Elizabeth R. M. Diehl
David C. Diehl2
Siang Yu Tham- 1Department of Environmental Horticulture, University of Florida, Gainesville, FL, United States
- 2Department of Family, Youth and Community Sciences, University of Florida, Gainesville, FL, United States
Introduction: College students across the United States are struggling with significant and increasing levels of stress and anxiety, which contribute to both personal and academic distress. There is a growing need to develop and evaluate programs to reduce stress and anxiety and build resilience in students. The focus of this study was to explore the use of therapeutic horticulture (TH) with university students, specifically hypothesizing that participants would experience reductions in stress and anxiety and increases in resilience and academic resilience after participating in the program.
Methods: Fifty-one university students participated in at least eight weeks of therapeutic horticulture programming and completed pre- and post-surveys assessing participants’ perceived stress, state and trait anxiety, general resilience, and academic resilience. Paired sample t-tests were computed to determine if there was significant change on each outcome variable from the pre-survey to the post-survey.
Results: Significant pre-post improvements in outcomes were found for: academic resilience, including perseverance, help seeking, and managing negative emotions; perceived stress; state and trait anxiety; and general resilience. Findings indicate that therapeutic horticulture is potentially beneficial across a variety of relevant outcomes.
Discussion: The findings indicate that therapeutic horticulture is a promising intervention model for improving mental health and academic outcomes for U.S. college students. These outcomes are critical for overall health and well-being, as well as academic performance, which contributes to lifelong positive outcomes. Future research should include strong study designs that include random assignment into conditions.
Introduction
College students across the United States are challenged by significant and increasing levels of stress and anxiety. The Healthy Minds Network (2021) reported that more than 60% of college students met the criteria for at least one mental health problem during the 2020–2021 academic year, up almost 50% from 2013 (Lipson et al., 2022). Fifty percent of students either agreed or strongly agreed that they needed assistance with emotional or mental health issues. Just 16% of students were currently receiving therapy or counseling (Healthy Minds Network, 2021). The 2024 State of Higher Education Report stated that one in three students currently enrolled in college considered dropping out and of those, 64% cited emotional stress or mental health concerns (Gallup-Lumina Foundation, 2024).
Psychological distress, in turn, can impact academic success. A recent study reported that 53% of students experiencing anxiety, 54% experiencing stress, and almost 61% experiencing depression stated that it negatively impacted academic performance (ACHA, 2022). In addition to stress and anxiety, 80% of college students may experience loneliness during their college experience (Arnett, 2000). Negative outcomes for young adults experiencing loneliness include susceptibility to illness (Miller, 2011), more alcohol consumption (Arpin et al., 2015), poor sleep quality (Segrin and Burke, 2014), poor college performance (Wohn and LaRose, 2014), and increased risk of suicide (Chang et al., 2015).
These mental health challenges are entry points for a vicious cycle of worsening mental health. Depression and anxiety can lead to social withdrawal which increases the risk of loneliness and social isolation (Luo, 2023). Likewise, loneliness and social isolation are predictors for developing anxiety and depression and can contribute to their increase over time (U.S. Surgeon General, 2023). A systematic review found that children and adolescents experiencing social isolation and loneliness are at an increased risk of anxiety and depression which remains high up to nine years later (Loades et al., 2020). Similarly, researchers found a positive correlation between anxiety symptoms and academic stress in college students and that academic stress is a risk factor for anxiety symptoms (Beiter et al., 2015). Additionally, anxiety affects and is impacted by physical health (WHO, 2023).
Stress
Stress is often defined as the psychological and/or physiological response to perceived threats or other internal/external stressors (APA, 2018a). It impacts emotions, influences behavior, and encompasses changes that affect almost every bodily system (Anisman and Merali, 1999; APA, 2018a). According to the Spring 2022 National College Health Assessment, 75% of students reported moderate or severe psychological stress. Stress was reported as an academic impediment by 37.3% of all students in 2023 compared to 32% in 2016, representing a 17% increase (ACHA, 2016, 2023). Not only can stress negatively impact academic performance (Córdova et al., 2023), but students experiencing a high level of stress also report reduced enjoyment in learning (Flinn et al., 2016), poorer skill acquisition (Córdova et al., 2023), and decreased memory retrieval (Córdova et al., 2023; Wolf, 2017).
Anxiety
The American APA (2018b) defines anxiety as an emotion characterized by worry, tension, intrusive thoughts, and physiological changes such as increased blood pressure and heart rate. Related to fear, anxiety tends to be correlated with a future-oriented focus on a broad or diffuse threat. Repeated patterns of anxiety can lead to sleep problems (Dunn et al., 2022), negative health outcomes (Aquin et al., 2017; WHO, 2023), and decreased cognitive performance (Majeed et al., 2023; Hartanto and Yang, 2022). In 2023, 30.4% of students reported having a diagnosed anxiety condition compared to 24.9% in 2016, representing a 22% increase (ACHA, 2016, 2023). Researchers found that high academic distress was associated with a higher probability of student anxiety (Zakeri et al., 2021). Anxiety is also positively associated with student burnout (Abreu Alves et al., 2022), reduced academic engagement (Mou et al., 2022), and lower academic performance (Moreira de Sousa et al., 2018).
