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Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Natural environments can reduce stress and mental fatigue, promoting short-term recovery and long-term health improvements. andHorticultural therapy and wilderness programs showed significant improvements in reducing symptoms of anxiety and depression. This review gives at hand that a rathersmall but reliable evidence base supports the effectiveness and appropriateness of NAT as a relevant resource for public health.Annerstedt, M. and P. Währborg (2011)IdentificationFirst Author’s Name: Matilda AnnerstedtYear: 2011Place: SwedenDate of the search: May 2009.Objective: To systematically evaluate the available scientific evidence for nature-assisted therapy (NAT).Email of the Corresponding Author: matilda.annerstedt@ltj.slu.seDOI: 10.1177/1403494810396400Participants/ PopulationType: Patients with a disease or a condition of ill health.Setting: Various settings including gardens, wilderness, and outdoor environments.Age: No age restrictionGender: Both males and femalesInterventionNature-assisted therapy (NAT) involving plants, natural materials, and/or outdoor environments.Comparison / CompetitorNo certain treatment or activity, art therapy, cognitive stimulation games, exercise, craft working, and current events discussions.OutcomesPsychological, intellectual, social, or physiological or physical outcomes that were related to depression, chronic schizophrenia, schizoaffective, bipolar disorder,mood and anxiety disorders, behavioral disturbance, personality disorders, alcoholism, other substance abuse or addiction and post-traumatic stress disorder, mentalfatigue, attentional fatigue.Study DesignRandomized controlled trials, non-randomized intervention studies, observational studies, qualitative studiesQuality and/or BiasGRADE systemGeneral NoteFundings: This research received no specific grant from any funding agency in the public, commercial, or not- for-profit sectors.Conflict of interest: Not reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 3 2Nature-assisted therapy: Systematic review of controlled and o observational studiesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest bathing significantly reduces cortisol levels, a stress biomarker, in most studies. The practice is associated with improvements inanxiety and depression, though specific data on these outcomes are less detailed. There is some heterogeneity in the results, with a few studies showing no significantchanges in cortisol levels.Antonelli, Barbieri, & Donelli, 2019IdentificationFirst Author’s Name: Michele AntonelliYear: 2019Place: ItalyDate of the search: February 2019.Objective: to investigate the effects of forest bathing on levels of salivary or serum cortisol as a stress biomarker in order to understand whether forest bathing canreduce stress.Email of the Corresponding Author: michele.1989@hotmail.itDOI: 10.1007/s00484-019-01717-xParticipants/ PopulationType: Healthy participantsSetting: Forest environmentsAge: Various, including children, young adults, and elderly participantsGender: Both males and femalesIntervention:Forest bathing as staying in a forest, either walking or simply resting and watching it, and taking in its air for a specified amount of timeComparison / CompetitorVisiting a city environment (urban watching and/or walking)OutcomesParticipants’ salivary cortisol levelsStudy design:Randomized controlled trials (RCTs), non-randomized studies (NRS), and uncontrolled trials.Quality and/or BiasNational Institutes of Health dedicated tools (NIH tool)General NoteFundings: Not reportedConflict of interest: Not reportedQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis?Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no/) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) NOverall confidence: Low ### Page 4 3Systematic review of quantitative studies assessing the relationship between environment and mental health in rural areasNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Greater green space might have higher well-being, marginally less depression, and reduced hospitalizations. The effects of green spaceon mental health were modest for agricultural areas, indicating some heterogeneity in the results.Batterham, P. J., et al. (2022)IdentificationFirst Author’s Name: Philip J. BatterhamYear: 2022Place: AustraliaDate of the search: March 2021.Objective: The aim of this systematic review was to synthesize quantitative evidence for the relationship between environmental factors (drought, climate and extremeweather events, land use/environmental degradation, green space/vegetation, engagement in natural resource management activities) and mental health or well-beingin rural areas.Email of the Corresponding Author: mailto:philip.batterham@anu.edu.auDOI: 10.1111/ajr.12851Participants/ PopulationType: Residents of rural areas.Setting: Rural areas.Age: Mean age reported in some studies is 49.8 years (SD = 3.6).Gender: Women constituted on average 49.3% of participants in the studies where sex was reported.InterventionEnvironmental factors such as drought, climate change, land use, green space, and natural resource management activities.Comparison / CompetitorAlternative exposure or usual care or exposure.OutcomesMental health and well-being, including general psychological distress, symptoms of common mental disorders (anxiety disorders, depression), suicidality, self-harm,and psychological well-being, levels of depression, stress and anxiety.Study designCross-sectional studies, longitudinal cohort studies, ecological studies.Quality and/or BiasJoanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional StudiesGeneral NoteFundings: Ian Potter Foundation; National Health and Medical Research Council, Grant/ Award Number: 1158707 and 1173146Conflict of interest: not reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) Y11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 5 4Nature Exposure, Even as Little as 10 Minutes, is Likely to Yield Short-Term Benefits for Adults with Mental Illness: A Meta AnalysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature exposure significantly improves affect, anxiety, cognition, depression, mood, and quality of life for adults with mental illness.The meta-analysis showed moderate effect sizes for all studies and smaller, but significant, effect sizes for studies with control groups.Bettmann, J. E., et al. (2024)IdentificationFirst Author’s Name: Joanna E. BettmannYear: 2024Place: USADate of the search: April 2020.Objective: to assess the effects of nature exposure on the social, mental, and physical health of adults with mental illness.Email of the Corresponding Author: …….DOI: 10.1089/eco.2023.0063Participants/ PopulationType: Adults with diagnosed mental illness.Setting: natural environments, including urban parks, wilderness, and other green spaces.Age: Mean age of 42.07 years for all studies; 42.82 years for control group studies.Gender: Not specified in detail.InterventionExposure as an experience in nature that lasted at least 10 min and took place in a natural setting, with no upper limit on time.Comparison / CompetitorControl groups with different activities or environments.OutcomesThe authors defined symptoms of mental illness similar to include any Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, except somaticdisorders and developmental disabilities.Study designRandomized and non-randomized trials.Quality and/or BiasRoB 2 for randomized trials, ROBINS-I for non-randomized trials.General NoteFundings: Funding was received from Nature-Human Health Utah to support the dissemination of this work.Conflict of interest: Not reportedQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)NA10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 6 5Neurobiological effects of urban built and natural environment on mental health: Systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Exposure to natural settings is associated with reduced stress and increased relaxation, showing higher alpha EEG values and strongerfunctional connectivity. While most studies support the benefits of natural environments, some findings show mixed results.Bolouki, A. (2023)IdentificationFirst Author’s Name: Ahmad BoloukiYear: 2023Place: IranDate of the search: September 2021.Objective: To provide an overview of the existing literature on how brain function changes when exposed to natural and urban settings.Email of the Corresponding Author: ahmad.slb@yahoo.comDOI: 10.1515/reveh-2021-01372Participants/ PopulationType: General human populationSetting: Urban and natural environments.Age: All agesGender: Not specified.InterventionExposure to natural and urban environments.Comparison / CompetitorUrban environments.OutcomesMental health outcomes such as stress, relaxation, cognitive function, etc.Study designEEG, fMRI, and fNIRS studies.Quality and/or BiasNot reported.General NoteFundings: No funding to declare.Conflict of interest: Author states no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) P8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 7 6Exploring the role of exposure to green and blue spaces in preventing anxiety and depression among young people aged 14-24 years living in urban settings: A systematicreview and conceptual framework.Note. