Horticultural Therapy and Depression Reduction Among Older Adults in Urban Environments: A Qualitative Synthesis and Meta-Analysis
Main Article Content
Population aging has become a major global public health challenge, with depression emerging as one of the most common mental health problems affecting older adults, particularly those living in urban environments. Limited access to green spaces, social isolation, reduced physical activity, and environmental stressors increase the vulnerability of older populations to depressive symptoms. Horticultural therapy has gained attention as a non-pharmacological, nature-based intervention that may improve psychological well-being through plant interaction, meaningful activities, physical engagement, and social connectedness. This study aims to systematically review and synthesize empirical evidence regarding the effectiveness of horticultural therapy in reducing depression among older adults in urban environments. A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines. Literature searches were performed across the Scopus, PubMed, and ScienceDirect databases, identifying 11 eligible randomized controlled trials and quasi-experimental studies involving 775 participants. A random-effects model was applied to estimate the pooled effect size of horticultural therapy on depressive symptoms. The findings revealed a moderate beneficial effect of horticultural therapy on depression reduction among older adults (SMD = ?0.59; 95% CI: ?0.73 to ?0.45), with consistent positive effects across different intervention formats, including gardening activities, therapeutic gardens, and technology-assisted horticultural programs. These findings indicate that horticultural therapy can support healthy aging by improving emotional well-being, reducing depressive symptoms, and strengthening social participation. However, future research should employ larger randomized controlled trials, standardized intervention protocols, and longer follow-up periods to establish sustainable implementation strategies in urban healthcare and community settings.
Keywords:
Depression, Healthy Aging, Horticultural Therapy, Nature-Based Therapy, Urban Aging
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Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15(3), 169-182. https://doi.org/10.1016/0272-4944(95)90001-2
Gigliotti, C., & Jarrott, S. E. (2005). Effects of Horticulture Therapy on Engagement and Affect. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 24(4), 367–377. https://doi.org/10.1353/cja.2006.0008
He, J., Lin, J., Sun, W., Cheung, T., Cao, Y., Fu, E. Y., Chan, S. H., & Tsang, H. W. H. (2023). The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis [Review of The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis]. Scientific Reports, 13(1). Nature Portfolio. https://doi.org/10.1038/s41598-023-45839-0
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Humayun, A., Madawana, A. M., Hassan, A., Mahmud, A., Kamaruddin, N., Noor, S., Noor, S. A., & Nawi, M. A. A. (2025). Artificial intelligence as a predictive tool for mental health status: Insights from a systematic review and meta-analysis [Review of Artificial intelligence as a predictive tool for mental health status: Insights from a systematic review and meta-analysis]. PLoS ONE, 20(9). Public Library of Science. https://doi.org/10.1371/journal.pone.0332207
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Jung, Y., Kim, K., Kim, W., Yu, Y., & Kim, H. (2025). Improving Sleep Quality Through Urban Gardening: An Exploratory Study. Journal of Sleep Medicine, 22(3), 93–103. https://doi.org/10.13078/jsm.250019
Kim, Y., Lee, S. H., Park, C. S., Bae, H., Kim, Y. J., & Huh, M. R. (2020). A horticultural therapy program focusing on gardening activities to promote psychological, emotional and social health of the elderly living in a homeless living facility for a long time: A pilot study. Journal of People, Plants, and Environment, 23(5), 565-576. https://doi.org/10.11628/ksppe.2020.23.5.565
Li, H., Ding, Y., Zhao, B., Xu, Y., & Wei, W. (2023). Effects of immersion in a simulated natural environment on stress reduction and emotional arousal: A systematic review and meta-analysis [Review of Effects of immersion in a simulated natural environment on stress reduction and emotional arousal: A systematic review and meta-analysis]. Frontiers in Psychology, 13. Frontiers Media. https://doi.org/10.3389/fpsyg.2022.1058177
