been conducted, allof which converge to suggest strong support for BA as a stand-alone therapy for MDD. In this paper we review, evaluate and classify the evidence pertinent to this intervention and provide recommendations concerning its standing as a front line treatment. We conclude that the evidence is strong, the quality of research is generally very good and the effects sizes are compelling. Through both a qualitative and meta-analytic review of this evidence we also suggest the typesof future studies that will establish greater confidence in BA as a front line treatment of choice therapy for Major Depressive Disorder.
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Depression may affect up to 10% of the population, with symptoms recurring in half of affected people. In mild to moderate depression, there is no reliable evidence that any one treatment is superior in improving symptoms of depression, but the strength of evidence supporting different treatments varies. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of psychological treatments, and of interventions to reduce relapse rates, in mild to moderate or severe depression? What are the effects of psychological interventions to improve delivery of treatments in mild to moderate or severe depression? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 55 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: befriending, care pathways, cognitive therapy, combining antidepressant drugs and psychological treatments, interpersonal psychotherapy, non-directive counselling, problem-solving therapy, relapse prevention programme.
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Our objective was to examine the extent to which serious psychological distress (SPD) is associated with behavioral and social correlates among US adults with self-reported disabilities. Self-reported data on disability, SPD, and behavioral and social correlates were collected from 202,383 participants (aged > or = 18 years) of the 2007 Behavioral Risk Factor Surveillance System. Adults with self-reported disabilities were identified using two standardized questions--one relating to activity limitation, the other to special equipment. The age-adjusted prevalence of SPD among adults with disabilities was nearly seven times higher than among adults without disabilities (14.1 % vs. 1.8 %, respectively). Adults with disabilities who have both activity limitations and who use assistive technology, and those with activity limitations only consistently experienced a higher prevalence of SPD than those who used assistive technology only (age-adjusted prevalence: 21.0 % and 12.7 % vs. 4.9 %). After adjusting for age, sex, race/ethnicity, educational attainment, marital status, and employment status, in the past 30 days SPD was more common among Hispanic persons, and was significantly associated with younger age, lower educational attainment, marital history, and employment status. Adults with SPD and disabilities experienced increased levels of risk behaviors, life dissatisfaction, and inadequate social support. Most importantly, just over half of adults with disabilities and SPD (51.6 % [95 % CI = 48.6-54.6]) were receiving medical care for a mental health condition compared to 20.6 % (95 % CI = 19.9-21.3) without SPD. Given that SPD is strongly associated with both the behavioral and psychosocial determinants of health, this work underscores the need for evidence-based interventions that may reduce its prevalence among people living with disabilities.
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The identification of various individual, social and physical environmental factors affecting physical activity (PA) behavior in Canada can help in the development of more tailored intervention strategies for promoting higher PA levels in Canada. This study examined the influences of various individual, social and physical environmental factors on PA participation by gender, age and socioeconomic status, using data from the 2002 nationwide survey of the Physical Activity Monitor. In 2002, 5,167 Canadians aged 15-79 years, selected by random-digit dialling from household-based telephone exchanges, completed a telephone survey. The short version of the International Physical Activity Questionnaire was used to collect information on total physical activity. The effects of socio-economical status, self-rated health, self-efficacy, intention, perceived barriers to PA, health benefits of PA, social support, and facility availability on PA level were examined by multiple logistic regression analyses. Self-efficacy and intention were the strongest correlates and had the greatest effect on PA. Family income, self-rated health and perceived barriers were also consistently associated with PA. The effects of the perceived health benefits, education and family income were more salient to older people, whereas the influence of education was more important to women and the influence of perceived barriers was more salient to women and younger people. Facility availability was more strongly associated with PA among people with a university degree than among people with a lower education level. However, social support was not significantly related to PA in any subgroup. This study suggests that PA promotion strategies should be tailored to enhance people's confidence to engage in PA, motivate people to be more active, educate people on PA's health benefits and reduce barriers, as well as target different factors for men and women and for differing socio-economic and demographic groups.