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Exposure to green and blue spaces, such as parks and forests, can improve mood and reduce state anxiety immediately after theintervention. The studies included in the review showed variability in settings, populations, and outcomes, with some focusing on broader mental health terms rather thanclinical levels of anxiety or depression.Bray, I., et al. (2022)IdentificationFirst Author’s Name: Isabelle BrayYear: 2022Place: UKDate of the search: July 2020.Objective: to explore whether exposure to green and blue spaces reduces the risk of anxiety and depression among young people aged 14–24 years living in urbansettings and provide a conceptual framework.Email of the Corresponding Author: Issy.Bray@uwe.ac.ukDOI: 10.1016/j.envres.2022.114081Participants/ PopulationType: Young people aged 14–24 years living in urban settings.Setting: Urban settings green spacesAge: 14–24Gender: Not specifiedInterventionExposure to green and blue spacesComparison / CompetitorControl and/or alternative or non-exposure to nature.OutcomesOutcomes ranged from measures of mood/affect and stress/anxiety experiences, closely linked to the concepts of clinical anxiety and depression.Study designRandomized trials, non-randomized intervention studies, cohort studies, cross-sectional surveys, qualitative studiesQuality and BiasQuantitative sources were assessed for quality, including risk of bias, using the Effective Public Healthcare Panacea Project’s Quality Assess- ment Tool forQuantitative Studies (Effective public healthcare, 2020) and CASP tools for other study designs.General NoteFundings: This work was funded by a Wellcome Trust Mental Health Priority Area ‘Active Ingredients’ commission awarded to IB at the University of the West ofEngland, Bristol. For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising fromthis submission. The funder did not influence the reporting of results.Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the workreported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 8 7Benefits to Performance and Well-Being of Nature-Based Exercise: A Critical Systematic Review and Meta-AnalysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-based exercise significantly reduced perceived stress (p = 0.032) and anxiety compared to indoor exercise. Participants engagingin nature-based exercise showed improved depressive symptoms. High levels of bias and between-study heterogeneity were observed, indicating mixed findings acrossstudies.Brito, H. S., et al. (2022)IdentificationFirst Author’s Name: Henrique S. BritoYear: 2022Place: PortugalDate of the search: April 2021.Objective: to conduct a systematic review and meta-analysis of the experimental literature that relates to differences in exercise performance and well-being betweenexercising in nature and in conventional indoor venues.Email of the Corresponding Author: hbrito@e-fmh.ulisboa.ptDOI: 10.1021/acs.est.1c05151Participants/ PopulationType: Various kinds of general populationSetting: Outdoor nature-based environments and indoor built environments.Age: Approximate pooled mean age of 29.9 years.Gender: 49% female, 15% of trials did not disclose gender.InterventionPhysical activity in any nature-based environmentComparison / CompetitorIndoor physical activityOutcomesAt least one of the reported outcome(s) of the exercise task was performance efficacy, performance efficiency, and or well-being related. Examples of suitableperformance efficacy outcomes (i.e., outcomes related to how well participants performed the task) include running speed, work rate, power output, and distanceachieved. Directed attention scores, working memory scores, perceived exertion scores and arousal scores, and heart rate numbered among applicable performanceefficiency related outcomes (i.e., measures that were related to cognitive, psychological, and physiological functioning during the exercise task). The well-being-related outcomes that were considered suitable included any self-reported measures that were related to positive and negative mental states (such as affect, happiness,tension, and or stress).Study designRandomized independent groups trials, crossover trialsQuality and BiasCochrane Collaboration’s Tool for assessing Risk of Bias in randomized trials, method of Ding et al. for crossover trials.General NoteFundings: Partly funded by the “Fundaç ̃ ao para a Ciê ncia e Tecnologia” (grant number UIDB/00447/2020, awarded to CIPER− “Centro Interdisciplinar para o Estudoda Performance Humana” (unit 447).Conflict of interest: The authors declare no competing financial interestQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)N16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 9 8Blue care: A systematic review of blue space interventions for health and wellbeingNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Blue care can have direct benefits for mental health, especially in improving psycho-social ellbeing.There was inconsistent and mixedevidence across studies. The literature on blue space interventions is highly heterogeneous, with varied methods and conceptualizations, making it challenging to drawdefinitive conclusions.Britton, E., et al. (2018)IdentificationFirst Author’s Name: Easkey BrittonYear: 2018Place: IrelandDate of the search: August 2017.Objective: To address the gap in understanding the health benefits of blue space within existing interventions for targeted individuals. It systematically identifies,summarizes and synthesizes studies that have examined the benefits, if any, of blue care for attaining or restoring psychological and/or physical health and wellbeing.Email of the Corresponding Author: easkey.britton@nuigalway.ieDOI: 10.1093/heapro/day103Participants/ PopulationType: Individuals with a defined need, including those with mental health issues, physical disabilities, and other specific conditions.Setting: Marine or coastal environments, freshwater environments, and a mix of green and blue spaces.Age: Primarily adults, followed by youths (pre-teen and teen, <18 years), and very few aged over 65 years.Gender: Both male and female participants, with some studies including only one gender.InterventionBlue space exposure with therapeutic purposesComparison / CompetitorControl and/or non-exposureOutcomesAttaining or restoring psychological and/or physical health and wellbeing.Design:Qualitative, mixed-method, and quantitative designs.Quality and BiasA quality appraisal tool was not applied.General NoteFundings: This study is part of the NEAR Health project, funded by the Environmental Protection Agency (EPA) and the Health Service Executive under Grant AwardNo. 2015- HW-MS-2.Conflict of interest: Not reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) Y11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 10 9Urban environment in pregnancy and postpartum depression: An individual participant data meta-analysis of 12 European birth cohortsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The associations between green spaces and postpartum depression (PPD) were close to null. There was considerable heterogeneitybetween cohorts, indicating variability in the effects of green space exposure on PPD across different populations.Cadman, T., et al. (2024)IdentificationFirst Author’s Name: Tim CadmanYear: 2024Place: DenmarkDate of the search: Not explicitly mentionedObjective: To investigate associations between urban environment exposures during pregnancy and postpartum depression (PPD).Email of the Corresponding Author: tica@sund.ku.dkDOI: 10.1016/j.envint.2024.108453Participants/ PopulationType: Women with singleton deliveries to liveborn children from 12 European birth cohorts.Setting:12 European birth cohorts from eight countries.Age: Not explicitly mentionedGender: FemaleInterventionExposure to urban environmental factors such as ambient air pollution, road traffic noise, natural green and blue spaces, and built environment during pregnancy.Comparison / CompetitorAlternative exposure, control and/or other interventionsOutcomesMaternal postpartum depression (PPD) assessed 3–18 months after birth using self-completed questionnaires.Study designThe study includes individual participant data meta-analysis of 12 European birth cohorts.Quality and/or BiasNot explicitly reported.General NoteFundings: This project has received funding from the European Union’s Hori- zon 2020 research and innovation programme under grant agreement No 874853(ATHLETE project). Tim Cadman was supported by a Marie Curie-Sklodowska Individual Fellowship (URBINEX, 120616). IS Global acknowledges support fromthe Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019- 2023” Program (CEX2018-000806-S), and support from theGeneralitat de Catalunya through the CERCA Program to ISGlobal. HEM was supported by the Stichting Volksbond Rotterdam, the Netherlands Organization forScientific Research (NWO) Aspasia grant (No. 015.016.056), the European Union’s Horizon 2020 Research and Innovation Program (LifeCycle, Grant Agreement733 206 & Happy- Mums 101057390), and the Marie Skłodowska-Curie Actions Innovative Training Network (MSCA-ITN) programme (Serotonin and BEYOND,Grant agreement No: 953327). The funding agencies had no role in the design and conduct of the study, collection, management, analyses and interpretation of thedata; and preparation, review or approval of the manuscript and the decision to submit it for publication. DAL works in a unit that is supported by the University ofBristol and UK Medical Research Council (MC_UU_00011/6).Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence thework reported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) P8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) Y11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 11 10New Perspectives in Psychopathology and Psychological Well-being by Using Forest Therapy: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The therapy significantly reduces stress, anxiety, and depression levels, as evidenced by improvements in mood and physiologicalmeasures such as heart rate and cortisol levels. Further research is needed to confirm its long-term benefits and effectiveness across different populations.Caponnetto, P., et al. (2022)IdentificationFirst Author’s Name: Pasquale CaponnettoYear: 2022Place: ItalyDate of the search: Not explicitly mentioned.Objective: To investigate, through a review of available literature, the applications of forest therapy existing in various severe or mild disorders in order to understandif this technique can represent a credible alternative to traditional treatments, and consequently arouse the interest of future experimental research in different contexts.Email of the Corresponding Author: mailto:p.caponnetto@unict.itDOI: 10.2174/18743501Participants/ PopulationType: College students, elderly, women with postmenopausal insomnia, patients with alcoholism syndrome, patients with PTSD, patients with chronic widespreadpain, and psychiatric patients.Setting: Various natural environments including bamboo forests, national forestry centers, and urban forest areas.Age: Ranges from 19 to 49 years old.Gender: Both males and females.InterventionForest therapy (Shinrin-Yoku)Comparison / CompetitorControl and/or non-exposureOutcomesSevere or mild disorders (such as university stress, insomnia in menopause, dementia in the elderly, and depression in alcoholics) as well as more seriousconditions (such as chronic widespread pain, PTSD, and affective and psychotic disorders)Study designVarious designs including prospective clinical studies, qualitative interviews, and pre- and post-test designs.Quality and BiasNot reportedGeneral NoteFundings: The authors declare no conflict of interest, financial or otherwise.Conflict of interest: NoneQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) N4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 12 11Is greenery associated with mental health among residents of aged care facilities? A systematic search and narrative reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Exposure to greenery and use of greenspace in RACFs show promise for promoting mental health, but findings relied mainly on non-validated measures of mental health. Seven out of nine studies reported positive associations between greenery and residents’ mental well-being.Carver, A., et al. (2020)IdentificationFirst Author’s Name: Alison CarverYear: 2020Place: AustraliaDate of the search: July 2017.Objective: To summarize evidence of associations between greenery in older adults living in residential aged care facilities (RACFs) and residents’ mental health.Email of the Corresponding Author: alison.Carver@acu.edu.auDOI: 10.1080/13607863.2018.1516193Participants/ PopulationType: Residents of aged care facilitiesSetting: Residential aged care facilities (RACFs)Age: Older adultsGender: Not specifiedInterventionExposure to greenery and use of greenspace in RACFsComparison / CompetitorControl and/or non-exposureOutcomesWell-being, depression, stressStudy designQuasi-experimental studies, observational studiesQuality and BiasNot reportedGeneral NoteFundings: JV is supported by an Australian National Heart Foundation Future Leader Fellowship (ID 101928).Conflict of interest: The authors report no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 13 12Indicators of the Psychosocial and Physiological Effects of Forest Therapy: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest therapy has positive effects on both psychological and physiological health, including stress reduction, depression relief, andcardiovascular benefits. While most studies reported positive outcomes, there was some variability in the magnitude and consistency of these effects across different forestenvironmentsChun, H. R., et al. (2023)IdentificationFirst Author’s Name: Hae-ryoung ChunYear: 2023Place: KoreaDate of the search: Not explicitly mentionedObjective: A systematic review was conducted on the health outcomes of forest therapy from 2010 to 2021. We summarized natural therapeutic elements and foresttherapy sites, characteristics, and health outcomes.Email of the Corresponding Author: persontime@hotmail.comDOI: 10.3390/f14071407Participants/ PopulationType: General populationSetting: Various forest environmentsAge: 10-60 yearsGender: Not explicitly mentionedInterventionForest Therapy programsComparison / CompetitorControl and/or alternative therapyOutcomesHealth outcomes such as reduction in depression, psychological enhancement, stress alleviation; and an enhancement in the cardiovascular system and the endocrinesystemStudy designPre–post studies, randomized controlled trials (CRTs), quasi-experimental studies, within-group comparisons, crossover study, between-group pre–post-test studiesQuality and BiasCochrane’s ROB toolGeneral NoteFundings: This study was supported by the R&D Program for Forest Science Technology (project no.: 2021388A00-2123-0102) of the Korea Forest Service (KoreaForestry Promotion Institute).Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: low ### Page 14 13Psycho-Physiological Stress Recovery in Outdoor Nature-Based Interventions: A Systematic Review of the Past Eight Years of ResearchNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Positive effects on various emotional parameters related to stress recovery. Mixed results with some studies showing significant decreasesin cortisol levels and other stress hormoneCorazon, S. S., et al. (2019)IdentificationFirst Author’s Name: Sus Sola CorazonYear: 2019Place: DenmarkDate of the search: April 2018.Objective: To provide an overview and synthesis of the past eight years’ research into the psycho-physiological effects of outdoor nature-based interventions, relatedto stress recovery.Email of the Corresponding Author: suoe@ign.ku.dkDOI: 10.3390/ijerph16101711Participants/ PopulationType: Adults (18+), all ethnicities, all countries, with or without stress-related issues/illness, without mental disabilities or other serious physical or mental illness.Setting: Outdoors natural green environmentsAge: 18+Gender: MixedInterventionExposure to all types of outdoors natural green environments, with all types of sedentary and light exercise activities, in all time durations.Comparison / CompetitorAll kinds of comparisons or no comparison groupOutcomesPhysiological (cardiovascular, endocrine, and immune) and psychological (mood, physiological stress, and well-being) outcomes related to stress prevention or stresstreatment.Study designRandomized Controlled Trials (RCT), Clinical Trials (CCT), pre-post studiesQuality and BiasEffective Public Health Practice Project (EPHPP)General NoteFundings: 15th of June Foundation, Denmark (grant number 2017-N-154)Conflict of interest: The authors declare no conflict of interestQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis?NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no/) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 15 14Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-based interventions (NBIs) were found to be effective in reducing depressive mood and anxiety, and improving positive