RESUMEN
OBJECTIVES: Converging evidence indicates that Horticultural Therapy (HT) contributes to significant reductions in stress, loneliness, and depression, notable risk factors for suicidality. This pilot study aimed to assess the initial feasibility and acceptability of HT when virtually administered. INTERVENTION: Telehealth-delivered horticultural therapy (TeleHT) was administered to groups of Veterans, including those with elevated suicide risk over the course of four weeks. Participants were each sent a package through the mail of at-home gardening supplies that were used to facilitate multisensory, nature experiences during weekly HT sessions administered via Zoom. OUTCOME MEASURES: Participants completed thermometer-based scales for the suicide risk factors of stress, loneliness, depression, and pain before and after each TeleHT session. Post-intervention qualitative assessments were completed upon the conclusion of the four-week intervention. RESULTS: Significant reductions in stress, depression, and loneliness risk were observed from weekly pre- to post-session measures (p < 0.05), with 89.1 % HT completion rate. Stress, pain, depression, and loneliness indices also showed small to medium sized symptom reduction amongst Veterans with no history of suicidality (Cohen's d=-0.70, d=-0.49, d=-0.62, d=-0.71), while those with elevated suicide risk at baseline also showed reduction in these risk factors with small to medium effect sizes (d=-0.58, d=-.018, d=-0.46, d=-0.41). Qualitative post-intervention assessments indicated a high degree of acceptability and pointed to the inclusion of mailed gardening packages as particularly relevant to positive experiences. CONCLUSIONS: While future work is needed to fully assess efficacy, findings from this pilot study demonstrate an initial feasibility and acceptability through a high retention rate and positive qualitative assessments for TeleHT that mirror that of the in-person intervention.
RESUMEN
OBJECTIVES: Novel approaches to mental health and suicide prevention are lacking. Converging evidence has shown the effectiveness of horticultural therapy (HT) in improving mental health symptoms, but whether it would reduce suicide risk and contributing risk factors is unknown. DESIGN: Using a cohort model, HT was delivered 3.5 h over four weekly, sessions administered by a registered horticultural therapist to veterans with history of suicide ideation or attempt who felt isolated and experienced ongoing environmental stressors with interest in learning new coping strategies. SETTING: HT delivery occurred in an urban garden, through a community partnership between the VA (Veterans Administration) and the New York Botanical Garden. Guided by principles of biophilia, participating veterans took part in nature walks, self-reflection and journaling, and planting activities. OUTCOME MEASURES: Stress, mood, pain, and social isolation levels were measured weekly pre-post HT sessions using thermometer scales, with concordant validity to validated clinical instruments. RESULTS: Of the 20 men and women with a history of suicide attempts/ideation, HT demonstrated immediate improvements after each session across all symptom domains in magnitude of reduction in stress, pain, mood, and loneliness. The effect sizes were in medium to large range (Cohen's d>.5). Additionally, a single HT session showed a sustained effect over subsequent 2-to-4 weeks as observed by the significantly decreased pre-session thermometer scores in subsequent weeks. Reductions in mood symptoms correlated with decline in suicidal ideation (rs = 0.63). CONCLUSION: HT intervention maybe a promising therapeutic modality for improving overall wellness in suicide prevention in at-risk veteran populations.