Book
The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades. Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research. The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society. © 2007 by the National Academy of Sciences. All rights reserved.
Article
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
Article
Self-rated health status has been found to be an independent predictor of morbidity and mortality, and racial/ethnic disparities in self-rated health status persist among the U.S. adult population. Black and Hispanic adults are more likely to report their general health status as fair or poor compared with white adults. In addition, the prevalence of disability has been shown to be higher among blacks and American Indians/Alaska Natives (AI/ANs) (3). To estimate differences in self-rated health status by race/ethnicity and disability, CDC analyzed data from the 2004-2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report summarizes the results of that analysis, which indicated that the prevalence of disability among U.S. adults ranged from 11.6% among Asians to 29.9% among AI/ANs. Within each racial/ethnic population, adults with a disability were more likely to report fair or poor health than adults without a disability, with differences ranging from 16.8 percentage points among Asians to 37.9 percentage points among AI/ANs. Efforts to reduce racial/ethnic health disparities should explicitly include strategies to improve the health and well being of persons with disabilities within each racial/ethnic population.
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In Japan, Horticultural activity improves the quality of life for all people by beautifying neighborhoods, stimulating social inter-action, producing nutritious food, encouraging selfreliance, conserving resources, and creating opportunities for recreation and education. However, the psychological effects of horticultural activities in community based programs have not been, discussed in as far as they provide useful tools to improve quality of life. In this study, subjects (61 in total, 22 men and 39 women, mean age=46) were engaged in activities related to horticulture: active participation involved planting non-flowering pansy plants while passive participation involved observing a community garden. One group engaged in active participation was given 2 h to garden while two other groups were given 6 h to complete their Horticultural Activity (HA). POMS data for all groups was collected both before and after of their gardening activities. The 6 h HA group members in experiment 3 filled out the POMS form 2 h into the activity in addition the before and after inventories. The overall POMS score for 2 h of horticultural activity was significantly higher than that of simply observing for 2 h. The greatest psychological effects were found among the group that engaged in 2 h of horticultural activity. The result suggests that 2 h of horticultural activity induces the best psychological effects. Thus, the POMS scores indicate that horticultural activities have positive psychological effects under suitable conditions. These findings indicate that horticultural activity improves mood state, suggesting that it may be a useful tool for community based programs aiming to reduce stress. Therefore, to the extent that horticultural activities contribute to community residents' stress reduction, these findings support the role of horticultural activity as an effective component of community based programs. A principal goal for community based programs is establishing the conditions that will encourage individuals to participate. The benefits of stress reduction gained from 2 h of horticultural activity may be an important condition for sustainable participation.
Article
• We evaluated, among depressed medical patients who are high utilizers of health care, whether improved vs unimproved depression is associated with differences in the course of functional disability. At baseline, 6 months, and 12 months, depression and disability were assessed among a sample of enrollees in health maintenance organizations (N = 145) in the top decile of users of ambulatory health care who exceeded the 70th percentile of health maintenance organization population norms for depression. Improved depression was defined as a reduction of at least one third in depressive symptoms averaged across the two follow-up times. At the 12-month follow-up, persons with severe-improved depression experienced a 36% reduction in disability days (79 days per year to 51 days per year) and a 45% reduction in disability score. Persons with moderateimproved depression experienced a 72% reduction in disability days (62 days per year to 18 days per year) and a 40% reduction in disability score. In contrast, persons with severe-unimproved depression reported 134 disability days per year at baseline, while persons with moderateunimproved depression reported 77 disability days per year at baseline. Neither group with unimproved depression showed improvement in either disability days or disability score during the 1-year follow-up period. High utilizers of health care with severe-unimproved depression were more likely to have current major depression and to be unemployed. Improved (relative to unimproved) depression was associated with borderline differences in the severity of physical disease and in the percent married. We conclude that depression and disability showed synchrony in change over time. However, depression and disability may show synchrony in change with disability because both depression and disability are controlled by some other factor that influences the chronicity of depression (eg, chronic disease or personality disorder). The finding of synchronous change of depression and disability provides a rationale for randomized controlled trials of depression treatments among depressed and disabled medical patients to determine whether psychiatric intervention might improve functional status in such patients. Such research is needed to determine whether there is a causal relationship between depression offset and reductions in functional disability.