affect.There was high heterogeneity in the pooled analysis of RCTs, particularly for depressive mood and anxiety outcomesCoventry et al. 2021IdentificationFirst Author’s Name: Coventry et al. 2021Year: 2021Place: UKDate of the search: September 2020.Objective: to assess the effect of nature-based activities on mental health.Email of the Corresponding Author: peter.coventry@york.ac.ukDOI: 10.1016/j.ssmph.2021.100934Participants/ PopulationType: Adults (aged ≥18 years) in community-based settings with or without mental and/or physical health problems.Setting: Community-based (non-hospital) settings.Age: Adults aged ≥18 yearsGender: Not specifiedInterventionStructured outdoor activities in green and/or blue space for health and wellbeing.Comparison / CompetitorNon-nature based equivalent activities, usual care.OutcomesChanges in mental health symptoms on continuous scale including depressive mood, anxiety, positive and negative affect.Study designRandomized controlled trials (RCTs), controlled studies, and single group before and after studies.Quality and BiasCochrane Risk of Bias tool and for Controlled and single group before and after studies, a modified version of the NICE (2012) quality appraisal checklist was usedGeneral NoteFundings: UK Research and Innovation Closing the Gap Network+ (ES/S004459/1)Conflict of interest: None reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis?Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no/no meta-analysis) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 16 15Long-Term Exposure to Residential Greenspace and Healthy Ageing: a Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The reviewed studies provided inadequate/limited but suggestive evidence for a beneficial association between greater long-termgreenspace exposure and healthy ageing.de Keijzer, C., et al. (2020)IdentificationFirst Author’s Name: Carmen de KeijzerYear: 2020Place: SpainDate of the search: March 2019.Objective: To systematically review the available observational evidence on the association between long-term exposure to residential outdoor greenspace and healthat older age and rate the evidence as sufficient, limited, or inadequate.Email of the Corresponding Author: payam.dadvand@isglobal.orgDOI: 10.1007/s40572-020-00264-7Participants/ PopulationType: Older adultsSetting: Residential outdoor greenspaceAge: adults >35Gender: Not specifiedInterventionLong-term exposure to residential outdoor greenspaceComparison / CompetitorNon-exposedOutcomesHealth at an older age, including mental health, cognitive function, physical capability, cardiometabolic risk, morbidity, and perceived wellbeing including depressionand/or anxiety symptomsStudy designCross-sectional, longitudinal, and ecological studies.Quality and BiasThe level of evidence was rated based on the guidelines suggested by the International Agency for Research on Cancer (IARC) and adapted by other reviews similarto this review.General NoteFundings: Funding Information Mariska Bauwelinck is funded by an individual PhD grant supported by the Research Foundation-Flanders (FWO) (grant number11A9718N) and a Gustave Boël-Sofina Fellowship (grant num- ber V422218N). PD [RYC-2012-10995] is funded by Ramón y Cajal fellowships awarded by theSpanish Ministry of Economy and Competitiveness. The funders have not been involved in any part of the study design or reporting.Conflict of interest: The authors declare that they have no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) N9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 17 16Green areas and health outcomes: A systematic review of the scientific literatureNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Green spaces positively influence physical and mental health, social interaction, and well-being.Contradictory results suggest the needfor further research to quantify the relationship between green spaces and health.Di Nardo, F., et al. (2010)IdentificationFirst Author’s Name: Francesco Di NardoYear: 2010Place: ItalyDate of the search: October 2010.Objective: to perform literature searches of electronic journal databases for studies and reviews that focus on the relationship between green spaces and health.Email of the Corresponding Author: giuseppe.latorre@uniroma1.itDOI: 10.2427/5699Participants/ PopulationType: General populationSetting: Urban and rural environments.Age: Not specifiedGender: Not specifiedInterventionExposure to green or public open spaces with a health perspectiveComparison / CompetitorNon-exposed or far from green or public open spacesOutcomesBenefits on physical and mental healthStudy designCase-control study, cohort studies, cross-sectional studiesQuality and BiasNot reportedGeneral NoteFundings: Not reportedConflict of interest: Not reportedQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) NOverall confidence: Critically Low ### Page 18 17Exploring the association between campus environment of higher education and student health: A systematic review of findings and measuresNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Natural environments, including perceived naturalness, blue space, and greenness, support students’ mental health and quality of life.Specifically, blue space was the most preferred place for mental restoration, and scattered trees helped reduce depression symptoms.Ding, Y., et al. (2024)IdentificationFirst Author’s Name: Yizhen DingYear: 2024Place: USADate of the search: June 2023.Objective: To conduct a systematic review and synthesized existing empirical works examining the association between the university/college campuses built andnatural environments and students’ health.Email of the Corresponding Author: yizhend2@tamu.eduDOI: 10.1016/j.ufug.2023.128168Participants/ PopulationType: Higher-education studentsSetting: University/college campusesAge: Ranges from 16 to 30 years in various studies.Gender: Both male and female.InterventionExposure to green and natural spaces at university/college campusesComparison / CompetitorNon-exposed or alternative campus environmentsOutcomesPhysical activity, mental health, physiological responses, overall health, quality of life.Study designCross-sectional studies, experimental studies, longitudinal studyQuality and BiasEffective public healthcare panacea project quality assessment tool and quality assessment results using EPHPP toolGeneral NoteFundings: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reportedin this paper.Conflict of interest: not reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 19 18A systematic review and meta-analysis of nature-based mindfulness: Effects of moving mindfulness training into an outdoor natural settingNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-based mindfulness interventions have statistically significant and medium-sized positive effects on psychological, physiological,and interpersonal outcomes. The overall combined effects from pre- to post-intervention were statistically significant and of medium size (g = 0.54, p < 0.001).Djernis, D., et al. (2019)IdentificationFirst Author’s Name: Dorthe DjernisYear: 2019Place: DenmarkDate of the search: August 2018.Objective: to systematically review quantitative studies of mindfulness interventions conducted in nature (nature-based mindfulness), and to analyze the effects throughmeta-analyses.Email of the Corresponding Author: ddj@ign.ku.dkDOI: 10.3390/ijerph16173202Participants/ PopulationType: Adults and adolescents (>12 years) with or without a formal mental or physical diagnosis.Setting: Natural environments characterized as forests/wild nature, gardens/parks, and mixed outdoor environments.Age: Mean age of 30.71 years (range 12–89).Gender: 51.8% female.InterventionNature-Based MindfulnessComparison / CompetitorStudy groups were compared with (1) interventions without exposure to nature but with guided mindfulness, or (2) non-active control conditions (e.g., waiting lists orwritten materials). Studies were also included if they employed other or no comparators, in which case they were then evaluated as open trials.OutcomesAny psychological (e.g., depression), physiological (e.g., heart rate), or interpersonal (e.g., prosocial orientation) outcomes based on client-level data for which aneffect size could be calculated.Study designOpen trials, controlled studies with active and passive control conditionsQuality and BiasThe Effective Public Health Practice Project (EPHPP) tool was used.General NoteFundings: This research received no external funding.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did thereport justify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?