Resilience
Resilience encompasses three key components: an adversity, which constitutes a stressful or traumatic experience; observable signs of healthy functioning following the adversity; and mechanisms that prevent or facilitate recovery from the typical distress. These mechanisms, also referred to as the protective factors, enable the individual to recover from adversity (Hamby et al., 2017). The concept of resilience was originally conceptualized as individual, intrinsic traits such as coping skills and positivity. Further research on resilience increasingly acknowledges the protective role of extrinsic factors as well, including social relationships and resources within one’s environment (Luthar et al., 2000; Van Breda, 2001). Research based in social-ecological models has emphasized that resilience is characterized by complex interactions between the individual and specific characteristics of their environment. Researchers have proposed models that explore the qualities of different contexts that help facilitate resilience (Masten et al., 2023; Ungar, 2011; Ungar et al., 2013).
College is a time of significant transition to young adulthood (Walters et al., 2018), which can be challenging and stressful for many students as they experience changes in their environment, social and family relationships, education, responsibilities, and finances, among other areas. Resilience has been demonstrated to be an effective mechanism in empowering students to navigate these challenges, particularly in reducing stress and alleviating depressive symptoms (Smith and Yang, 2017). Despite these benefits, a meta-analysis by Chua et al. (2022) found that globally, 36% of college students reported low resilience. Students exhibiting low levels of resilience demonstrate poorer well-being, increased stress levels, a higher likelihood of dropping out of school (Ang et al., 2022; Sosu and Pheunpha, 2019), decreased academic motivation (Pascoe et al., 2019), impaired memory retrieval (Trammell and Clore, 2014), and poor academic performance (Chua et al., 2022). A study of first- and second-year medical students revealed that general distress and lack of adaptive coping strategies were associated with burnout (Abreu Alves et al., 2022). The study also reported that academic engagement served as a protective factor, reducing the effect of burnout on dropout intention.
Academic resilience
Because education is a primary focus of the college experience, an area of resilience that is of particular interest is that of academic resilience. Academic resilience refers to the capacity to return to healthy academic or educational functioning following an adversity (Cassidy, 2016). Several risk factors may influence an individual’s academic performance including stress, anxiety, depression, and loneliness (Wohn and LaRose, 2014), as well as chronic illness, undesirable living conditions or homelessness, experiencing a natural disaster, and facing financial hardships among others (Horton, 2015; Masten, 1994; Sosu and Pheunpha, 2019; Yang and Wang, 2022). While numerous studies have been conducted on resilience and protective factors in mental health, research in protective factors influencing academic resilience remains limited.
Although the reasons for the dramatic increase in mental health challenges among college students during the past decade are not fully understood, contributing factors may include perceived increases in parental expectations (Curran and Hill, 2022), impacts of social media and social ‘worth’ (Powdthavee, 2014; Scelfo, 2015), financial stressors (McAlpine, 2021; NASPA, 2023), shifting societal values (McAlpine, 2021), and more recently, the trauma of Covid-19 (Kim et al., 2022; Lipson et al., 2022). On the more positive side, the awareness of mental health issues and reduction in the associated stigma may allow more students to voice their struggles (McAlpine, 2021; NASPA, 2023). Additionally, advances in treatment and medications have enabled more students with mental illness to go to college (Abrams, 2020; Biancolli, 2021).
College counseling and wellness centers everywhere are overwhelmed with almost 90% of center directors reporting an increase in the number of students seeking services in 2019 (LeViness et al., 2019). This high demand leads to longer wait times for students, mounting pressure on counseling centers, and counselor burnout (Abrams, 2020; Biancolli, 2021). However, colleges have unique access to students and therefore have greater opportunity to provide resources and additional interventions to those in need. As Lipson et al. (2022) point out, colleges and universities are ideal settings to approach mental health issues during a significant stage of life.
Therapeutic horticulture
Therapeutic Horticulture (TH) is a process that uses structured horticultural activities as a therapeutic modality to support program and health goals and improve well-being through active and passive participation (AHTA, 2013). This process was described as early as the 19th century by Dr. Benjamin Rush, recognized as the ‘father’ of American psychiatry. He was the first to document the positive effect that working in a garden had on individuals with mental illness (Monroe, 2015). Horticultural activities have long-proven therapeutic benefits for people experiencing mental health issues and have been associated with significant improvements in quality of life, well-being, social relations, and physical and cognitive outcomes (Elsadek et al., 2019; Gonzalez et al., 2010; Shao et al., 2020). Additional studies have found horticulture interventions led to significant decreases in stress (Egerer et al., 2022; Kaplan, 1995; Ulrich et al., 1991), anxiety (Gonzalez et al., 2010; Son et al., 2004; Yang et al., 2022), and social isolation (Howarth et al., 2020). Therapeutic horticulture has also been shown to boost mood (Elsadek et al., 2019), life satisfaction (Son et al., 2004), and self-esteem (Sonti and Svendsen, 2018; Wood et al., 2016), enhance interpersonal relationships (Waliczek et al., 2005) and improve body image (Swami et al., 2020). Because TH uses plants and nature as a vehicle for exploring mental health issues, there may be less stigma and/or cultural barriers associated with participation.
While substantial research has been conducted on the mental health and stress reduction benefits of therapeutic horticulture interventions on other populations including children, adults, and seniors (Lu et al., 2023; Rosa et al., 2023), few studies have been published about these benefits for college students. However, some benefits from exposure to gardens and greenspace have been reported for college students, including lower perceived stress (Holt et al., 2019; Larson et al., 2022; Macchi and Coccia, 2022; Matias et al., 2023; Mecham and Joiner, 2021), increased positive emotions and well-being (Baur, 2020; Holt et al., 2019; Mecham and Joiner, 2021; Stepansky et al., 2022), improved self-efficacy (Macchi and Coccia, 2022), as well as improved academic self-efficacy (Guo et al., 2023). These benefits were generally greater for those actively participating in the garden or in a horticultural activity.