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Depression in older adults contributes to decreased health, increased mortality and lower quality of life. As participation in outdoor recreation has been correlated with decreased depression levels among other populations, it is hypothesised that higher participation in outdoor recreation will be correlated with lower depression levels among older adults. In particular this study examined whether participation in outdoor recreation was associated with reported symptoms of depression among adults aged 65 years and older. To do so, regression, ANOVA and t-tests were used to examine an existing statewide survey of 1216 Montana, USA residents aged 65 years and older. The findings indicate a correlation between outdoor recreation participation and lower depression levels. Current major depression was more prevalent among individuals over 65 years of age who had not participated in outdoor recreation during the past year. The strongest negative correlation existed among individuals over 65 years of age who participated in outdoor recreation four or more times per week. Further study examining the causality of this relationship is suggested, given the significant potential to improve older adults' quality of life.
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• The prevalence of mental disorders (DSM-III-R Axes I and II) among adolescent suicide victims (n = 53) was investigated in a nationwide psychological autopsy study in Finland. The data were collected comprehensively through interviews of the victims' relatives and attending health care personnel and from official records. Following independent assessment by two psychiatrists, the DSM-III-R diagnoses were assigned in consensus meetings. A large majority of the victims (94%) suffered from a mental disorder. The most prevalent disorders were depressive disorders (51%) and alcohol abuse or dependence (26%). The prevalence of adjustment disorders (21%) was higher than in most studies from other countries. Personality disorder was diagnosed in 32% of the cases. Comorbidity was found in 51% of the victims. The results indicate a strong relatedness between adolescent suicide and the presence of depression, antisocial behavior, and alcohol abuse.
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Objective: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. Measurements: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. Results: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. Conclusion: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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The nine-item Patient Health Questionnaire depression scale is a dual-purpose instrument that can establish provisional depressive disorder diagnoses as well as grade depression severity.
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Three experiments were designed to test the hypothesis that exposure to restorative environments facilitates recovery from mental fatigue. To this end, participants were first mentally fatigued by performing a sustained attention test; then they viewed photographs of restorative environments, nonrestorative environments or geometrical patterns; and finally they performed the sustained attention test again. Only participants exposed to the restorative environments improved their performance on the final attention test, and this improvement occurred whether they viewed the scenes in the standardized time condition or in the self-paced time condition. Results are in agreement with Kaplan's [(1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15, 169–182] attention restoration theory, and support the idea that restorative environments help maintain and restore the capacity to direct attention.
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This article builds on environmental justice (EJ) research that examines the differential exposure of disadvantaged populations to environmental hazards and health resources. This article presents a multidisciplinary ecologic framework that postulates macro and meso-level determinants of health are operationalized through segregation and community zoning, planning, and development to create living conditions in urban landscapes. This article promotes the need for a more holistic approach to community health by defining communities as "human ecological systems" with health occurring across a continuum and at multiple scales. By modifying ecologic features of the environment, we can increase the capacity of disadvantaged communities to overcome their exposure to environmental hazards and enhance their access to health resources to achieve environmental justice and improve community health.
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Depression and anxiety are the most common psychiatric conditions in late life. Despite their prevalence, we know relatively little about their unique manifestation in older adults. And, Although the most common intervention for late-life depression and anxiety continues to be medication, research on psychosocial interventions for late-life depression and anxiety has burgeoned in the past several years. Unfortunately, this growing body of intervention research has yet to be widely translated into improved systems of care for late-life depression. This article is one step toward synthesizing the knowledge in this growing area of research. The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety. In addition, intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed. A brief description of various approaches to psychosocial intervention with anxious and/or depressed older adults is also presented.
