Nurse‑led horticultural activities as an early intervention for mild‑to‑moderate depressive symptoms among youth in Hong Kong: an exploratory randomised controlled trial

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Abstract
Background: Studies have revealed an increasing prevalence of depressive symptoms among youth globally, including in Hong Kong, posing a serious threat to their mental health and quality of life. While it has been shown that horticultural activities are promising for reducing depressive symptoms in adults and older populations, their effectiveness among youth—particularly in Chinese communities—remains underexplored. This study examined the feasibility, applicability and effectiveness of horticultural activities in reducing depressive symptoms among Hong Kong youth, as well as reducing anxiety and enhancing self-esteem and quality of life. Methods: The intervention group attended four weekly 2-h nurse-led structured horticultural sessions on a local farm. The control group received regular mental health parameters monitoring by the researcher and a mental health information pamphlet. Outcomes, including depressive and anxiety symptoms, self-esteem and quality of life, were measured at baseline (T 0 ), post-intervention (T 1 ) and 4 weeks later (T 2 ). The feasibility of the intervention was assessed through recruitment metrics and participants’ feedback. Results: Between October and December 2023, 108 Hong Kong Chinese youth aged 15–24 years who self-reported depressive symptoms, were equally and randomly assigned to either the intervention ( n = 54) or control group ( n = 54). The intervention was feasible and well accepted, with an eligibility rate of 94.2%, a recruitment rate of 77.7%, and retention rates of 88.9% at T 1 and 69.4% at T 2 . Horticultural activities significantly reduced the severity of depressive symptoms ( β = −1.207, 95% CI: −1.820 to − 0.043, P = .028), with the most notable improvement observed between T 0 and T 1 ( P = .05, generalised estimating equation [GEE] analysis). Conclusions: Horticultural activities are a feasible, low-cost and acceptable intervention for reducing depressive symptoms among Hong Kong youth. Given horticultural activities’ potential to promote mental well-being, their integration into community-based mental health programmes should be considered. Further large-scale trials are recommended to validate their broader psychological benefits. Trial registration: Chinese Clinical Trial Registry ChiCTR2300075575 (registered on 8 September 2023).

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