Aim of study
This study sought to understand the role that therapeutic horticulture (TH) could play in improving mental health and academic outcomes in students at the University of Florida. The specific hypotheses were that participants would experience reductions in stress and anxiety and increases in resilience and academic resilience after participating in the program.
Materials and methods
Selection and recruitment of participants
Recruitment for this study took place via social media posts, campus flyers, email announcements, and information provided at the UF Counseling & Wellness Center (CWC). Interested students were invited to email or call the study PI. During that initial contact the PI and/or study staff inquired about student status. If the individual was a current student at UF they were invited to join the group and informed of the research study. Students were not required to take part in the study to join the TH group but were invited to join the study if there were at least eight weeks remaining in the current semester.
Eighty-five participants from the student body of the University of Florida consented to participate in this research study (IRB# 202101905). The study took place in three phases over three semesters; Fall 2021, Spring 2022, and Fall 2022. Fifty-one participants who attended at least eight sessions and completed both the pre-survey and post-survey are included in the analyses here.
Therapeutic horticulture program protocol
Students were admitted to the TH group on a rolling basis if there was space but invited to participate in the study only if there were at least eight sessions remaining in the semester. In addition, some students declined to participate in the research study so there was a mix of research and non-research participants in each group. All participants took part in the same activities no matter their status.
Sessions were offered at different times during the week (mornings and afternoons) to accommodate academic schedules. Fall cohorts began in September and ended in December. Spring cohorts began in January and ended in April. Each session lasted 75 min and followed the same schedule, which included 15 min of ongoing propagation work in a mini tabletop greenhouse, 20 min exploring a wellness strategy, and 40 min engaged in a horticulture activity. The structure and schedule of each session was the same throughout the groups. By the end of their eighth session, each participant had been introduced to eight different wellness strategies and participated in eight different horticulture activities. The underlying goals of each session were to: (1) build skills and confidence in working with plants; (2) introduce and practice a wellness strategy; (3) increase understanding of the role that plants and nature can play in personal wellness; and (4) build community among participants.
Each group met in the same greenhouse located on the University of Florida campus in Wilmot Botanical Gardens. The greenhouse is a 2,700 sf conservatory-style glass greenhouse with bathrooms, accessible features, and a fully air-conditioned reception area connected to the greenhouse. The greenhouse has a large area with tables and chairs where a group can work and interact comfortably. Most of the horticulture activities took place in the greenhouse while most of the wellness strategies were explored in the quieter reception area.
The greenhouse sits in the SW corner of the 4.8-acre gardens which contain a variety of garden features and plant types in both sunny and shady areas. The garden was used as an integral part of several horticulture activities such as collecting natural materials to use in projects. A few wellness strategies also took place in the gardens such as mindful walking.
Session content
Participants were assigned to a TH group with 6–12 other participants based on the group that worked best for their schedule. TH sessions were facilitated by a professionally registered horticultural therapist and a program manager with training in the use of horticulture as a therapeutic modality.
During each session, participants explored a wellness strategy, led by a counselor from the Counseling & Wellness Center at UF, and then engaged in a related horticulture activity. Wellness strategies included mindfulness, cognitive defusion, anxiety reduction techniques, and self-compassion strategies, among others. Horticulture activities included hands-on basic plant care such as plant propagation techniques and methods, proper planting and maintenance, and general plant identification and knowledge. Participants also participated in plant art activities and regularly took plants and plant crafts home.
Study design and data collection
This study used a single-group, non-experimental pre−/post-survey method. At the first visit, participants completed the informed consent. After signing the ICF, they filled out a demographic questionnaire inquiring about their age, race/ethnicity, gender, academic major, and gardening experience, among other information. Participants then filled out a set of four self-report psychometric questionnaires and then immediately joined the TH session with the rest of the group.
The therapeutic horticulture sessions ran for 12–13 weeks each semester. Study participants were asked to attend sessions once per week. If a participant was not able to attend at least eight sessions, their participation in the study was discontinued. The participant could continue attending the sessions, but any data collected was not used in final data analyses. At the participant’s eighth visit, following the scheduled TH activity, they completed the same four psychometric surveys as during their first visit. Participants who completed their eighth visit and corresponding questionnaires could continue to attend the remaining sessions, but no further data was collected from these individuals.
Measures
Stress. Participants’ perceived stress was measured using the Perceived Stress Scale (PSS) (Cohen et al., 1983), which is based on a 5-point Likert Scale and is the most widely used psychometric tool to gauge the perception of stress. This study used the validated 10-item Perceived Stress Scale, which has strong validity and reliability (Roberti et al., 2006).
Anxiety
State and trait anxiety were assessed using the State–Trait Anxiety Inventory Short Form (STAI-6) (Spielberger et al., 1983) which seeks to gauge anxiety levels. This leading measure of personal anxiety differentiates between the temporary condition of state anxiety and the more general or persisting trait anxiety using a 4-point Likert scale. The short-form version of the STAI has been validated as a reliable alternative to the full scale (Zsido et al., 2020).
General resilience
General resilience was measured using the Brief Resilience Scale (BRS) (Smith et al., 2008). This six-item scale includes both positively and negatively worded statements that are responded to using a 5-point Likert scale. The scale assesses one’s ability to bounce back or recover from stress.
Academic resilience
The Academic Resilience Scale (ARS-30) was used to explore process rather than outcome aspects of resilience (Cassidy, 2016). This 30-item, vignette-based scale measures academic resilience based on specific adaptive behavioral and cognitive-affective responses when confronted with academic adversity.