Article
This retrospective study assessed the interacting relationships between child behavior problems, marital satisfaction, maternal depression, and family cohesion in 43 mothers and school-aged boys from a clinical sample. Mothers rated their child's behavior, marital satisfaction, level of depression, and perceived family cohesion. Results suggest that mothers with depressive symptoms report lower levels of marital satisfaction and higher levels of child behavior problems. Findings also suggest that maternal depression acts as a mediating mechanism for child behavior. In addition, marital dissatisfaction is related to lower levels of family cohesion. A discussion of the findings is presented, followed by implications for future research and clinical practice from a family systems perspective.
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This report reviews available evidence to illustrate that outdoor recreation can be used as a viable therapeutic medium for people with enduring mental health problems. It illustrates how outdoor recreation is in keeping with government mental health promotion strategies and that, if outdoor recreation is considered as an occupational role, it can facilitate positive self-identity and enhance quality of life for people with enduring mental health problems. The term ‘outdoor recreation’ encompasses activities that take place in an outdoor environment, including walking, hiking, orienteering and cycling, and more adventurous activities such as climbing, kayaking, canoeing and sailing.
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This study investigated the relationship between self-rated human health and outdoor recreation, comparing three categories of Swedish outdoor recreationists. Data were obtained from three different surveys, concerning outdoor recreation in all of Sweden, outdoor recreation in southern Swedish forests and hunting in all of Sweden. The influence of outdoor recreation on health was measured by comparing self-rated health in the current situation with a hypothetical situation where the possibility for outdoor recreation was suggested to be removed. The removal resulted in a reduction of average self-rated health in all three samples. The average reduction was significantly different between the samples. The results in this paper suggest that methods usually used in medical research can also be useful in the context of measuring the influence of outdoor recreation on human health.
Article
Depression and anxiety disorders are associated with excess disability. The authors searched the recent geriatric literature for studies associating late-life depression or anxiety with physical disability. Studies showed depression in old age to be an independent risk factor for disability; similarly, disability was found to be a risk factor for depression. Anxiety in late life was also found to be a risk factor for disability, although not necessarily independently of depression. Increased disability due to depression is only partly explained by differences in socioeconomic measures, medical conditions, and cognition. Physical disability improves with treatment for depression; comparable studies have not been done for anxiety. The authors discuss how these findings inform current concepts of physical disability and discuss the implications for future intervention studies of late-life depression and anxiety disorders.
Article
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Article
We compared psychophysiological stress recovery and directed attention restoration in natural and urban field settings using repeated measures of ambulatory blood pressure, emotion, and attention collected from 112 randomly assigned young adults. To vary restoration needs, we had half of the subjects begin the environmental treatment directly after driving to the field site. The other half completed attentionally demanding tasks just before the treatment. After the drive or the tasks, sitting in a room with tree views promoted more rapid decline in diastolic blood pressure than sitting in a viewless room. Subsequently walking in a nature reserve initially fostered blood pressure change that indicated greater stress reduction than afforded by walking in the urban surroundings. Performance on an attentional test improved slightly from the pretest to the midpoint of the walk in the nature reserve, while it declined in the urban setting. This opened a performance gap that persisted after the walk. Positive affect increased and anger decreased in the nature reserve by the end of the walk; the opposite pattern emerged in the urban environment. The task manipulation affected emotional self-reports. We discuss implications of the results for theories about restorative environments and environmental health promotion measures.