(yes/partial yes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis orother evidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discussits likely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 20 19Psychological effects of outdoor activity in type 2 diabetes: A reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: One study examined depression and found no significant improvement after the intervention.Fraser, M., et al. (2020)IdentificationFirst Author’s Name: Matthew FraserYear: 2020Place: ScotlandDate of the search: February 2018.Objective: The aim of this systematic review was to examine whether psychological problems in people with type 2 diabetes, were improved following exercise in anout- door environment.Email of the Corresponding Author: 08005183@uhi.ac.ukDOI: 10.1093/heapro/daz064Participants/ PopulationType: Individuals with type 2 diabetesSetting: Outdoor exercise environmentsAge: Over 18 years old.Gender: Both male and femaleInterventionAny form of physical activity conducted in an outdoor exercise environment.Comparison / CompetitorControl groups or no intervention groupsOutcomesOutcome measure of psychological problem (depression, anxiety, quality of life, stress, general wellbeing).Study designRandomized and non-randomized trialsQuality and BiasThe Downs and Black Quality Index (Downs and Black, 1998).General NoteFundings: This work was funded by the European Social Fund (ESF).Conflict of interest: None declared.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 21 20Nature and children's health: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: There is a positive relationship between nature contact and children’s health, especially for physical activity and mental health. Positiveassociations with cognitive, behavioral, and mental health outcomes.Fyfe-Johnson, A. L., et al. (2021)IdentificationFirst Author’s Name: Amber L. Fyfe-JohnsoYear: 2021Place: USADate of the search: February 2021.Objective: to systematically evaluate evidence regarding the relationship between nature contact and children’s health.Email of the Corresponding Author: amber.fyfe-johnson@wsu.eduDOI: 10.1542/peds.2020-049155Participants/ PopulationType: ChildrenSetting: Various settings including residential areas, schools, and general green spaces.Age: 19 or youngerGender: Not specified.InterventionGardening, green space activity (eg green space not near residence or school), residential green space, school green space, greening intervention, wilderness experience,nature walk, and “other.” Studies in which researchers evaluated mixed spaces were categorized as others. Measures of nature exposure included self or proxy-reportmeasures, intervention-associated exposures, and objective measures such as land-use data and Normalized Difference Vegetation Index, an approach used to estimatethe density of green on an area of land. Studies with multiple nature exposures were included; each exposure was included independently.Comparison / CompetitorControl and/or Non-exposed or alternative exposureOutcomesPhysical activity, cognitive, behavioral, and mental health, BMI, cardiovascular and metabolic measures, asthma and allergy, academic and learning outcomes.Study designObservational studies, randomized controlled trials (CRTs), experimental studies, cross-sectional studies, longitudinal studiesQuality and BiasCochrane tools for bias assessment, Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) for nonrandomized designs and Risk of Bias 2 (RoB 2) forRCTs and Methods Appraisal Tool (MMAT).General NoteFundings: Funding by BestStart Washington. BestStart Washington has no role in the design and conduct of the study.Conflict of interest: The authors have indicated they have no potential conflicts of interest to disclose.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 22 21The role of connection with nature in empirical studies with physiological measurements: a systematic literature reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Evidence for a mediating effect of nature connectedness on associations between nature exposure and cognitive function, brain activity,blood pressure, cortisol level, and mental health.Gál, V. and Z. Dömötör (2023)IdentificationFirst Author’s Name: Vera GálYear: 2023Place: HungaryDate of the search: February 2023.Objective: To assess the role of nature relatedness at the level of physiological processes and to summarize the results published so far.Email of the Corresponding Author: vera.gal@ppk.elte.huDOI: 10.1007/s42977-023-00185-0Participants/ PopulationType: Any humanSetting: Various placesAge: Not specifiedGender: Not specifiedInterventionExposure to nature and connection with natureComparison / CompetitorAlternative exposureOutcomesObjective measure of at least one physiological variable related to stress measurementStudy designEmpirical studiesQuality and BiasNot reportedGeneral NoteFundings: Open access funding provided by Eötvös Loránd University.Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the workreported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 23 22Mental health benefits of long-term exposure to residential green and blue spaces: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Limited evidence of mental health benefits of long-term residential surrounding greenness in adults. Inadequate evidence for access togreen space and studies in children.Gascon, M., et al. (2015)IdentificationFirst Author’s Name: Mireia GasconYear: 2015Place: SpainDate of the search: October 2014.Objective: to systematically review the available literature on the long-term mental health benefits of residential green and blue spaces byincluding studies that used standardized tools or objective measures of both the exposures and the outcomes of interest.Email of the Corresponding Author: mgascon@creal.caDOI: :10.3390/ijerph120404354Participants/ PopulationType: Various populations from different countries, including children and adults.Setting: Residential areas with green and blue spaces.Age: Children (3-10 years) and adults (15 years older).Gender: Not specified.InterventionLong-term exposure to residential green and blue spacesComparison / CompetitorNon-exposed or alternative exposure.OutcomesMental health benefits, including reduced risk of poor mental health, stress, depression, anxiety, and other related disorders.Study designLongitudinal studies, cross-sectional studies, ecological studiesQuality and BiasThe guidelines for the level of evidence used by the International Agency for Research on CancerGeneral NoteFundings: This project was funded by the CERCA Institutes Integration Program (SUMA 2013) (promoted and managed by the Secretariat for Universities andResearch of the Ministry Economy and Knowledge of the Government of Catalonia (SUR), the Agency for Management of University and Research Grants (AGAUR)and the CERCA Institute). Payam Dadvand is funded by a Ramón y Cajal fellowship (RYC-2012-10995) awarded by the Spanish Ministry of Economy andCompetitiveness. Margarita Triguero-Mas is funded by a pre-doctoral grant from the Catalan Government (AGAUR FI- DGR-2013).Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 24 23Outdoor blue spaces, human health, and well-being: A systematic review of quantitative studiesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Positive association with exposure to blue spaces concerning mental health and well-being. The results suggest potential health benefitsof outdoor blue spaces, mainly with respect to mental health and well-being and the promotion of physical activity.Gascon, M., et al. (2017)IdentificationFirst Author’s Name: Mireia GasconYear: 2017Place: Spain.Date of the search: July 2016.Objective: To systematically review the current quantitative evidence on human health and well-being benefits of outdoor blue spaces.Email of the Corresponding Author: mireia.gascon@isglobal.orgDOI: 10.1016/j.ijheh.2017.08.004Participants/ PopulationType: Various populations across different studies.Setting: Residential and non-residential outdoor blue spaces.Age: All agesGender: Not specifiedInterventionOutdoor blue space exposureComparison / CompetitorAlternative exposure and/or no exposureOutcomesMental health, well-being, physical activity, general health, obesity, cardiovascular outcomes.Study designCross-sectional, longitudinal, ecological, pre/post observationalQuality and BiasThe guidelines for the level of evidence used by the International Agency for Research on CancerGeneral NoteFundings: This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 666773.Conflict of interest: The authors have no conflicts of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 25 24Relationship between green and blue spaces with mental and physical health: A systematic review of longitudinal observational studiesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Mixed evidence of a protective relationship between exposure to green space and health. High heterogeneity in exposure measures andadjustment for confounding