Academic journal article Research and Theory for Nursing Practice

Therapeutic Horticulture in Clinical Depression: A Prospective Study

Academic journal article Research and Theory for Nursing Practice

Therapeutic Horticulture in Clinical Depression: A Prospective Study

Article excerpt

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 (ΔBDI . 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.

Keywords: major depression; attention; supplementary intervention; nature intervention; horticultural therapy

Worldwide, depression affects 5.8% of all men and 9.5% of all women in any given year (Fletcher et al., 2007). Clinically depressed persons suffer from impaired mood and distortion of cognition (American Psychiatric Association, 1994; Porter, Gallagher, Thompson, & Young, 2003), including attentional impairment (Delaloye et al., 2008; Gollan, Pane, McCloskey, & Coccaro, 2008; Keilp, Gorlyn, Oquendo, Burke, & Mann, 2008; Porter et al., 2003; Wells & Matthews, 1994). Depression tends to recur and become chronic (Evans & Charney, 2003; World Health Organization, 2001), followed by increased risk for work disability (Lopez & Murray, 1998; Ustun, 1999). Recurrent episodes are characterized by increases in severity, duration, and frequency (Thase, 1992). The majority of depressed clients are treated in primary care only (Fletcher et al., 2007), and management of depressive disorders tends to be suboptimal (Gilbody, Whitty, Grimshaw, & Thomas, 2003).

Cognitive-behavioral or interpersonal psychotherapies and antidepressant medications are beneficial as separate treatments (Butler, Hatcher, Price, & von Korff, 2007). However, a substantial number of patients do not respond to conventional treatments. Given the individual and societal consequences of clinical depression, it is important to open for a wide range of treatment and care strategies (Ebmeier, Donaghey, & Steele, 2006) and to investigate the active components in those strategies (Fletcher et al., 2007).

A comparatively small amount of research has been done on complementary or supplementary interventions in depression (Ernst, Rand, & Stevinson, 1998; Jorm, Christensen, Griffiths, & Rodgers, 2002). Several studies report positive effects due to an increase in pleasant activities (Cuijpers, van Straten, & Warmerdam, 2007; Hammen & Glass, 1975; Jorm et al., 2002; Lewinsohn & Graf, 1973; Zeiss, Lewinsohn, & Munoz, 1979). Music therapy is associated with improvements in mood (Ernst et al., 1998; Maratos, Gold, Wang, & Crawford, 2008), and different relaxation therapies like yoga, meditation, and progressive relaxation appear promising ( Jorm, Morgan, & Hetrick, 2008). Other evidence suggests that physical exercise alleviates depression (Babyak et al., 2000; Martinsen & Stephens, 1994).

Less effort has been invested in examining the degree to which exposure to natural environments or activities performed in natural environments might alleviate depression. …

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