Article
EXECUTIVE SUMMARY: Physical inactivity, overweight, and obesity are growing national concerns owing to their associations with chronic diseases and overall well-being. Parks and recreation providers play a pivotal role in addressing these public health issues by providing the public with infrastructure that enables outdoor physical activity. Information about the health-related benefits of outdoor recreation can aid parks and recreation managers and policymakers in describing the benefits associated with recreation infrastructure and in their decision making regarding investments of scarce financial resources to provide high-quality recreation opportunities. Our analysis of county-level data for Oregon shows a measurable relationship between adult physical activity, overweight, obesity, and recreation supply and demand. The proportions of adults that are physically active are positively associated with the proportion of overweight adults, recreational trail densities, and the frequency of participation in recreational activities. The proportions of adults that are overweight are positively associated with the proportion of physically active adults, but negatively associated with hiking trail densities and frequency of participation in recreational activities. The proportions of adults that are obese, however, are negatively associated with frequency of participation in non-motorized trail-related recreational activities. The results of this macro-level model are consistent with information provided by micro-level analyses described in previous literature, in particular that the supply of and demand for recreation activities are associated with physically active people. In turn, counties comprising more active residents are associated with healthier counties as measured by the proportion of adults considered to be overweight. These macro-level relationships can be used by parks and recreation providers to indicate "at-risk" communities—those with low recreation supply and demand, and high proportions of overweight and obese people—and we provide an example using Oregon counties. Several policy recommendations emerge for parks and recreation providers based on our model results combined with evidence from the reviewed literature. First, parks and recreation providers should support the development of local recreation facilities, including non-motorized trails, and promote their use by providing information about them and other existing resources. Second, providers should promote the overall health benefits of being physically active via outdoor recreation. Third, providers should identify at-risk communities and allocate resources to these communities in developing and promoting recreation opportunities. We illustrate each of these recommendations with examples of how they are being addressed in Oregon.
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Recent research by a team from Deakin University explored the health and wellbeing benefits of civic environmentalism – voluntary communal actions undertaken to promote ecosystem sustainability, typified by membership of a ‘friends of parks’ group. The research confirmed what was known intuitively: that belonging to such a group and undertaking the activities associated with such a group exposes people not only to the benefits of the natural environment, but also to other people and to opportunities to make a contribution which is socially valued.On the basis of those findings, a pilot project involving intentional engagement of people suffering depression and related disorders in supported nature-based activities in a woodland environment is being implemented and evaluated. This article reports on that project and discusses the implications of its findings to date, and the findings of the three earlier projects, both for urban woodland/forest managers and for the health sector.As this contribution indicates, there appears to be potential for the use of civic environmentalism to promote health, wellbeing and social connectedness for individuals and the wider population, as well as for groups with identified health vulnerabilities. However, the realization of the benefits of such an approach will be dependent on co-operation between the environment and health sectors to create and promote opportunities for increased civic environmentalism, and to identify and address the barriers to their effective use.
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Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20%-30% of oncology patients. To determine the associations of pain and depression with health-related quality of life (HRQL), disability, and health care use in cancer patients. The Indiana Cancer Pain and Depression study is a randomized clinical trial comparing telecare management vs. usual care for patients with cancer-related pain and/or clinically significant depression. In this article, baseline data on patients enrolled from 16 urban or rural community-based oncology practices are analyzed to test the associations of pain and depression with HRQL, disability, and health care use. Of the 405 participants, 32% had depression only, 24% pain only, and 44% both depression and pain. The average Hopkins Symptom Checklist 20-item depression score in the 309 depressed participants was 1.64 (on 0-4 scale), and the average Brief Pain Inventory (BPI) severity score in the 274 participants with pain was 5.2 (on 0-10 scale), representing at least moderate levels of symptom severity. Symptom-specific disability was high, with participants reporting an average of 16.8 of the past 28 days (i.e., 60% of their days in the past four weeks) in which they were either confined to bed (5.6 days) or had to reduce their usual activities by 50% (11.2 days) because of pain or depression. Moreover, 176 (43%) participants reported being unable to work because of health-related reasons. Depression and pain had both individual and additive adverse associations with quality of life. Most patients were currently not receiving care from a mental health or pain specialist. Depression and pain are prevalent and disabling across a wide range of types and phases of cancer, commonly co-occur, and have additive adverse effects. Enhanced detection and management of this disabling symptom dyad is warranted.
