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Behavioral Sciences
Volume 16
Issue 6
10.3390/bs16060974
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Systematic Review

Nature-Based Interventions for Individuals with Psychiatric Disorders: A Mixed Methods Systematic Review with Random-Effects Meta-Analysis of Mental Health and Functional Outcomes

by
Alessandra Giammanco
1,2,
Erin Grace Lawrence
3,
Ailbhe Madigan
4,
Karol Basta
5,
Giada Tripoli
1,4,
Aisling O’Neill
6,
Natasha Moses
7,
Helena Farstad
8,
Peter Coventry
9 and
Uzma Zahid
4,*
1
Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90129 Palermo, Italy
2
Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy
3
Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London E1 2AB, UK
4
Institute of Psychiatry, Psychology & Neuroscience, King’s College, London SE5 8AF, UK
5
Public Health, Royal Free Hospital, London NW3 2QG, UK
6
Department of Psychology, St. Patrick’s University Hospital, D08 K7YW Dublin, Ireland
7
South West London and St. George’s Mental Health NHS Trust, London SW17 0YF, UK
8
Independent Researcher, London SE5 8AF, UK
9
School of Nursing and Public Health, Manchester Metropolitan University, Manchester M15 6GX, UK
*
Author to whom correspondence should be addressed.
Behav. Sci. 2026, 16(6), 974; https://doi.org/10.3390/bs16060974 (registering DOI)
Submission received: 7 April 2026 / Revised: 25 May 2026 / Accepted: 3 June 2026 / Published: 11 June 2026
(This article belongs to the Special Issue Nature-Based Interventions for Mental Health)
Review Reports Versions Notes

Abstract

Nature-based interventions (NBIs) are increasingly used in mental health services, but their effectiveness in people with psychiatric disorders, and how these individuals experience them, remains unclear. This review synthesised quantitative and qualitative evidence on NBIs in psychiatric populations. Eligible studies evaluated outdoor NBIs against controlled comparators, excluding neurodevelopmental/degenerative conditions and indoor or virtual interventions. Quantitative outcomes were synthesised using random-effects meta-analysis; qualitative data were analysed using thematic synthesis. Twenty-eight studies were included, mostly involving people with diagnoses of schizophrenia or depression. NBIs were associated with greater improvements in clinical symptoms than controlled comparators (pooled effect size 0.71 [95% CI 0.29–1.12]; p = 0.0009), with moderate heterogeneity (I2 = 48.6%). The qualitative synthesis identified five themes: Being in Nature, Personal Growth, Psychological Wellbeing, Social Relationships, and Physical Benefits. Participants reported reduced stress, improved mood and coping, strengthened identity, enhanced social connection, and increased energy. NBIs, particularly horticultural programmes and guided outdoor activities, may offer promising recovery-oriented adjuncts to psychiatric care. The next step is to build a translational evidence base by harmonising recovery-relevant outcomes and developing pragmatic, scalable models of delivery that can be embedded within routine mental health services, informed by mixed methods evaluation.
Keywords: nature-based interventions; psychosis; schizophrenia; mental health; wellbeing nature-based interventions; psychosis; schizophrenia; mental health; wellbeing

Share and Cite

MDPI and ACS Style

Giammanco, A.; Lawrence, E.G.; Madigan, A.; Basta, K.; Tripoli, G.; O’Neill, A.; Moses, N.; Farstad, H.; Coventry, P.; Zahid, U. Nature-Based Interventions for Individuals with Psychiatric Disorders: A Mixed Methods Systematic Review with Random-Effects Meta-Analysis of Mental Health and Functional Outcomes. Behav. Sci. 2026, 16, 974. https://doi.org/10.3390/bs16060974

AMA Style

Giammanco A, Lawrence EG, Madigan A, Basta K, Tripoli G, O’Neill A, Moses N, Farstad H, Coventry P, Zahid U. Nature-Based Interventions for Individuals with Psychiatric Disorders: A Mixed Methods Systematic Review with Random-Effects Meta-Analysis of Mental Health and Functional Outcomes. Behavioral Sciences. 2026; 16(6):974. https://doi.org/10.3390/bs16060974

Chicago/Turabian Style

Giammanco, Alessandra, Erin Grace Lawrence, Ailbhe Madigan, Karol Basta, Giada Tripoli, Aisling O’Neill, Natasha Moses, Helena Farstad, Peter Coventry, and Uzma Zahid. 2026. "Nature-Based Interventions for Individuals with Psychiatric Disorders: A Mixed Methods Systematic Review with Random-Effects Meta-Analysis of Mental Health and Functional Outcomes" Behavioral Sciences 16, no. 6: 974. https://doi.org/10.3390/bs16060974

APA Style

Giammanco, A., Lawrence, E. G., Madigan, A., Basta, K., Tripoli, G., O’Neill, A., Moses, N., Farstad, H., Coventry, P., & Zahid, U. (2026). Nature-Based Interventions for Individuals with Psychiatric Disorders: A Mixed Methods Systematic Review with Random-Effects Meta-Analysis of Mental Health and Functional Outcomes. Behavioral Sciences, 16(6), 974. https://doi.org/10.3390/bs16060974

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