Lifestyle Prescription for Depression with a Focus on Nature Exposure and Screen Time: A Narrative Review

Abstract

Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.

The relationship between nature exposure and depression among Chinese prisoners: a moderated mediation model

“…Roberts and Helbich (2021) conducted a seven-day smartphone-based tracking study and further pointed out that exposure to green surroundings, both at home and on the road, has been linked to a reduction in depression. Some reviews and metaanalyses also confirmed the association of nature exposure and depressive disorder (Roberts et al, 2019;Jakstis and Fischer, 2021;Balanzá-Martínez and Cervera-Martínez, 2022). For example, a recent meta-analysis reported that short-term contact (10-90 min) with natural spaces is linked to a small decrease in depressive mood (Roberts et al, 2019).…”

Association between behavioral patterns and depression symptoms: dyadic interaction between couples

“…The association between behavioral patterns and depression symptoms is probably bidirectional (54). Second, the duration of cohabitation, which is an important confounding factor (55), was not specifically ascertained among our participants. Future research should consider the duration of cohabitation when estimating the association between behavioral patterns and depression.…”

“…Future research should consider the duration of cohabitation when estimating the association between behavioral patterns and depression. Third, although we adjusted for as many potential confounders as possible, there are still residual confounders (i.e., mental and physical health, time spent outdoors, and screen time) ( 44 , 56 ). Fourth, we used the PHQ-9 to assess depression symptom.…”