Lee, M., Lee, J., Park, B.-J., & Miyazaki, Y. (2018). Interaction with indoor plants may reduce psychological and physiological stress by suppressing autonomic nervous system activity in young adults: A randomized crossover study. Journal of Physiological Anthropology, 37(1), 21. https://doi.org/10.1186/s40101-018-0187-7
Lin, T.-Y., Huang, C.-M., Hsu, H.-P., Liao, J.-Y., Cheng, V. Y. W., Wang, S.-W., & Guo, J.-L. (2020). Effects of a combination of three-dimensional virtual reality and hands-on horticultural therapy on institutionalized older adults physical and mental health: Quasi-experimental design. Journal of Medical Internet Research, 22(11), e19002. https://doi.org/10.2196/19002
Makizako, H., Tsutsumimoto, K., Doi, T., Makino, K., Nakakubo, S., Liu-Ambrose, T., & Shimada, H. (2020). Exercise and horticultural programs for older adults with depressive symptoms and memory problems: A randomized controlled trial. Journal of Clinical Medicine, 9(1), 99. https://doi.org/10.3390/jcm9010099
Lu, S., Liu, J., Xu, M., & Xu, F. (2023). Horticultural therapy for stress reduction: A systematic review and meta-analysis [Review of Horticultural therapy for stress reduction: A systematic review and meta-analysis]. Frontiers in Psychology, 14. Frontiers Media. https://doi.org/10.3389/fpsyg.2023.1086121
McCaffrey, R., Hanson, C., & McCaffrey, W. (2010). Garden walking for depression: A research report. Holistic Nursing Practice, 24(5), 252-259. https://doi.org/10.1097/HNP.0b013e3181f1acd7
Mhuireach, G., Wymelenberg, K. V. D., & Langellotto, G. (2023). Garden soil bacteria transiently colonize gardeners’ skin after direct soil contact. Urban Agriculture & Regional Food Systems, 8(1). https://doi.org/10.1002/uar2.20035
Nicholas, S. O., Giang, A. T., & Yap, P. L. K. (2019). The effectiveness of horticultural therapy on older adults: A systematic review. Journal of the American Medical Directors Association, 20(10), 1351.e1-1351.e11. https://doi.org/10.1016/j.jamda.2019.06.021
Park, S. A., Lee, A. Y., Son, K. C., Lee, W. L., & Kim, D. S. (2016). Gardening intervention for physical and psychological health benefits in elderly women at community centers. HortTechnology, 26(4), 474-483. https://doi.org/10.21273/HORTTECH.26.4.474
Rawtaer, I., Feng, L., Mahendran, R., Ng, K. S., Tam, W. W. S., Kua, E. H., & Ho, R. C. M. (2018). Effects of horticultural therapy on Asian older adults: A randomized controlled trial. International Journal of Environmental Research and Public Health, 15(8), 1705. https://doi.org/10.3390/ijerph15081705
Roberts, H., Lissa, C. J. V., Hagedoorn, P., Kellar, I., & Helbich, M. (2019). The effect of short-term exposure to the natural environment on depressive mood: A systematic review and meta-analysis [Review of The effect of short-term exposure to the natural environment on depressive mood: A systematic review and meta-analysis]. Environmental Research, 177, 108606–108606. Elsevier BV. https://doi.org/10.1016/j.envres.2019.108606
Shen, J.-L., Hung, B.-L., & Fang, S. (2022). Horticulture therapy affected the mental status, sleep quality, and salivary markers of mucosal immunity in an elderly population. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-14534-x
Shi, Y., & Wu, W. (2023). Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress [Review of Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress]. BMC Medicine, 21(1). BioMed Central. https://doi.org/10.1186/s12916-023-03076-2
Soga, M., Gaston, K. J., & Yamaura, Y. (2017). Gardening is beneficial for health: A meta-analysis. Preventive Medicine Reports, 5, 92-99. https://doi.org/10.1016/j.pmedr.2016.11.007
Ticinesi, A., Zuliani, G., Spaggiari, R., Volpato, S., Maggi, S., & Franceschi, C. (2025). The social microbiome of older people. Ageing Research Reviews, 115, 103008–103008. https://doi.org/10.1016/j.arr.2025.103008
Tse, M. M. Y. (2010). Therapeutic effects of an indoor gardening programme for older people living in nursing homes. Journal of Clinical Nursing, 19(7-8), 949-958. https://doi.org/10.1111/j.1365-2702.2009.02803.x
