Primary-care based participatory rehabilitation: users' views of a horticultural and arts project

Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce

OBJECTIVES

The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings.

METHODS

Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria.

RESULTS

Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework.

CONCLUSIONS

Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.

Nature's Contributions to Human Health: A Missing Link to Primary Health Care? A Scoping Review of International Overview Reports and Scientific Evidence

Nature's contributions to human health (NCH) have gained increased attention internationally in scientific and policy arenas. However, little attention is given to the role of the health care sector in this discussion. Primary health care (PHC) is a vital backbone for linking knowledge and practice within the organization of health care. The objective of this scoping review is to evaluate how international overview reports and scientific literature on NCH address to PHC. More specifically, we extracted data on arguments, practice supporting tools and guidelines, challenges and constraints, and management approaches to integrate NCH and PHC. The scientific literature search was run in Web of Science. Two independent reviewers screened the scientific publications. Through the scientific literature search, we identified 1,995 articles of which 79 were eligible for analysis. We complemented the search with a selection of six international overview reports. Both the international overview reports and the scientific publications paid limited attention to the role of PHC regarding NCH. To cope with the current challenges and constraints to integrate NCH and PHC, more evidence on NCH, further development of PHC practice supporting tools, bottom–up integrated approaches, and closer interdisciplinary collaborations are required.

Steps to benefit from social prescription: a qualitative interview study

BACKGROUND

The popularity of social prescribing has grown in recent years following a series of high-profile recommendations in scientific reviews, political reports, and media coverage. Social prescribing has the potential to address multiple health and social problems, but few studies have examined how it works.

AIM

To explore the ways by which social prescribing may be beneficial to individuals undertaking socially prescribed activity (SPA).

DESIGN AND SETTING

A qualitative interview study involving people attending a range of SPA.

METHOD

Participants were purposively recruited from a multi-activity social prescribing provider. Data were collected using semi-structured face-to-face interviews. Analysis used a thematic approach, in which emerging themes were contextualised with interview transcripts and findings from existing literature.

RESULTS

The study identified five themes, which together formed a journey of engagement and participation. While not always present for any one individual, the themes occurred in a consistent order: receiving professional support for social problems; engaging with others through participation in SPA; learning different ways to relate to other people and developing new skills; changing perceptions by realising personal assets and becoming open to the possibility of new futures; and developing a positive outlook on the present while moving forwards in pursuit of future goals and better health.

CONCLUSION

SPA appears to benefit individuals by a process that begins with personalised professional help to address social problems and moves through engagement with activities and others, to the recognition of personal and social assets and opportunities.

Effects of horticultural therapy: Perspectives of frail and pre-frail older nursing home residents

AIM

The aim of the study was to explore the perceptions and experiences of a group of frail and/or pre-frail older nursing home residents in relation to horticultural therapy.

METHOD

A total of 22 frail/pre-frail residents were interviewed. A qualitative content analysis approach was adopted to interpret the data from four nursing homes.

RESULTS

Four main themes were identified: (a) "Horticultural therapy is an enjoyable activity and a good pastime in nursing home life"; (b) "Joining the programme made me happier"; (c) "Horticultural activities facilitated socialization among the residents"; and (4) "Not much mention was made of the programme by the staff outside the sessions."

CONCLUSION AND IMPLICATION FOR PRACTICE

The findings provide evidence of the positive effects of horticultural therapy on perceived well-being among frail nursing home residents and expand the existing state of knowledge on the use of horticultural therapy in long-term residential care. Among others nursing implications, they are also important to develop appropriate and meaningful nursing practice to improve frail residents' perceived quality of life in the institution they now call "home."

Nature-based interventions in institutional and organisational settings: a scoping review

The objective of this review was to scope the literature on nature-based interventions that could be conducted in institutional settings where people reside full-time for care or rehabilitation purposes. Systematic searches were conducted across CINAHL, Medline, Criminal Justice Abstracts, PsycINFO, Scopus, Social Care Online and Cochrane CENTRAL. A total of 85 studies (reported in 86 articles) were included. Four intervention modalities were identified: Gardening/therapeutic horticulture; animal-assisted therapies; care farming and virtual reality-based simulations of natural environments. The interventions were conducted across a range of settings, including inpatient wards, care homes, prisons and women's shelters. Generally, favourable impacts were seen across intervention types, although the reported effects varied widely. There is a growing body of literature on nature-based interventions that could be applied to a variety of institutional settings. Within most intervention types, there is sufficient research data available to perform full systematic reviews. Recommendations for future systematic reviews are offered.