The effect of nature exposure on the mental health of patients: a systematic review
The effect of nature-based interventions on self-reported mental well-being in patients with physical disease is gaining increasing attention. However, there is a lack of randomized controlled trials investigating this area. Due to the massive costs in health care systems, there is a need for new strategies to address these issues and an urgent need for attention to this field. Nature-based interventions are low cost, easy to implement, and should get attention within the health care field. Therefore, the objective was to find the impact of nature interventions on mental well-being in humans with a physical disease.
In four major databases (PubMed, Cinahl, PsycINFO, and Cochrane Library), a systematic review of quantitative studies of nature’s impact on self-reported mental health in patients with physical disease was performed. A total of 1909 articles were retrieved but only five met the inclusion criteria and were summarized.
All five studies were quantitative, with a control group and a nature-based intervention. A source of heterogeneity was identified: the patients in one of the five studies were psychosomatic. In the four studies with somatic patients, significant benefit of nature on self-reported mental health outcomes was found; the only study that failed to show a significant benefit was the one with psychosomatic patients.
A significant effect of nature on mental well-being of patients with somatic disease was found. The result in patients with psychosomatic disease is inconclusive, and more studies in this category are needed. Further research on the effect of nature on mental health is merited, with special attention to standardizing intervention type and dose as well as outcome measures within each medical discipline.
KeywordsSystematic review Patients Nature Nature-based interventions Mental well-being
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors. The study is a literature review.
- 3.Bratman, G. N., Hamilton, J. P., & Daily, G. C. (2012). The impacts of nature experience on human cognitive function and mental health: Nature experience, cognitive function, and mental health. Annals of the New York Academy of Sciences, 1249(1), 118–136. https://doi.org/10.1111/j.1749-6632.2011.06400.x.CrossRefPubMedGoogle Scholar
- 6.Nilsson, K. (Ed.). (2011). Forests, trees, and human health. New York: Springer.Google Scholar
- 8.Bragg, R., & Atkins, G. (2016). A review of nature-based interventions for mental health care. London: Natural England.Google Scholar
- 10.World Health Organization, Department of Mental Health and Substance Abuse, Victorian Health Promotion Foundation, & University of Melbourne. (2004). Promoting mental health: concepts, emerging evidence, practice: summary report. Geneva: World Health Organization.Google Scholar
- 14.Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (n.d.). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement.Google Scholar
- 15.Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., … Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), e1000100. https://doi.org/10.1371/journal.pmed.1000100.CrossRefPubMedGoogle Scholar
- 18.The Joanna Briggs Institute. (2017). Checklist for quasi-experimental studies. The Joanna Briggs Institute. Retrieved from http://joannabriggs.org/assets/docs/critical-appraisal-tools/JBI_Quasi-Experimental_Appraisal_Tool2017.pdf.
- 20.Watzek, D., Mischler, E., Sonam, D., Gubler-Blum, B., Abbatiello, C., Radlinger, L., & Verra, M. L. (2016). Effectiveness and economic evaluation of therapeutic nordic walking in patients with psychosomatic disorders: A pragmatic randomized controlled trial. Journal of Psychology Research. https://doi.org/10.17265/2159-5542/2016.11.005.Google Scholar
- 21.Hitzig, S. L., Alton, C., Leong, N., & Gatt, K. (2012). The Evolution and evaluation of a therapeutic recreation cottage program for persons with spinal cord injury. Therapeutic Recreation Journal, 46(3), 218–233.Google Scholar
- 24.WHO. (2002). Mental health: new understanding, new hope (repr.). Geneva: World Health Organization.Google Scholar
- 29.Holm, L. V., Hansen, D. G., Johansen, C., Vedsted, P., Larsen, P. V., Kragstrup, J., & Søndergaard, J. (2012). Participation in cancer rehabilitation and unmet needs: a population-based cohort study. Supportive Care in Cancer, 20(11), 2913–2924. https://doi.org/10.1007/s00520-012-1420-0.CrossRefPubMedGoogle Scholar
- 30.Thompson Coon, J., Boddy, K., Stein, K., Whear, R., Barton, J., & Depledge, M. H. (2011). Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environmental Science & Technology, 45(5), 1761–1772. https://doi.org/10.1021/es102947t.CrossRefGoogle Scholar
- 32.Mikkelsen, S., Jensen, J., A. B., & Olesen, F. (2008). Cancer rehabilitation: Psychosocial rehabilitation needs after discharge from hospital? A qualitative interview study. Scandinavian Journal of Primary Health Care, 26(4), 216–221. https://doi.org/10.1080/02813430802295610.CrossRefPubMedGoogle Scholar