Tu, H., & Chiu, P.-Y. (2020). Meta-analysis of controlled trials testing horticultural therapy for the improvement of cognitive function [Review of Meta-analysis of controlled trials testing horticultural therapy for the improvement of cognitive function]. Scientific Reports, 10(1). Nature Portfolio. https://doi.org/10.1038/s41598-020-71621-7
Vuong, Q., Sari, N. P. W. P., La, V., & Nguyen, M.-H. (2025). Exploring the health benefits of home gardens: biological, psychological, and therapeutic perspectives. Discover Public Health, 22(1). https://doi.org/10.1186/s12982-025-00987-8
Ulrich, R. S. (1983). Aesthetic and affective response to natural environment. In I. Altman & J. F. Wohlwill (Eds.), Behavior and the natural environment (pp. 85-125). Springer. https://doi.org/10.1007/978-1-4613-3539-9_4
Wang, C., Zu-guo, T., & Luo, Q. (2023). The impact of exercise on mental health during the COVID-19 pandemic: a systematic review and meta-analysis [Review of The impact of exercise on mental health during the COVID-19 pandemic: a systematic review and meta-analysis]. Frontiers in Public Health, 11. Frontiers Media. https://doi.org/10.3389/fpubh.2023.1279599
World Health Organization. (2023). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
Wu, M., Li, C., Hu, T., Zhao, X., Qiao, G., Gao, X., Zhu, X., & Yang, F. (2023). Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis [Review of Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis]. JMIR Mhealth and Uhealth, 12. JMIR Publications. https://doi.org/10.2196/50787
Xu, M., Lu, S., Liu, J., & Xu, F. (2023). Effectiveness of horticultural therapy in aged people with depression: A systematic review and meta-analysis. Frontiers in Public Health, 11, 1142456. https://doi.org/10.3389/fpubh.2023.1142456
Zeng, L., Zhao, X., Yu, Y., Hu, T., Li, C., Wu, M., & Yang, F. (2023). Effects of Tai Chi on depression of middle-aged and older adults: an updated systematic review and meta-analysis [Review of Effects of Tai Chi on depression of middle-aged and older adults: an updated systematic review and meta-analysis]. BMC Complementary Medicine and Therapies, 23(1). BioMed Central. https://doi.org/10.1186/s12906-023-04207-1
Zhang, Y. W., Wang, J., & Fang, T. H. (2022). The effect of horticultural therapy on depressive symptoms among the elderly: A systematic review and meta-analysis. Frontiers in Public Health, 10, 953363. https://doi.org/10.3389/fpubh.2022.953363
Chen, C.-R., & Lee, Y.-W. (2025). Efficacy of horticultural therapy on patients with depressive disorder. https://doi.org/10.37766/inplasy2025.2.0057
Chen, Y.-M., & Ji, J.-Y. (2015). Effects of horticultural therapy on psychosocial health in older nursing home residents: A preliminary study. The Journal of Nursing Research, 23(3), 167-171. https://doi.org/10.1097/jnr.0000000000000063
Chu, H.-Y., Chen, M.-F., Tsai, C.-C., Chan, H.-S., & Wu, T.-L. (2019). Efficacy of a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan. Geriatric Nursing, 40(4), 386-391. https://doi.org/10.1016/j.gerinurse.2018.12.012
Cieslik, B., Juszko, K., Kiper, P., & Szczepanska-Gieracha, J. (2023). Immersive virtual reality as support for the mental health of elderly women: A randomized controlled trial. Virtual Reality, 27(3), 2227-2235. https://doi.org/10.1007/s10055-023-00797-w
Fan, C.-C., Choy, C.-S., Huang, C.-M., Chih, P.-S., Lee, C.-C., Lin, F.-H., & Guo, J.-L. (2022). The effects of a combination of 3D virtual reality and hands-on horticultural activities on mastery, achievement motives, self-esteem, isolation, and depression: A quasi-experimental study. BMC Geriatrics, 22, 744. https://doi.org/10.1186/s12877-022-03431-7
Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363-389. https://doi.org/10.1146/annurev.clinpsy.032408.153621
Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15(3), 169-182. https://doi.org/10.1016/0272-4944(95)90001-2
Gigliotti, C., & Jarrott, S. E. (2005). Effects of Horticulture Therapy on Engagement and Affect. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 24(4), 367–377. https://doi.org/10.1353/cja.2006.0008
He, J., Lin, J., Sun, W., Cheung, T., Cao, Y., Fu, E. Y., Chan, S. H., & Tsang, H. W. H. (2023). The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis [Review of The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis]. Scientific Reports, 13(1). Nature Portfolio. https://doi.org/10.1038/s41598-023-45839-0