between studies. Few studies addressed the relationship between blue space and health.Geneshka, M., et al. (2021)IdentificationFirst Author’s Name: Mariya GeneshkaYear: 2021Place: UKDate of the search: July 2020.Objective: To assess thee evidence from longitudinal observational studies on the relationship between exposure to green and blue space with mental and physicalhealth in adults.Email of the Corresponding Author: mmg529@york.ac.uk (M.G.); peter.coventry@york.ac.uk (P.C.)DOI: 10.3390/ijerph18179010Participants/ PopulationType: Adults aged 18 years or older.Setting: Various locations, primarily high-income countries.Age: 18 years or older.Gender: anyInterventionGreen and/or blue space exposureComparison / CompetitorAlternative exposureOutcomesThe primary outcome was mental and/or physical health. Mental health conditions included those which are classified by the National Institute for Health and CareExcellence NICE as common (depression, generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder (OCD)and post-traumatic stress disorder (PTSD)) and severe mental health disorders (bipolar disorder, psychosis and schizophrenia).Study designLongitudinal observational studies.Quality and BiasThe Newcastle–Ottawa Scale (NOS) was used for risk of bias assessment.General NoteFundings: The research was funded by the NIHR Applied Research Collaboration Yorkshire and Humber https://www.arc-yh.nihr.ac.uk/. The views expressed arethose of the author(s), and not necessarily those of the NIHR or the Department of Health and Social Care.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 26 25Impact of Green Space Exposure on Children’s and Adolescents’ Mental Health: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Beneficial association with green space exposure, particularly with hyperactivity and inattention problems. Limited evidence suggests abeneficial association with mental well-being in children and depressive symptoms in adolescents and young adults.Gert-Jan, V. and M. Danckaerts (2018)IdentificationFirst Author’s Name: Gert-Jan VanakenYear: 2018Place: BelgiumDate of the search: March 2018.Objective: This systematic review aims to provide an overview of observational studies assessing the association between empirical green space exposure withstandardized outcome measures of mental health problems, mental well-being and developmental problems in children, adolescents, and young adults.Email of the Corresponding Author: gertjan.vanaken@kuleuven.beDOI: 10.3390/ijerph15122668Participants/ PopulationType: Children, adolescents, and young adults with an age limit of 25 years.Setting: Residential or school surroundings.Age: 25 or youngerGender: Not specified.InterventionGreen space exposureComparison / CompetitorAlternative exposure and/or controlOutcomesMental health and neurocognitive developmentStudy designCross-sectional, longitudinal, ecologicalQuality and BiasNot reportedGeneral NoteFundings: This research received no external funding.Conflict of interest: The authors declare no conflicts of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 27 26Association between urban greenspace and health: A systematic review of literatureNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Almost all included studies found a positive association between urban greenspace and both PA and MH, while a few demonstrated anon-effect or a negative effect on MH outcomes. Some methodological limitations exisGianfredi, V., et al. (2021)IdentificationFirst Author’s Name: Vincenza GianfrediYear: 2021Place: ItalyDate of the search: September 2020.Objective: To analyze the association between publicly accessible urban greenspaces exposure and two selected health outcomes (objectively measured physicalactivity (PA) and mental health outcomes (MH)).Email of the Corresponding Author: gianfredi.vincenza@hsr.itDOI: 10.3390/ijerph18105137Participants/ PopulationType: General human populationSetting: Urban greenspacesAge: Not specifiedGender: Not specifiedInterventionUrban greenspaces exposureComparison / CompetitorNon-exposure and/or control groupsOutcomesThe most prevalent MH disorders, such as depression, anxiety, and psychosocial stress.Study designObservational studies (cross-sectional, cohort, ecological), interventional studies (pre-post intervention, randomized controlled trials, quasi-experimental)Quality and BiasNew-Ottawa Scale (NOS) for observational studies, Risk of Bias-2 (RoB-2) for randomized trials, National Institute of Health quality assessment tool for pre-postintervention studies, and a modified version of NOS for cross-sectional studies.General NoteFundings: This research was funded by Fondazione Banco di Monte Lombardia in Italy, within the project Green Areas & Infrastructures and Public Health Outcomes.Conflict of interest: The authors declare no conflict of interest. The financier did not intervene in data collection, selection or interpretation.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no)7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 28 27A Systematic Review and Meta-Analysis of Nature Walk as an Intervention for Anxiety and DepressionNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature walks effectively improve mental health, positively impacting depression and anxiety. Significant positive effect of nature walkon improving depression and anxiety symptoms.Grassini, S. (2022)IdentificationFirst Author’s Name: Simone GrassiniYear: 2022Place: NorwayDate of the search: February 2022.Objective: The present systematic review and meta-analysis quantitatively analyze and qualitatively discuss the studies published on the effect of nature walk ondepression and anxiety published during the past decade.Email of the Corresponding Author: simone.grassini@ntnu.noDOI: 10.3390/jcm11061731Participants/ PopulationType: Various, including university students, clinical depression patients, and general participants from different countries.Setting: Natural environments such as forests, green suburbs, and urban areas.Age: Ranges from 18 to 72 yearsGender: Both male and female participants, with some studies having only male or only female participants.InterventionNature walkComparison / CompetitorUrban walks, other forms of physical activities, and non-walking conditions.OutcomesDepression and anxiety levels and symptomsStudy designRandomized controlled trials (RCTs), Pre-and post trails.Quality and BiasThe Newcastle–Ottawa ScaleGeneral NoteFundings: This research received no external funding.Conflict of interest: The author declares no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 29 28The effects of workplace nature-based interventions on the mental health and well-being of employees: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Consistently positive effects on mental health indices and cognitive ability. Mixed results for recovery and restoration, work and lifesatisfaction, and psychophysiological indicators.Gritzka, S., et al. (2020)IdentificationFirst First Author’s Name: Susan GritzkaYear: 2020Place: IrlandDate of the search: November 2018.Objective: To review scientific evidence on the effectiveness of NBI to promote mental health and well-being among actual employees in actual workplace settingsCorrespondence author’ Email of the Corresponding Author: giovanna.calogiuri@inn.noDOI: 10.3389/fpsyt.2020.00323Participants/ PopulationType: EmployeesSetting: Actual workplace settingsAge: Mean age ranged from 28 to 49 yearsGender: Predominantly female (mean % female = 67%)InterventionAny type of nature-based interventions (NBI) in the workplaceComparison / CompetitorNo intervention-control conditions or to display a clear contrast to nature, encompassing equivalent interventions in a nonnatural environmentOutcomesMental health indices, cognitive ability, recovery and restoration, work and life satisfaction, psychophysiological indicators.Study designRandomized controlled trials (RCTS), quasi-CRTs, controlled trials (CTS), randomized crossover trials (RXT), quasi-RXTs, crossover trials (XTS).Quality and BiasRevised Cochrane risk-of-bias toolGeneral NoteFundings: Department of Physical Education and Sport Sciences at the University of Limerick and Enterprise Ireland during the research phase. Economical supportfor Open Access publication was received from INN University.Conflict of interest: Not reportedQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis?NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) NOverall confidence: Low ### Page 30 29Can Even a Small Amount of Greenery Be Helpful in Reducing Stress? A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Even very small-scale greening, including indoor green walls and potted plants, may provide effective help for stress relief.Gu, J., et al. (2022)IdentificationFirst First Author’s Name: Jiaqi GuYear: 2022Place: ChinaDate of the search: April 2022.Objective: To synthesize evidence on the effectiveness of small-scale greening as an intervention in reducing physical and psychological stress levels and promotingpeople’s physical and mental health.Email of the Corresponding Author: 2016300820005@whu.edu.cnDOI: 10.3390/ijerph19169778Participants/ PopulationType: Office workers, students, senior citizens, and patients with specific diseases.Setting: Various settings including indoor and outdoor environments.Age: Participants ranged from young adults (mean age < 30) to senior citizens (range 61–97 years).Gender: Both male and female participants were included.InterventionSmall-scale greening was defined as green facilities less than 0.4 ha in size, including outdoor greening, such as green roofs, pocket parks, private gardens, and streettrees, and small-scale green features, such as indoor green walls, decorative planters, and greeneryComparison / CompetitorNo greening or any other comparative intervention within the environment.OutcomesThe primary outcome was stress reduction. This should be a quantitative measure. The measure must refer to current physiological stress responses, as well as self-reported psychological indicators (e.g., mood, anxiety, distress, perceived stress, recovery, attention, or cognitive functioning)Study designRandomized controlled trials (RCTs) and non-randomized controlled trialsQuality and BiasCochrane Risk of Bias and The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool.General NoteFundings: This research received no external funding.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis?(yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 31 30Community environmental healing benefits: A systematic review comparing intervening variables, environments, and outcomesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Community environments have significant healing benefits, with restorativeness, emotions and mood, stress, and well-being being themain intervening variables. Natural environments are often emphasized, but built environments also offer substantial healing benefits.He, N., et al. (2024)IdentificationFirst Author’s Name: Nan HeYear: 2024Place: ChinaDate of the search: August 2023.Objective: To summarize studies on community healing environments with regard to restorativeness, emotions and mood, stress, and wellbeing.Email of the Corresponding Author: leiqing@tongji.edu.cnDOI: 10.1002/jcop.23129Participants/ PopulationType: General populationSetting: Community environmentsAge: Not specifiedGender: Not specifiedInterventionExposure and/or accessibility to blue‐green spacesComparison / CompetitorNon-exposure and or control group or alternative exposureOutcomesPsychological and physiological outcomes associated with community healing environments.Study designExperimental and quasi-experimental designs, including randomized controlled trials and intervention measures.Quality and BiasThe quality assessment checklist used by Spano et al. (2023)General NoteFundings: National Natural Science Foundation of ChinaConflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 32 31Therapeutic horticulture as a potential tool of preventive geriatric medicine improving health, well-being and life quality - A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The study outcomes demonstrated positive results of horticultural therapy on human health and well-being, particularly in a psychologicaldimension and to a smaller but still significant extent physiological aspect.Heród, A., et al. (2022)IdentificationFirst Author’s Name: Anna HeródYear: 2022Place: PolandDate of the search: December 2021.Objective: To summarize and synthesize the evidence of horticultural therapy on older adults health and wellbeing.Email of the Corresponding Author: anna.herod@student.urk.edu.plDOI: 10.2478/fhort-2022-0008Participants/ PopulationType: Older adults (≥60 years), living independently, in assisted living, under personal care or in other kinds of elderly care facilities.Setting: Various settings including independent living, assisted living, personal care, and other elderly care facilities.Age: ≥60 years.Gender: Not specifiedInterventionHorticultural therapy programs, gardening activities, and passive contact with nature.Comparison / CompetitorControl groups with no intervention or different types of leisure activities.OutcomesHuman health and well-being in psychological and physiological aspects.Study designRandomized controlled trials (RCTs), non-RCTs, controlled pre-/post-studies, and qualitative studies.Quality and/or BiasThe quality of the included articles was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Levels of Evidence guidelines (JHNEBP).General NoteFundings: This work was supported by the Polish Ministry of Education and ScienceConflict of interest: The authors have no conflicts of interest to declare that are relevant to the content of this article.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) P8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 33 32A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Lonelinessand Mental Health ProblemsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The studies varied widely in design, settings, and participant characteristics, making it difficult to draw definitive conclusions about theoverall effectiveness of green space exposure on stress, anxiety, and depression.Hsueh, Y. C., et al. (2022)IdentificationFirst Author’s Name: Yung-Chia HsuehYear: 2022Place: UKDate of the search: June 2021.Objective: To synthesize the literature describing local community-based interventions that target place-based factors to address loneliness and mental health problems,informing the development of future public health approaches.Email of the Corresponding Author: yung.hsueh.20@alumni.ucl.ac.ukDOI: 10.3390/ijerph19084766Participants/ PopulationType: General and clinical populationsSetting: Local communitiesAge: Various age groups, including working-age adults, older adults, and schoolchildrenGender: Not specifiedInterventionActive engagement in local green spacesComparison / CompetitorNone-participating and/or control groupsOutcomesDepression and stress levelStudy designPre-post study design, cross-sectional, qualitative, ethnographyQuality and BiasMixed Methods Appraisal Tool (MMAT)General NoteFundings: This project was funded by the Loneliness & Social Isolation in Mental Health Research Network, which is funded by UK Research and Innovation (UKRI;Grant reference: ES/S004440/1) and their support to A.P. and L.V.’s salary is gratefully acknowledged. Any views expressed here are those of the project investigatorsand do not necessarily represent the views of the Loneliness & Social Isolation in Mental Health Research Network or UKRI. L.V. and A.D. are additionally supportedby the UK Prevention Research Partnership project ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing (MR/S037527/1). FH issupported by a Wellcome Trust Clinical Research Training Fellowship (Grant no 203618/Z/16/Z). A.P. and F.M. are additionally supported by the NIHR UniversityCollege London Hospital’s Biomedical Research Centre.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 34 33Effects of Forest-Based Interventions on Mental Health: A Meta-Analysis of Randomized Controlled TrialsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest-based interventions significantly improved mental health with an overall effect size of 1.25, which was large and statisticallysignificant.Kang, M. J., et al. (2022)IdentificationFirst Author’s Name: Mi-Jung KangYear: 2022Place: KoreaDate of the search: August 2021.Objective: to investigate the effects of forest therapy on anxiety, depression, and negative and positive mental condition through a meta-analysis of recent randomizedcontrolled trials, using the PRISMA guideline.Email of the Corresponding Author: hs.kim@eulji.ac.krDOI:10.3390/ijerph19084884Participants/ PopulationType: General human populationSetting: Forest environmentAge: Not specified.Gender: Not specified.InterventionForest therapy programs.Comparison / CompetitorComparisons were conducted using studies that included no-treatment control groups (participants who did not receive forest therapy), treatment- as-usual groups, andalternative intervention groups.OutcomesMental health indicated the results of an intervention such as anxiety, depression, and negative and positive mental condition.Study designRandomized controlled trials (RCTs).Quality and BiasThe Risk of Bias (RoB) 2.0General NoteFundings: This research received no external funding.Conflict of interest: The authors declare that they have no competing interests.