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Link to original content: http://pubmed.ncbi.nlm.nih.gov/39517317/
Efficacy of Horticultural Therapy on Positive, Negative, and Affective Symptoms in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials - PubMed Skip to main page content
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Review
. 2024 Oct 22;12(21):2104.
doi: 10.3390/healthcare12212104.

Efficacy of Horticultural Therapy on Positive, Negative, and Affective Symptoms in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Yi-Wen Lee  1 , Tzu-Ting Chen  2   3 , Chih-Wei Hsu  2 , Ming-De Chen  4 , Pao-Yen Lin  2 , Yu-Chi Huang  2 , Chi-Fa Hung  2 , Chyi-Rong Chen  2   3
Affiliations
Review

Efficacy of Horticultural Therapy on Positive, Negative, and Affective Symptoms in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Yi-Wen Lee et al. Healthcare (Basel). .

Abstract

Background/Objectives: Positive symptoms, negative symptoms, and emotional disturbances are core features of schizophrenia. Although horticultural therapy (HT) has shown promise as an adjunctive treatment, evidence supporting its effectiveness remains limited. This systematic review and meta-analysis aimed to assess the impact of HT on total symptoms, positive symptoms, negative symptoms, and emotional disturbances in individuals with schizophrenia. Methods: We conducted a search for randomized controlled trials (RCTs) published up to March 2024 across multiple databases, including PubMed, Embase, Cochrane Library, CINAHL, CEPS, CNKI, Wanfang, and Yiigle. A random-effects model was employed to calculate the standardized mean difference (SMD). Results: A total of 35 studies enrolling 2899 participants were included. Our results indicated that, in the short term (≦3 months), HT has moderate to large effect sizes on total symptoms (SMD = 0.690, 95% CI 0.463 to 0.916), positive symptoms (SMD = 0.695, 95% CI 0.038 to 1.351), negative symptoms (SMD = 0.681, 95% CI 0.395 to 0.967), depression (SMD = 0.646, 95% CI 0.334 to 0.959), and anxiety (SMD = 0.627, 95% CI 0.364 to 0.890), with more pronounced benefits for anxiety symptoms in patients with a shorter duration of illness. In the long term (>3 months), HT shows large effect sizes for total symptoms (SMD = 1.393, 95% CI 0.858 to 1.928), negative symptoms (SMD = 1.389, 95% CI 0.935 to 1.842), anxiety (SMD = 1.541, 95% CI 1.042 to 2.040), and moderate to large effect sizes for positive symptoms (SMD = 0.667, 95% CI 0.077 to 1.258) and depression (SMD = 0.707, 95% CI 0.198 to 1.217). Additionally, longer weekly treatment durations are associated with better outcomes for total symptoms and negative symptoms. Schizophrenia patients with more severe initial symptoms may be potential responders to HT. Conclusions: These findings support the efficacy of HT in improving symptoms and emotional well-being in schizophrenia patients. Further trials with more rigorous designs are warranted to confirm these benefits.

