{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:06:12Z","timestamp":1784264772022,"version":"3.55.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Horticultural therapy (HT) is a promising non-pharmacological intervention for geriatric depression. However, the optimal \u201cdose\u201d required for maximum clinical efficacy remains poorly defined.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the efficacy of HT in alleviating geriatric depression and to quantify the dose\u2013response relationship between intervention intensity and clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A systematic search was conducted across eight databases (including PubMed, Embase, and Cochrane Library, etc) for randomized controlled trials (RCTs) published up to 24 February 2026. Standardized mean differences (SMD) were pooled using a random-effects model. The dose\u2013response relationship was modeled using restricted cubic splines (RCS).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of eight RCTs involving 585 participants were initially identified. Systematic sensitivity analysis identified one study as a significant statistical outlier. After its exclusion, the final meta-analysis included seven studies with 435 participants. HT was associated with a significant reduction in geriatric depression scores (SMD\u202f=\u202f\u22120.52; 95% CI: \u22120.86 to \u22120.18;\n p<\/jats:italic>\n \u202f=\u202f0.0078). Heterogeneity remained moderate (I\n 2<\/jats:sup>\n \u202f=\u202f65.6%). The RCS model revealed an exploratory, hypothesis-generating non-linear dose\u2013response relationship (\n p<\/jats:italic>\n \u202f=\u202f0.076), suggesting that the antidepressant benefit might peak at a cumulative dose of approximately 700\u2013800\u202fmin. However, this finding should be interpreted with caution due to the limited number of studies. Subgroup analysis indicated that the GDS-30 scale showed a marginally significant trend toward higher sensitivity to treatment effects than the GDS-15 (\n p<\/jats:italic>\n \u202f=\u202f0.055). No significant publication bias was detected via Egger\u2019s test (\n p<\/jats:italic>\n \u202f=\u202f0.936) and Begg\u2019s test (\n p<\/jats:italic>\n \u202f=\u202f0.652).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n HT is an effective intervention for geriatric depression. A cumulative dose of 700\u2013800\u202fmin represents a potential exploratory therapeutic window for maximizing efficacy while minimizing potential fatigue in frail older adults.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n PROSPERO<\/jats:ext-link>\n , CRD420261323722.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1824111","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:23:38Z","timestamp":1784262218000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dose-response efficacy of horticultural therapy for geriatric depression: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"14","author":[{"given":"Qing","family":"Li","sequence":"first","affiliation":[{"name":"Jinan Development Service Center of Parks","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuna","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiwen","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/gmh.2024.72","article-title":"Cognitive social capital and geriatric depression: a community-based case-control study among the rural elderly people of Bangladesh","volume":"11","author":"Islam","year":"2024","journal-title":"Glob Ment Health (Camb)"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"23111","DOI":"10.1038\/s41598-025-09113-9","article-title":"A systematic review and meta-analysis of shugan jieyu capsule combined with escitalopram in the treatment of senile depression","volume":"15","author":"Tang","year":"2025","journal-title":"Sci Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1111\/phn.70084","article-title":"The effect of gardening activities applied to older people in a nursing home on psychological wellness and depression: a single-blind randomized controlled study","volume":"43","author":"Kabakci","year":"2026","journal-title":"Public Health Nurs"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1016\/j.tree.2023.06.002","article-title":"Biophilia revisited: nature versus nurture","volume":"38","author":"Gunnarsson","year":"2023","journal-title":"Trends Ecol Evol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"56","DOI":"10.3390\/ijerph17010056","article-title":"The nature of reality: human stress recovery during exposure to biodiverse, multisensory virtual environments","volume":"17","author":"Schebella","year":"2019","journal-title":"Int J Environ Res Public 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frailty","volume":"17","author":"McPhee","year":"2016","journal-title":"Biogerontology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1002\/jrsm.11","article-title":"Outlier and influence diagnostics for meta-analysis","volume":"1","author":"Viechtbauer","year":"2010","journal-title":"Res Synth Methods"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/j.gerinurse.2018.12.012","article-title":"Efficacy of a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan","volume":"40","author":"Chu","year":"2019","journal-title":"Geriatric 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cognitive function and emotion of empty nest elderly in rural areas","volume":"36","author":"Ren","year":"2022","journal-title":"Chin Prim Health Care"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"277","DOI":"10.4278\/ajhp.130709-QUAN-354","article-title":"Evidence to support including lifestyle light-intensity recommendations in physical activity guidelines for older adults","volume":"29","author":"Loprinzi","year":"2015","journal-title":"Am J Health Promot"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1111\/j.1467-9280.2008.02225.x","article-title":"The cognitive benefits of interacting with nature","volume":"19","author":"Berman","year":"2008","journal-title":"Psychol Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1017\/S1041610296002505","article-title":"The geriatric depression scale: a review of its development and utility","volume":"8","author":"Montorio","year":"1996","journal-title":"Int 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Dement"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1037\/0022-3514.78.5.943","article-title":"Culture, control, and perception of relationships in the environment","volume":"78","author":"Ji","year":"2000","journal-title":"J Pers Soc Psychol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1016\/j.ctim.2014.08.009","article-title":"Effectiveness of horticultural therapy: a systematic review of randomized controlled trials","volume":"22","author":"Kamioka","year":"2014","journal-title":"Complement Ther Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1142456","DOI":"10.3389\/fpubh.2023.1142456","article-title":"Effectiveness of horticultural therapy in aged people with depression: a systematic review and meta-analysis","volume":"11","author":"Xu","year":"2023","journal-title":"Front Public Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s10664-024-10504-1","article-title":"Recommendations for analysing and meta-analysing small sample size software engineering experiments","volume":"29","author":"Kitchenham","year":"2024","journal-title":"Empir Softw Eng"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1186\/s12889-025-22263-9","article-title":"Effect of gardening activities on domains of health: a systematic review and meta-analysis","volume":"25","author":"Wang","year":"2025","journal-title":"BMC Public Health"}],"container-title":["Frontiers in Public 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