Data analysis
All outcome measures were treated as continuous variables and paired sample t-tests were computed to determine if there was significant change on each outcome variable from the pre-survey to the post-survey. All analyses were conducted using the Statistical Package for the Social Sciences (SPSS), version 29.
Participant profile
Fifty-one individuals, who completed eight therapeutic sessions and also completed the pre-survey and post-survey, are included in this study. Study participants were currently registered students at the University of Florida, representing 34 different majors. The participants ranged in age from 18–53, with a median age of 22. This includes roughly equal numbers of undergraduate (52.9%) and graduate students (47.1%). About 71% of participants identified as female, 24% identified as male, and 6% identified as queer / gender nonconforming. Demographic and background characteristics are reported in Table 1.
Table 1. Participant characteristics.
Results
The analysis of change from pre-survey to post-survey revealed significant positive change for all outcomes measured. For academic resilience, the total score improved from pre-test to post-test, t(50) = 6.81, p < 0.001, as did the three subscales: perseverance, t(50) = 5.92, p < 0.001; help seeking, t(50) = 4.88, p < 0.001; and negative emotions, t(50) = 5.05, p < 0.001. Effect sizes for these improvements ranged from 0.61 to 0.87. On the measure of perceived stress, mean scores were significantly reduced from pre to post, t(50) = 4.62, p < 0.001, with an effect size of 0.62. Similarly, measures of state anxiety, t(50) = 8.34, p < 0.001, and trait anxiety, t(50) = 3.75, p < 0.001, were also significantly reduced, with effect sizes of 1.18 and 0.53, respectively. General resilience significantly increased, t(50) = 2.61, p = 0.011, with an effect size of 0.33. See Table 2 for detailed descriptive and inferential statistics.
Table 2. Description of findings for change over time on all outcome variables.
Discussion
Confirming the study’s primary hypothesis, participation in the therapeutic horticulture program was associated with a significant increase in students’ academic resilience, a finding with a large effect size of 0.87. Furthermore, improvements in the sub-scores of perseverance, reflecting and adaptive help-seeking, and avoidance of negative affective and emotional response were reported, suggesting a positive impact on academic life. Positive outcomes related to academic resilience are especially important in college student populations because of the centrality of educational success in student life. Further, academic resilience has been linked to positive outcomes such as enjoyment of school, participation in class, and general self-esteem (Martin and Marsh, 2006). Elnaem et al. (2024) also found that academic resilience correlates with positive academic outcomes, with coping strategies and social support playing critical roles in influencing how students manage academic adversity.
Scores on the Brief Resilience Scale, which measures general resilience, also indicate a statistically significant improvement, with an effect size of 0.33. Considerable research shows that resilience has protective effects on mental well-being and plays a mediating role in state and trait anxiety (Bacchi and Licinio, 2017; Peng et al., 2022). Resilient students have the adaptive ability to overcome adversity and anxiety in times of heightened challenge (Devi et al., 2021).
A statistically significant reduction of both state and trait anxiety was found as demonstrated by the scores on the STAI-6. These findings suggest that therapeutic horticulture is effective in alleviating both temporary and persisting conditions of anxiety. These results parallel previous studies which demonstrate the effectiveness of therapeutic horticulture in significantly reducing anxiety among other groups (Gonzalez et al., 2010; Son et al., 2004; Yang et al., 2022).
The scores on the Perceived Stress Scale revealed significant reduction in perceived stress, which suggests a positive effect of TH interventions on reducing stress. These results support studies with other groups on the effectiveness of a TH intervention on stress (Egerer et al., 2022; Kaplan, 1995; Ulrich et al., 1991). In an academic setting, these findings are significant since stress is a risk factor for poor academic performance (Wohn and LaRose, 2014), and more specifically, decreased memory retrieval (Wolf, 2017), poorer skill acquisition (Córdova et al., 2023), and reduced enjoyment in learning (Flinn et al., 2016). Reducing stress and the negative emotions that often accompany stress may lead to more effective learning. Perhaps the intentional community-building efforts in this study led to increased social support among participants. Kugbey et al. (2015) reported a significant negative correlation between social support and stress in academia; when social support increases, stress decreases. The feeling of being supported is crucial in helping students manage their stress levels and shield them from various psychological issues (Camara et al., 2017).
Limitations/improvements
This study has several limitations. First, there was no random assignment in this study. Participants signed up for the study knowing there were horticulture activities involved. Therefore the sample may be subject to selection bias since it is possible that some participants may have had a positive attitude toward the intervention. Second, the study did not include a control group to determine if the reported changes were in fact due to the TH intervention or other external influences during the semester. Third, all outcome measures used (ARS, PSS, BRS & STAI-6) rely on self-reported data, which could be influenced by social desirability bias, leading participants to over-report improvements or under-report negative emotions. Fourth, while race was not a focal variable of this analysis, the relatively high frequency of ‘No answer’ responses on the race question makes it more challenging to fully describe the characteristics of this sample. Lastly, the participants were all students enrolled at a single large public university and therefore the findings may not be generalizable to students at other institutions. Nevertheless, this research offers valuable insight into the potential benefits of therapeutic horticulture and serves as an important foundation for future studies on the impacts of TH on the mental health and academic resilience of college students.