Hudson, J. L., Minihan, S., Chen, W., Carl, T., Fu, M. Y., Tully, L. A., Kangas, M., Rosewell, L., McDermott, E., Wang, Y., Stubbs, T., & Martiniuk, A. (2023). Interventions for Young Children’s Mental Health: A Review of Reviews [Review of Interventions for Young Children’s Mental Health: A Review of Reviews]. Clinical Child and Family Psychology Review, 26(3), 593–641. Springer Science+Business Media. https://doi.org/10.1007/s10567-023-00443-6
Humayun, A., Madawana, A. M., Hassan, A., Mahmud, A., Kamaruddin, N., Noor, S., Noor, S. A., & Nawi, M. A. A. (2025). Artificial intelligence as a predictive tool for mental health status: Insights from a systematic review and meta-analysis [Review of Artificial intelligence as a predictive tool for mental health status: Insights from a systematic review and meta-analysis]. PLoS ONE, 20(9). Public Library of Science. https://doi.org/10.1371/journal.pone.0332207
Johandi, F., Giang, T., Cheng, L., Hay, M. C., & Yap, P. (2024). 2197 Effectiveness of horticultural therapy on the psychosocial and physical function of older adults with normal cognitive function. Age and Ageing, 53. https://doi.org/10.1093/ageing/afae139.086
Jung, Y., Kim, K., Kim, W., Yu, Y., & Kim, H. (2025). Improving Sleep Quality Through Urban Gardening: An Exploratory Study. Journal of Sleep Medicine, 22(3), 93–103. https://doi.org/10.13078/jsm.250019
Kim, Y., Lee, S. H., Park, C. S., Bae, H., Kim, Y. J., & Huh, M. R. (2020). A horticultural therapy program focusing on gardening activities to promote psychological, emotional and social health of the elderly living in a homeless living facility for a long time: A pilot study. Journal of People, Plants, and Environment, 23(5), 565-576. https://doi.org/10.11628/ksppe.2020.23.5.565
Li, H., Ding, Y., Zhao, B., Xu, Y., & Wei, W. (2023). Effects of immersion in a simulated natural environment on stress reduction and emotional arousal: A systematic review and meta-analysis [Review of Effects of immersion in a simulated natural environment on stress reduction and emotional arousal: A systematic review and meta-analysis]. Frontiers in Psychology, 13. Frontiers Media. https://doi.org/10.3389/fpsyg.2022.1058177
Lee, M., Lee, J., Park, B.-J., & Miyazaki, Y. (2018). Interaction with indoor plants may reduce psychological and physiological stress by suppressing autonomic nervous system activity in young adults: A randomized crossover study. Journal of Physiological Anthropology, 37(1), 21. https://doi.org/10.1186/s40101-018-0187-7
Lin, T.-Y., Huang, C.-M., Hsu, H.-P., Liao, J.-Y., Cheng, V. Y. W., Wang, S.-W., & Guo, J.-L. (2020). Effects of a combination of three-dimensional virtual reality and hands-on horticultural therapy on institutionalized older adults physical and mental health: Quasi-experimental design. Journal of Medical Internet Research, 22(11), e19002. https://doi.org/10.2196/19002
Makizako, H., Tsutsumimoto, K., Doi, T., Makino, K., Nakakubo, S., Liu-Ambrose, T., & Shimada, H. (2020). Exercise and horticultural programs for older adults with depressive symptoms and memory problems: A randomized controlled trial. Journal of Clinical Medicine, 9(1), 99. https://doi.org/10.3390/jcm9010099
Lu, S., Liu, J., Xu, M., & Xu, F. (2023). Horticultural therapy for stress reduction: A systematic review and meta-analysis [Review of Horticultural therapy for stress reduction: A systematic review and meta-analysis]. Frontiers in Psychology, 14. Frontiers Media. https://doi.org/10.3389/fpsyg.2023.1086121
McCaffrey, R., Hanson, C., & McCaffrey, W. (2010). Garden walking for depression: A research report. Holistic Nursing Practice, 24(5), 252-259. https://doi.org/10.1097/HNP.0b013e3181f1acd7
Mhuireach, G., Wymelenberg, K. V. D., & Langellotto, G. (2023). Garden soil bacteria transiently colonize gardeners’ skin after direct soil contact. Urban Agriculture & Regional Food Systems, 8(1). https://doi.org/10.1002/uar2.20035
Nicholas, S. O., Giang, A. T., & Yap, P. L. K. (2019). The effectiveness of horticultural therapy on older adults: A systematic review. Journal of the American Medical Directors Association, 20(10), 1351.e1-1351.e11. https://doi.org/10.1016/j.jamda.2019.06.021
Park, S. A., Lee, A. Y., Son, K. C., Lee, W. L., & Kim, D. S. (2016). Gardening intervention for physical and psychological health benefits in elderly women at community centers. HortTechnology, 26(4), 474-483. https://doi.org/10.21273/HORTTECH.26.4.474
