There is evidence suggesting that the prevalence of mental health issues is higher among people living in urban areas compared to those in rural and countryside settings. Given that the therapeutic benefits of horticultural therapy (HT) and participation in urban agricultural activities have been demonstrated in numerous studies with different experimental designs and levels of rigor, such research appears to offer a promising approach to improve the mental health and well-being of individuals experiencing elevated levels of depression, anxiety, and/or perceived stress.
1Tate et al. (2026) from the United Kingdom, writing in the journal Cities, describe a systematic review of published studies retrieved from four scientific databases focusing on horticultural therapy and urban agriculture related to depression, anxiety, and acute stress. Keyword searches for urban agriculture, mental health conditions, and study types were performed. Over 1,000 titles were identified through title and abstract keyword searches, and 55 were subsequently selected for full-text review. Ultimately, 11 studies met the screening criteria for outcome measures, sample characteristics, and overall study design.
As is common in this field, experimental designs, intervention settings, and sample demographics varied. Sample sizes of the 11 studies ranged from 20 to 781 participants, and treatment outcomes were assessed with different instruments. The risk of bias in outcomes and findings ranged from low to moderate to high. In some ways, it would be beneficial if the studies were more consistent to improve reliability and repeatability. Most studies also lacked long-term follow-up assessments of treatment outcomes.
Three studies did not find that horticultural therapy treatments improved depressive symptoms. In contrast, six studies showed significant improvements, although different outcome measurement scales were used. Unfortunately, the diversity in demographics, methods, treatments, outcome measures, and follow-up procedures in research design can complicate independent reproducibility and confirmation, which is considered the gold standard for validating scientific results.
Only three of the 11 studies evaluated treatment outcomes for anxiety, and one did not record a positive improvement for participants. The findings regarding anxiety in this systematic review were considered insufficient to draw meaningful conclusions.
Of the six studies investigating stress, only three reported significant reductions in stress indicators following treatment. Two studies used somewhat ambiguous and unusual outcome measures: one used sick leave, a nonspecific indicator of stress, and the other combined sick leave with other healthcare consumption.
The authors state that it is “still unclear whether HT interventions can provide a scalable public policy solution to mental ill-health in cities.” This overall conclusion, perhaps, is the least favorable among the many systematic reviews and meta-analyses conducted to date regarding the therapeutic benefits of horticultural therapy and urban agriculture activities on depression, anxiety, and stress.
1Tate, C., Hashmi, S. M., O’Kane, N., & Hunter, R. F. (2026). A systematic review of horticultural therapy and urban agriculture interventions targeting depression, anxiety, and acute stress disorder. Cities, 169, 106554.
https://www.sciencedirect.com/science/article/pii/S0264275125008571
Charles Guy, BA, MS, PhD
Emeritus and Courtesy Professor
Horticultural Sciences Department, University of Florida
Steering Committee, Wilmot Botanical Gardens, University of Florida
Board of Advisors Committee, Wilmot Botanical Gardens, University of Florida