Article
Clinically depressed persons suffer from impaired mood and distortion of cognition. This study assessed changes in depression severity and perceived attentional capacity of clinically depressed adults (N=18) during a 12-week therapeutic horticulture program. The Beck Depression Inventory (BDI) and Attentional Function Index (AFI) were administered at baseline, twice during (4 and 8 weeks), and immediately after the intervention (12 weeks), and at a 3-month follow-up. Experiences of being away and fascination related to the intervention were measured at 4, 8, and 12 weeks. The mean BDI score declined 9.7 points from pretest (27.3) to posttest (p < .001) and were clinically relevant (deltaBDI > or =6) for 72% of the cases. The mean AFI score increased 10.2 points from pretest (68.8) to posttest (p = .06). The greatest change in BDI and AFI scores occurred in the initial weeks of the intervention. The reduction in BDI scores remained significant and clinically relevant at the 3-month follow-up (N=16). The decline in depression severity during the intervention correlated strongly with the degree to which the participants found that it captured their attention. Therapeutic horticulture may decrease depression severity and improve perceived attentional capacity by engaging effortless attention and interrupting rumination.
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A summary of the main findings of a review of the literature on social and therapeutic horticulture – the use of horticulture and gardening to promote health, well-being and social inclusion among vulnerable people.
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It has been posited that depression and sedentary lifestyle have bidirectional relationships. Although the role of baseline physical activity as a risk factor for emerging depression has been recently reviewed, there has been no systematic review of the literature to assess the reverse relationship. We reviewed the results of longitudinal studies in the world's literature that have studied the effect of baseline depression on ensuing levels of physical activity. MEDLINE, PsycINFO, CINHAL Plus, Health Source: Nursing Academic Edition and Cochrane databases were searched from 1959 to 2008 with a focus on depression, sedentary lifestyle and exercise. Published longitudinal studies in English and more than 100 patients were included. Eleven studies met our inclusion criteria, eight of which reported that baseline depression was significantly associated with subsequent sedentary lifestyle or poor adherence to the physical exercise regimens recommended by physicians after a coronary event. However, the studies used different depression scales and physical activity outcome measures, and varied a great deal in the range of potential confounders they controlled for. In addition, there were only three studies that were specifically designed to assess the role of baseline depression on the subsequent level of physical activity. Baseline depression may be a significant risk factor for development of sedentary lifestyle or decreased level of physical exercise. Future studies should examine mechanisms by which depression may lead to decline in activity.
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The aim of this paper is to offer a conceptual framework for nature-based health promotion in nursing and provide related recommendations for future nursing research. Empirical data suggest that interaction with nature has direct health benefits. When people attend to outdoor habitats, gardens and other forms of nature, they are more likely to engage in physical activity and other behaviours that improve health. Engaging with nature can even cultivate ecological sensibilities that motivate us to protect the health of our planet. Multidisciplinary theoretical and research publications from 1985 to 2008 were examined in the development of the framework. As the health of our planet continues to deteriorate, there is a pressing need for theoretically informed, ethical, sustainable ways of engaging with nature to promote human and environmental health. We adapt principles and socio-ecological thinking from the fields of nursing, health promotion and ecological restoration to delineate the essential elements of the proposed framework. Implications for nursing. Although evidence-based knowledge about nature-based health promotion is not readily used in nursing and health care, its development and application are critical to designing effective strategies to strengthen both human and environmental health. Nurses can use nature-based health promotion concepts to work with citizens, health practitioners and policymakers to explore and optimize reciprocal, health promoting relationships among humans and the natural environment. To the extent that nurses integrate nature-based health promotion into their research efforts, we can expect to contribute meaningfully to both environmental and human health in communities across the globe.
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The purpose of this manuscript is to describe the associations among current depression, as measured by the Patient Health Questionnaire 8, health-related quality of life, social support, life satisfaction, and disability status, using the 2006 Behavioral Risk Factor Surveillance System. A dose-response relationship exists between depression severity and mean number of days in the past 30 days of physical distress, pain, anxiety symptoms, and activity limitations as well as the prevalence of fair/poor general health, life dissatisfaction, inadequate social support, and disability. These profound associations underscore the need for recognition and treatment of depression in all healthcare settings.