Rawtaer, I., Feng, L., Mahendran, R., Ng, K. S., Tam, W. W. S., Kua, E. H., & Ho, R. C. M. (2018). Effects of horticultural therapy on Asian older adults: A randomized controlled trial. International Journal of Environmental Research and Public Health, 15(8), 1705. https://doi.org/10.3390/ijerph15081705
Roberts, H., Lissa, C. J. V., Hagedoorn, P., Kellar, I., & Helbich, M. (2019). The effect of short-term exposure to the natural environment on depressive mood: A systematic review and meta-analysis [Review of The effect of short-term exposure to the natural environment on depressive mood: A systematic review and meta-analysis]. Environmental Research, 177, 108606–108606. Elsevier BV. https://doi.org/10.1016/j.envres.2019.108606
Shen, J.-L., Hung, B.-L., & Fang, S. (2022). Horticulture therapy affected the mental status, sleep quality, and salivary markers of mucosal immunity in an elderly population. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-14534-x
Shi, Y., & Wu, W. (2023). Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress [Review of Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress]. BMC Medicine, 21(1). BioMed Central. https://doi.org/10.1186/s12916-023-03076-2
Soga, M., Gaston, K. J., & Yamaura, Y. (2017). Gardening is beneficial for health: A meta-analysis. Preventive Medicine Reports, 5, 92-99. https://doi.org/10.1016/j.pmedr.2016.11.007
Ticinesi, A., Zuliani, G., Spaggiari, R., Volpato, S., Maggi, S., & Franceschi, C. (2025). The social microbiome of older people. Ageing Research Reviews, 115, 103008–103008. https://doi.org/10.1016/j.arr.2025.103008
Tse, M. M. Y. (2010). Therapeutic effects of an indoor gardening programme for older people living in nursing homes. Journal of Clinical Nursing, 19(7-8), 949-958. https://doi.org/10.1111/j.1365-2702.2009.02803.x
Tu, H., & Chiu, P.-Y. (2020). Meta-analysis of controlled trials testing horticultural therapy for the improvement of cognitive function [Review of Meta-analysis of controlled trials testing horticultural therapy for the improvement of cognitive function]. Scientific Reports, 10(1). Nature Portfolio. https://doi.org/10.1038/s41598-020-71621-7
Vuong, Q., Sari, N. P. W. P., La, V., & Nguyen, M.-H. (2025). Exploring the health benefits of home gardens: biological, psychological, and therapeutic perspectives. Discover Public Health, 22(1). https://doi.org/10.1186/s12982-025-00987-8
Ulrich, R. S. (1983). Aesthetic and affective response to natural environment. In I. Altman & J. F. Wohlwill (Eds.), Behavior and the natural environment (pp. 85-125). Springer. https://doi.org/10.1007/978-1-4613-3539-9_4
Wang, C., Zu-guo, T., & Luo, Q. (2023). The impact of exercise on mental health during the COVID-19 pandemic: a systematic review and meta-analysis [Review of The impact of exercise on mental health during the COVID-19 pandemic: a systematic review and meta-analysis]. Frontiers in Public Health, 11. Frontiers Media. https://doi.org/10.3389/fpubh.2023.1279599
World Health Organization. (2023). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
Wu, M., Li, C., Hu, T., Zhao, X., Qiao, G., Gao, X., Zhu, X., & Yang, F. (2023). Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis [Review of Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis]. JMIR Mhealth and Uhealth, 12. JMIR Publications. https://doi.org/10.2196/50787
Xu, M., Lu, S., Liu, J., & Xu, F. (2023). Effectiveness of horticultural therapy in aged people with depression: A systematic review and meta-analysis. Frontiers in Public Health, 11, 1142456. https://doi.org/10.3389/fpubh.2023.1142456
Zeng, L., Zhao, X., Yu, Y., Hu, T., Li, C., Wu, M., & Yang, F. (2023). Effects of Tai Chi on depression of middle-aged and older adults: an updated systematic review and meta-analysis [Review of Effects of Tai Chi on depression of middle-aged and older adults: an updated systematic review and meta-analysis]. BMC Complementary Medicine and Therapies, 23(1). BioMed Central. https://doi.org/10.1186/s12906-023-04207-1
Zhang, Y. W., Wang, J., & Fang, T. H. (2022). The effect of horticultural therapy on depressive symptoms among the elderly: A systematic review and meta-analysis. Frontiers in Public Health, 10, 953363. https://doi.org/10.3389/fpubh.2022.953363