Conclusion
In this study, a structured therapeutic horticulture program led to significant improvements in general and academic resilience and reductions in stress and anxiety. These findings are noteworthy given the scarcity of research in this area and they contribute to a better understanding of the connections between plants, nature, and student mental health. This study points to an expanded, more holistic paradigm of addressing student mental health, one that moves beyond a sole focus on the university counseling center. There are many students whose mental health needs may be met by accessible, alternative routes to professional intervention and these findings support that possibility. Therapeutic horticulture programs may reduce the burden on university counseling centers by engaging students who are not yet in acute need of services, but are experiencing increasing academic and mental health distress. By sharing experiences and working together on intrinsically meaningful horticulture-based activities, students in this program developed community and social support while learning coping strategies. Through this process students can improve confidence, self-efficacy, and self-worth, strengthening their overall health and wellness and boosting academic resilience.
Data availability statement
The datasets in this article are not readily available because that is not a condition in our IRB contract. Questions about the dataset should be directed to bGVhaGRpZWhsQHVmbC5lZHU=.
Ethics statement
This study involving humans was approved by the University of Florida Institutional Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
Author contributions
ED: Data curation, Software, Project administration, Conceptualization, Visualization, Methodology, Funding acquisition, Writing – original draft, Writing – review & editing, Investigation, Supervision, Resources. DD: Formal analysis, Writing – review & editing, Validation, Software, Data curation. ST: Resources, Investigation, Writing – review & editing, Supervision, Writing – original draft.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The authors declare that no Gen AI was used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
Abreu Alves, S., Sinval, J., Lucas Neto, L., Marôco, J., Gonçalves Ferreira, A., and Oliveira, P. (2022). Burnout and dropout intention in medical students: the protective role of academic engagement. BMC Med. Educ. 22:83. doi: 10.1186/s12909-021-03094-9
ACHA (2016). American college health association-National College Health Assessment III: Reference group executive summary fall 2016. Silver Spring, MD: American College Health Association.
ACHA (2022). American college health association-National College Health Assessment III: Reference group executive summary spring 2022. Silver Spring, MD: American College Health Association.
AHTA (2013). Definitions and positions. Available online at: https://www.ahta.org/ahta-definitions-and-positions (Accessed August 20, 2023).
American College Health Assessment (2023). American college health association-National College Health Assessment III: Reference group executive summary fall 2023. Silver Spring, MD: American College Health Association.
Ang, W. H., Shorey, S., Zheng, Z. J., Ng, W. H., Chen, E. C., Shah, L. B., et al. (2022). Resilience for undergraduate students: development and evaluation of a theory-driven, evidence-based and learner centered digital resilience skills enhancement (RISE) program. Int. J. Environ. Res. Public Health 19:12729. doi: 10.3390/ijerph191912729
Anisman, H., and Merali, Z. (1999). Understanding stress: characteristics and caveats. Alcohol Res. Health 23, 241–249.
APA. (2018a). Stress. Available online at: https://dictionary.apa.org/stress (Accessed January 15, 2025).
APA. (2018b). Anxiety. Available online at: https://dictionary.apa.org/anxiety (Accessed January 15, 2025).
Aquin, J. P., El-Gabalawy, R., Sala, T., and Sareen, J. (2017). Anxiety disorders and general medical conditions: current research and future directions. Focus 15, 173–181. doi: 10.1176/appi.focus.20160044
Arnett, J. J. (2000). Emerging adulthood: a theory of development from the late teens through the twenties. Am. Psychol. 55, 469–480. doi: 10.1037/0003-066x.55.5.469
Arpin, S. N., Mohr, C. D., and Brannan, D. (2015). Having friends and feeling lonely. Personal. Soc. Psychol. Bull. 41, 615–628. doi: 10.1177/0146167215569722
Bacchi, S., and Licinio, J. (2017). Resilience and psychological distress in psychology and medical students. Acad. Psychiatry 41, 185–188. doi: 10.1007/s40596-016-0488-0
Baur, J. (2020). Campus community gardens and student health: a case study of a campus garden and student well-being. J. Am. Coll. Heal. 70, 377–384. doi: 10.1080/07448481.2020.1751174
Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., et al. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J. Affect. Disord. 173, 90–96. doi: 10.1016/j.jad.2014.10.054
Biancolli, A. (2021). Crisis on campus: Mental health counselors are feeling the crush. Mad in America: Science, psychiatry and social justice. Available online at: https://www.madinamerica.com/2021/10/mia-report-college-counseling/
Camara, M., Bacigalupe, G., and Padilla, P. (2017). The role of social support in adolescents: are you helping me or stressing me out? Int. J. Adolesc. Youth 22, 123–136. doi: 10.1080/02673843.2013.875480
Cassidy, S. (2016). The academic resilience scale (ARS-30): a new multidimensional construct measure. Front. Psychol. 7:1787. doi: 10.3389/fpsyg.2016.01787