Keywords: emotions; horticultural therapy; meta-analysis; psychiatric symptoms; schizophrenia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
(a) Risk of bias graph. (b) Risk of bias summary for the included studies. Ban 2001 is the Ref. [51]; Cao 2013 is the Ref. [52]; Chen 2013 is the Ref. [53]; Chen 2023 and Chen 2023 are the Ref [54,55]; Ding 2020 is the Ref. [56]; He 2020 is the Ref. [57]; Hu 2019 is the Ref. [58]; Huang 2017 is the Ref. [59]; Kam 2010 is the Ref. [82]; Kenmochi 2019 is the Ref. [85]; Kong 2019 is the Ref. [60]; Lee 2021 is the Ref. [84]; Lei 2019 is the Ref. [61]; Li 2015 is the Ref. [62]; Li 2020 is the Ref. [63]; Liang 2022 is the Ref. [64]; Liu 2018 is the Ref. [67]; Liu 2021 is the Ref. [66]; Liu 2023 is the Ref. [65]; Lu 2010 is the Ref. [68]; Shi 2020 is the Ref. [69]; Siu 2020 is the Ref. [81]; Sun 2024 is the Ref. [80]; Tao 2017 is the Ref. [70]; Wang 2022 is the Ref. [71]; Yang 2009 is the Ref. [73]; Yang 2011 is the Ref. [72]; Yang 2017 is the Ref. [83]; Yin 2015 is the Ref. [74]; Zhang 2015 is the Ref. [75]; Zhao 2022 is the Ref. [76]; Zhou 2003 is the Ref. [77]; Zhu 2016 is the Ref. [78]; Zhu 2019 is the Ref. [79].
Figure 3
Figure 3
Forest plot of HT on total symptoms in individuals with schizophrenia. Ban 2001 is the Ref. [51]; Cao 2013 is the Ref. [52]; Chen 2013 is the Ref. [53]; Chen 2023 is the Ref [55]; Ding 2020 is the Ref. [56]; He 2020 is the Ref. [57]; Hu 2019 is the Ref. [58]; Huang 2017 is the Ref. [59]; Kong 2019 is the Ref. [60]; Li 2020 is the Ref. [63]; Liang 2022 is the Ref. [64]; Liu 2018 is the Ref. [67]; Liu 2021 is the Ref. [66]; Liu 2023 is the Ref. [65]; Lu 2010 is the Ref. [68]; Wang 2022 is the Ref. [71]; Yang 2009 is the Ref. [73]; Zhao 2022 is the Ref. [76]; Zhu 2016 is the Ref. [78]; Zhu 2019 is the Ref. [79].
Figure 4
Figure 4
Forest plot of HT on positive symptoms in individuals with schizophrenia. Cao 2013 is the Ref. [52]; Hu 2019 is the Ref. [58]; Kenmochi 2019 is the Ref. [85]; Kong 2019 is the Ref. [60]; Li 2020 is the Ref. [63]; Liang 2022 is the Ref. [64]; Liu 2018 is the Ref. [67]; Liu 2023 is the Ref. [65]; Wang 2022 is the Ref. [71]; Zhao 2022 is the Ref. [76]; Zhu 2016 is the Ref. [78]; Zhu 2019 is the Ref. [79].
Figure 5
Figure 5
Forest plot of HT on negative symptoms in individuals with schizophrenia. Cao 2013 is the Ref. [52]; Hu 2019 is the Ref. [58]; Kenmochi 2019 is the Ref. [85]; Kong 2019 is the Ref. [60]; Lei 2019 is the Ref. [61]; Li 2020 is the Ref. [63]; Liang 2022 is the Ref. [64]; Liu 2018 is the Ref. [67]; Liu 2023 is the Ref. [65]; Shi 2020 is the Ref. [69]; Tao 2017 is the Ref. [70]; Wang 2022 is the Ref. [71]; Yang 2011 is the Ref. [72]; Yin 2015 is the Ref. [74]; Zhao 2022 is the Ref. [76]; Zhu 2016 is the Ref. [78]; Zhu 2019 is the Ref. [79].
Figure 6
Figure 6
Forest plot of HT on depression in individuals with schizophrenia. Chen 2023 is the Ref [54]; Hu 2019 is the Ref. [58]; Kam 2010 is the Ref. [82]; Kenmochi 2019 is the Ref. [85]; Kong 2019 is the Ref. [60]; Li 2015 is the Ref. [62]; Sun 2024 is the Ref. [80]; Yang 2017 is the Ref. [83]; Zhang 2015 is the Ref. [75]; Zhu 2019 is the Ref. [79].
Figure 7
Figure 7
Forest plot of HT on anxiety in individuals with schizophrenia. Hu 2019 is the Ref. [58]; Kam 2010 is the Ref. [82]; Kenmochi 2019 is the Ref. [85]; Lee 2021 is the Ref. [84]; Liu 2021 is the Ref. [66]; Siu 2020 is the Ref. [81]; Sun 2024 is the Ref. [80]; Yang 2017 is the Ref. [83]; Zhou 2003 is the Ref. [77].
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