Chang, E. C., Lian, X., Yu, T., Qu, J., Zhang, B., Jia, W., et al. (2015). Loneliness under assault: understanding the impact of sexual assault on the relation between loneliness and suicidal risk in college students. Personal. Individ. Differ. 72, 155–159. doi: 10.1016/j.paid.2014.09.001
Chua, J. H., Cheng, C. K. T., Cheng, L. J., Ang, W. H. D., and Lau, Y. (2022). Global prevalence of resilience in higher education students: a systematic review, meta-analysis and meta-regression. Curr. Psychol., 1–19. doi: 10.1007/s12144-022-03366-7
Cohen, S., Kamarck, T., and Mermelstein, R. (1983). A global measure of perceived stress. J. Health Soc. Behav. 24, 385–396. doi: 10.2307/2136404
Córdova, A., Caballero-García, A., Drobnic, F., Roche, E., and Noriega, D. C. (2023). Influence of stress and emotions in the learning process: the example of COVID-19 on university students: a narrative review. Healthcare 11:1787. doi: 10.3390/healthcare11121787
Curran, T., and Hill, A. P. (2022). Young people’s perceptions of their parents’ expectations and criticism are increasing over time: implications for perfectionism. Psychol. Bull. 148, 107–128. doi: 10.1037/bul0000347
Devi, H. M., Purborini, N., and Chang, H. (2021). Mediating effect of resilience on association among stress, depression, and anxiety in Indonesian nursing students. J. Prof. Nurs. 37, 706–713. doi: 10.1016/j.profnurs.2021.04.004
Dunn, C., Goodman, O., and Szklo-Coxe, M. (2022). Sleep duration, sleep quality, excessive daytime sleepiness, and chronotype in university students in India: a systematic review. J. Health Soc. Sci. 7, 36–52. doi: 10.19204/2022/SLPD3
Egerer, M., Lin, B., Kingsley, J., Marsh, P., Diekmann, L., and Ossola, A. (2022). Gardening can relieve human stress and boost nature connection during the COVID-19 pandemic. Urban For. Urban Green. 68:127483. doi: 10.1016/j.ufug.2022.127483
Elnaem, M. H., Wan Salam, W. N., Thabit, A. K., Mubarak, N., Abou Khatwa, M. M., Ramatillah, D. L., et al. (2024). Assessment of academic resilience and its associated factors among pharmacy students in twelve countries. Am. J. Pharm. Educ. 88:100693. doi: 10.1016/j.ajpe.2024.100693
Elsadek, M., Liu, B., and Lian, Z. (2019). Green façades: their contribution to stress recovery and well-being in high-density cities. Urban For. Urban Green. 46:126446. doi: 10.1016/j.ufug.2019.126446
Flinn, J. T., Miller, A., Pyatka, N., Brewer, J., Schneider, T., and Cao, C. G. (2016). The effect of stress on learning in surgical skill acquisition. Med. Teach. 38, 897–903. doi: 10.3109/0142159X.2015.1114597
Gallup-Lumina Foundation (2024). State of higher education 2024 report. Available online at: https://www.gallup.com/analytics/644939/state-of-higher-education.aspx?thank-you-report-form=1
Gonzalez, M. T., Hartig, T., Patil, G. G., Martinsen, E. W., and Kirkevold, M. (2010). Therapeutic horticulture in clinical depression: a prospective study of active components. J. Adv. Nurs. 66, 2002–2013. doi: 10.1111/j.1365-2648.2010.05383.x
Guo, S., Li, T., Xue, B., and Yang, X. (2023). Horticultural activities participation and college students’ positive mental characters: mediating role of academic self-efficacy. Horticulturae 9:334. doi: 10.3390/horticulturae9030334
Hamby, S., Grych, J., and Banyard, V. (2017). Resilience portfolios and poly-strengths: identifying protective factors associated with thriving after adversity. Psychol. Violence 8, 172–183.
Hartanto, A., and Yang, H. (2022). Testing theoretical assumptions underlying the relation between anxiety, mind wandering, and task-switching: a diffusion model analysis. Emotion 22, 493–510. doi: 10.1037/emo0000935
Healthy Minds Network (2021). Healthy minds study among colleges and universities, winter 2021 [data set]. Healthy Minds Network, University of Michigan, University of California Los Angeles, Boston University, and Wayne State University. Available online at: https://healthymindsnetwork.org/reserach/data-for-researchers
Holt, E., Lombard, Q., Best, N., Smiley-Smith, S., and Quinn, J. (2019). Active and passive use of green space, health, and well-being amongst university students. Int. J. Environ. Res. Public Health 16:424. doi: 10.3390/ijerph16030424
Horton, J. (2015). Identifying at-risk factors that affect college student success. Int. J. Process Educ. 7, 83–102.
Howarth, M., Brettle, A., Hardman, M., and Maden, M. (2020). What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription. BMJ Open 10:e036923. doi: 10.1136/bmjopen-2020-036923
Kaplan, S. (1995). The restorative benefits of nature: toward an integrative framework. J. Environ. Psychol. 15, 169–182. doi: 10.1016/0272-4944(95)90001-2
Kim, H., Rackoff, G.N., and Fitzsimmons-Craft, E.E. (2022). College mental health before and during the COVID-19 pandemic: Results from a nationwide survey. Cognitive Therapy and Research, 46, 1–10. doi: 10.1007/s10608-021-10241-5
Kugbey, N., Osei-Boadi, S., and Atefoe, E. A. (2015). The influence of social support on the levels of depression, anxiety and stress among students in Ghana. J. Educ. Pract. 6, 135–140.
Larson, L. R., Mullenbach, L. E., Browning, M. H. E. M., Rigolon, A., Thomsen, J., Metcalf, E. C., et al. (2022). Greenspace and park use associated with less emotional distress among college students in the United States during the COVID-19 pandemic. Environ. Res. 204:112367. doi: 10.1016/j.envres.2021.112367
LeViness, P., Gorman, K., Braun, L., Koenig, L., and Bershad, C. (2019). The Association for University and College Counseling Center Directors annual survey. Available online at: https://www.aucccd.org/assets/documents/Survey/2019%20AUCCCD%20Survey-2020-05-31-PUBLIC.pdf (Accessed September 3, 2023).
Lipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., et al. (2022). Trends in college student mental health and help-seeking by race/ethnicity: findings from the national healthy minds study, 2013–2021. J. Affect. Disord. 306, 138–147. doi: 10.1016/j.jad.2022.03.038
Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., et al. (2020). Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. J. Am. Acad. Child Adolesc. Psychiatry 59, 1218–1239.e3. doi: 10.1016/j.jaac.2020.05.009
Lu, S., Liu, J., Xu, M., and Xu, F. (2023). Horticultural therapy for stress reduction: a systematic review and meta-analysis. Front. Psychol. 14:1086121. doi: 10.3389/fpsyg.2023.1086121
Luo, M. (2023). Social isolation, loneliness, and depressive symptoms: a twelve-year population study of temporal dynamics. J. Gerontol. B Psychol. Sci. Soc. Sci. 78, 280–290. doi: 10.1093/geronb/gbac174
Luthar, S. S., Cicchetti, D., and Becker, B. (2000). The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 71, 543–562. doi: 10.1111/1467-8624.00164
Macchi, A., and Coccia, C. (2022). Effects of a cooking and gardening nutrition intervention in food insecure college students. J. Acad. Nutr. Diet. 122 Supplement:A60. doi: 10.1016/j.jand.2022.06.193
Majeed, N. M., Chua, Y. J., Kothari, M., Kaur, M., Quek, F. Y. X., Ng, M. H. S., et al. (2023). Anxiety disorders and executive functions: a three-level meta-analysis of reaction time and accuracy. Psychiatry Research Communications 3:100100. doi: 10.1016/j.psycom.2022.100100
Martin, A. J., and Marsh, H. W. (2006). Academic resilience and its psychological and educational correlates: a construct validity approach. Psychol. Sch. 43, 267–281. doi: 10.1002/pits.20149
Masten, A. S. (1994). “Resilience in individual development: successful adaptation despite risk and adversity” in Educational resilience in inner-city America: Challenges and prospects. eds. M. C. Wang and E. W. Gordon (New Jersey: Lawrence Erlbaum Associates, Inc.), 3–25.
Masten, A. S., Narayan, A. J., and Wright, M. O. D. (2023). “Resilience processes in development: multisystem integration emerging from four waves of research” in Handbook of resilience in children (Cham: Springer International Publishing), 19–46.
Matias, S., Bacon, K., Hee, A., and Deshpande, A. (2023). A mixed-methods explorative study on gardening and wellbeing among college students. J. Nutr. Educ. Behav. 55:1. doi: 10.1016/j.jneb.2023.05.004
McAlpine, K. (2021). Depression, anxiety, loneliness are peaking in college students. The Brink: Pioneering Research from Boston University. Available online at: https://www.bu.edu/articles/2021/depression-anxiety-loneliness-are-peaking-in-college-students/ (Accessed on September 12, 2023).
Mecham, N. A., and Joiner, L. R. (2021). “Even if we never ate a single bite of it, it would still be worth it”: college students’ gardening experiences. J. Ethnographic Qualitative Research 6, 231–242.
Miller, G. (2011). Why loneliness is hazardous to your health. Science 331, 138–140. doi: 10.1126/science.331.6014.138
Monroe, L. (2015). Horticulture therapy improves the body, mind and spirit. J. Ther. Hortic. 25, 33–40.
Moreira de Sousa, J., Moreira, C. A., and Telles-Correia, D. (2018). Anxiety, depression and academic performance: a study amongst Portuguese medical students versus non-medical students. Acta Medica Port. 31, 454–462. doi: 10.20344/amp.9996
Mou, Q., Zhuang, J., Gao, Y., Zhong, Y., Lu, Q., Gao, F., et al. (2022). The relationship between social anxiety and academic engagement among Chinese college students: a serial mediation model. J. Affect. Disord. 311, 247–253. doi: 10.1016/j.jad.2022.04.158
NASPA (2023) Current state of college & student mental health (September 2022). Available online at: https://yvy350.a2cdn1.secureserver.net/wp-content/uploads/2023/01/NASPA-Uwill-Research-Brief-1.pdf
Pascoe, M., Hetrick, S. E., and Parker, A. G. (2019). The impact of stress on students in secondary school and higher education. Int. J. Adolesc. Youth 25, 104–112. doi: 10.1080/02673843.2019.1596823
Peng, L., Hu, X., Lan, L., Xu, C., and Li, M. (2022). The moderating role of resilience in the relationship between state and trait anxiety and post-traumatic growth of medical freshmen. Acta Psychol. 230:103741. doi: 10.1016/j.actpsy.2022.103741
Powdthavee, N. (2014). “Social comparison theory” in Encyclopedia of quality of life and well-being research. ed. A. C. Michalos (Dordrecht: Springer). doi: 10.1007/978-94-007-0753-5_2740
Roberti, J. W., Harrington, L. N., and Storch, E. A. (2006). Further psychometric support for the 10-item version of the perceived stress scale. J. Coll. Couns. 9, 135–147. doi: 10.1002/j.2161-1882.2006.tb00100.x
Rosa, C. D., Chaves, T. S., Collado, S., Larson, L. R., Lee, K. J., and Profice, C. C. (2023). Horticultural interventions may reduce adults’ depressive symptoms: a systematic review of randomized controlled trials. J. Environ. Psychol. 91:102112. doi: 10.1016/j.jenvp.2023.102112
Scelfo, J. (2015). Suicide on campus and the pressure of perfection. The New York Times. Available online at: https://www.nytimes.com/2015/08/02/education/edlife/stress-social-media-and-suicide-on-campus.html
Segrin, C., and Burke, T. J. (2014). Loneliness and sleep quality: dyadic effects and stress effects. Behav. Sleep Med. 13, 241–254. doi: 10.1080/15402002.2013.860897
Shao, Y., Elsadek, M., and Liu, B. (2020). Horticultural activity: its contribution to stress recovery and wellbeing for children. Int. J. Environ. Res. Public Health 17:1229. doi: 10.3390/ijerph17041229
Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., and Bernard, J. (2008). The brief resilience scale: assessing the ability to bounce back. Int. J. Behav. Med. 15, 194–200. doi: 10.1080/10705500802222972
Smith, G. D., and Yang, F. (2017). Stress, resilience and psychological well-being in Chinese undergraduate nursing students. Nurse Educ. Today 49, 90–95. doi: 10.1016/j.nedt.2016.10.004
Son, K. C., Um, S. J., Kim, S. Y., Song, J. E., and Kwack, H. R. (2004). Effect of horticultural therapy on the changes of self-esteem and sociality of individuals with chronic schizophrenia. Acta Hortic. 639, 185–191.
Sonti, N. F., and Svendsen, E. S. (2018). Why garden? Personal and abiding motivations for community gardening in new York City. Soc. Nat. Resour. 31, 1189–1205. doi: 10.1080/08941920.2018.1484971
Sosu, E. M., and Pheunpha, P. (2019). Trajectory of university dropout: investigating the cumulative effect of academic vulnerability and proximity to family support. Front. Educ. 4. doi: 10.3389/feduc.2019.00006
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., and Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.
Stepansky, K., Delbert, T., and Bucey, J. C. (2022). Active student engagement within a university’s therapeutic sensory garden green space: pilot study of utilization and student perceived quality of life. Urban For. Urban Green. 67:127452. doi: 10.1016/j.ufug.2021.127452
Swami, V., Khatib, N. A., Vidal-Mollón, J., Vintila, M., Barron, D., Goian, C., et al. (2020). Visits to natural environments improve state body appreciation: evidence from Malaysia, Romania, and Spain. Ecopsychology 12, 19–23. doi: 10.1089/eco.2019.0065
Trammell, J. P., and Clore, G. L. (2014). Does stress enhance or impair memory consolidation? Cognit. Emot. 28, 361–374. doi: 10.1080/02699931.2013.822346
Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., and Zelson, M. (1991). Stress recovery during exposure to natural and urban environments. J. Environ. Psychol. 11, 201–230. doi: 10.1016/S0272-4944(05)80184-7
Ungar, M. (2011). The social ecology of resilience: A handbook of theory and practice : Springer Science & Business Media.
Ungar, M., Ghazinour, M., and Richter, J. (2013). Annual research review: what is resilience within the social ecology of human development? J. Child Psychol. Psychiatry 54, 348–366. doi: 10.1111/jcpp.12025
U.S. Surgeon General. (2023). Our Epidemic of loneliness and isolation: The U.S. Surgeon General’s Advisory on the healing effects of social connection and community. Office of the U.S. Surgeon General.
Van Breda, A. D. (2001). Resilience theory: A literature review. Pretoria, South Africa: South African Military Health Service.
Waliczek, T. M., Zajicek, J. M., and Lineberger, R. D. (2005). The influence of gardening activities on consumer perceptions of life satisfaction. HortScience 40, 1360–1365.
Walters, K. S., Bulmer, S. M., Troiano, P. F., Obiaka, U., and Bonhomme, R. (2018). Substance use, anxiety, and depressive symptoms among college students. J. Child Adolesc. Subst. Abuse 27, 103–111. doi: 10.1080/1067828X.2017.1420507
WHO. (2023). Anxiety disorders [fact sheet]. World Health Organization. Available online at: https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders#:~:text=Anxiety%20disorders%20are%20closely%20related,diseases%20such%20as%20cardiovascular%20disease (Accessed October 12, 2024).
Wohn, D. Y., and LaRose, R. (2014). Effects of loneliness and differential usage of Facebook on college adjustment of first-year students. Comput. Educ. 76, 158–167. doi: 10.1016/j.compedu.2014.03.018
Wolf, O. T. (2017). Stress and memory retrieval: mechanisms and consequences. Curr. Opin. Behav. Sci. 14, 40–46.
Wood, C. J., Pretty, J., and Griffin, M. (2016). A case–control study of the health and well-being benefits of allotment gardening. J. Public Health 38, e336–e344.
Yang, Y., Ro, E., Lee, T. J., An, B. C., Hong, K. P., Yun, H. J., et al. (2022). The multi-sites trial on the effects of therapeutic gardening on mental health and well-being. Int. J. Environ. Res. Public Health 19:8046. doi: 10.3390/ijerph19138046
Yang, S., and Wang, W. (2022). The role of academic resilience, motivational intensity and their relationship in EFL learners' academic achievement. Front. Psychol. 12. doi: 10.3389/fpsyg.2021.823537
Zakeri, M., De La Cruz, A., Wallace, D., and Sansgiry, S. S. (2021). General anxiety, academic distress, and family distress among doctor of pharmacy students. Am. J. Pharm. Educ. 85:8522. doi: 10.5688/ajpe8522
Keywords: therapeutic horticulture, college student mental health, academic resilience, student stress, student anxiety, student wellness, student resilience
Citation: Diehl ERM, Diehl DC and Tham SY (2025) The effects of therapeutic horticulture on student well-being and academic resilience. Front. Psychol. 16:1619827. doi: 10.3389/fpsyg.2025.1619827
Edited by:
Guangyu Wang, University of British Columbia, CanadaReviewed by:
Justin Quetone Moss, Oklahoma State University, United StatesMarta Luciane Fischer, Pontifical Catholic University of Parana, Brazil
Copyright © 2025 Diehl, Diehl and Tham. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Elizabeth R. M. Diehl, bGVhaGRpZWhsQHVmbC5lZHU=