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 35 34Is altitude a determinant of the health benefits of nature exposure? A systematic review and meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found that altitude and related physical variables can modify the health benefits of forest exposures, with significantassociations observed for emotional restoration, cognitive restoration, stress reduction, and physiological relaxation.Kim, E., et al. (2022)IdentificationFirst Author’s Name: Eunsoo KimYear: 2022Place: KoreaDate of the search: February 2020.Objective: To provide an up-to-date summary of interventional studies investigating the psycho-physiological effects of forests and urban forests, including details ontheir physical settings, and investigate an effect-modifying role of altitude and summarize data on themagnitude and shape of the association.Email of the Corresponding Author: bkim5020@korea.krDOI: 10.3389/fpubh.2022.1021618Participants/ PopulationType: General populationSetting: Forests or urban forestsAge: adultsGender: Both male and female participants.Intervention(1) Structured programs or activities in forests or urban forests with specific health promotion purposes. (2) Include description of forest settings in which theintervention was performed in terms of altitude or relevant variables (longitude and latitude, temperature, humidity, dew point, atmospheric pressure).Comparison / CompetitorWaitlist group, urban exposure group, normal daily routines, other comparative intervention with little or no nature exposureOutcomes1) Emotional restoration measured by using POMS, PANAS, STAI, BDI, SVS, and other relevant self-reporting measurements(2) Cognitive restoration measured by using PRS, ROS, and other relevant self-reporting measurements(3) Stress reduction: (saliva) cortisol, (saliva) amylase, adrenaline, noradrenaline, serotonin, melatonin, and other relevant stress markers(4) Physiological relaxation: change in blood pressure, heart rate, pulse rate, heart rate variability, skin conductance, brainwave, prefrontal activity, SpO2, EEG, andother relevant biomarkersStudy designRandomized controlled trials, randomized cross-over trials, non-randomized controlled studiesQuality and BiasGRADE method and RoB2.General NoteFundings: Not reportedConflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as apotential conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 36 35Effects of Korean forest healing programs on stress in adults: a systematic review and meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The pooled effect size of stress was -0.95, indicating a large effect size. Forest healing programs had a significant positive effect on stressrelief among adults.Kim, S.-Y. and J. Choi (2021)IdentificationFirst Author’s Name: So-Yeon KimYear: 2021Place: KoreaDate of the search: February 2021.Objective: To analyze the effects of forest healing programs on stress in the Korean adult population through a meta-analysis.Email of the Corresponding Author: jungkeechoi@gmail.comDOI: 10.1080/21580103.2021.2008020Participants/ PopulationType: Adults aged 18 years or older who have participated in a forest healing program.Setting: Forest healing programs in Korea.Age: 18 years or olderGender: MixedInterventionKorean forest healing programsComparison / CompetitorComparison groups that did not participate in a forest healing program.OutcomesStress reliefStudy designNon-randomized controlled trials (NRCTs).Quality and BiasBias assessment tool for non-randomized studies (RoBANS)General NoteFundings: Not reportedConflict of interest: No potential conflict of interest was reported by the authors.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 37 36Urban Green Space and Its Impact on Human HealthNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Urban green space exposure is consistently negatively associated with mortality, heart rate, and violence. It had reported positiveassociation with attention, mood, and physical activity, and mixed or no association regarding General health, weight status, depression, and stress.Kondo, M. C., et al. (2018)IdentificationFirst Author’s Name: Michelle C. KondoYear: 2018Place: USADate of the search: December 2017.Objective: To systematically review studies evaluating the association between urban green space and human health.Email of the Corresponding Author: tuf55745@temple.eduDOI: 10.3390/ijerph15030445Participants/ PopulationType: Urban residentsSetting: Urban areasAge: Not specified.Gender: Both male and female participants.InterventionExposure to urban green spaceComparison / CompetitorExposure to built urban settings or no green spaceOutcomesHuman health including general health, weight status, depression, and stress (via cortisol concentration).Study designExperimental (between-subjects and within-subjects), case-control or case cross-over, quasi-experimental, randomized controlled trial (RCT), longitudinal cohortQuality and BiasNot reportedGeneral NoteFundings: This study was funded in part by National Institutes of Health grants R01AA024941 and R01AA020331 and Centers for Disease Control and Preventiongrant R49CE002474.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 38 37Effect of nature walks on depression and anxiety: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature walks were effective for reducing state anxiety but not generalized anxiety. The effects on depression were inconsistent.Kotera, Y., et al. (2021)IdentificationFirst Author’s Name: Yasuhiro KoteraYear: 2021Place: UKDate of the search: October 2020.Objective: How effective are nature walks for depression and anxiety? and (ii) What quantity and quality of evidence has been reported?Email of the Corresponding Author: y.kotera@derby.ac.ukDOI: 10.3390/su13074015Participants/ PopulationType: Various populations including cancer survivors, university students, and nonclinical adults.Setting: Natural settings such as forests, woodlands, or parks.Age: Ranges from young adults (university students) to middle-aged individuals.Gender: Both males and females.InterventionNature walks onlyComparison / CompetitorUrban walks or no walks.OutcomesDepression and anxietyStudy designPre-post within-subject studies, quasi-experimental studies, experimental between-subjects studies.Quality and BiasThe Newcastle–Ottawa Scale (NOS)General NoteFundings: This research received no external funding.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) P8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 39 38Effects of Shinrin-Yoku (Forest Bathing) and Nature Therapy on Mental Health: a Systematic Review and Meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature walks were consistently effective in reducing state anxiety but not generalized anxiety. The effects on depression were inconsistent,with some studies showing benefits and others not.Kotera, Y., et al. (2022)IdentificationFirst Author’s Name: Yasuhiro KoteraYear: 2022Place: UKDate of the search: November 2019.Objective: How effective is Shinrin-yoku in helping to improve mental health outcomes? What quantity and quality of evidence is reported?Email of the Corresponding Author: Y.Kotera@derby.ac.ukDOI: 10.1007/s11469-020-00363-4Participants/ PopulationType: Various populations including Japanese workers, Polish adults, young women, university students, patients with chronic stroke, psychiatric patientsSetting: Forest environments.Age: Range from 18 to 79 years old.Gender: Both male and female participants.InterventionShinrin-yoku (forest bathing) and nature therapyComparison / CompetitorVarious comparators including urban settings and no intervention groups.OutcomesMental health measures (depression, anxiety, stress and anger) used at least at pre- and post-interventionStudy designRandomized controlled trials (RCTs), non-randomized trialsQuality and BiasFor non-randomized studies assessed using the Newcastle-Ottawa Scale (NOS), Randomized controlled trials appraised using the Quality Assessment Table ofRandomized Controlled Trials.General NoteFundings: Not reportedConflict of interest: The authors declare that they have no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no)15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no/p) YOverall confidence: High ### Page 40 39Spatial dimensions of the influence of urban green-blue spaces on human health: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Shinrin-yoku can effectively reduce mental health symptoms, particularly anxiety, in the short term. Significant heterogeneity was foundin the effects on depression, anxiety, and anger, indicating variability in outcomes across different studies.Labib, S. M., et al. (2020)IdentificationFirst Author’s Name: S.M. LabibYear: 2020Place: UKDate of the search: December 2018.Objective: 1.To identify the different data, scales and geospatial methods utilized in studying greenspace and its relation to human health in urban areas; 2. Toinvestigate how results vary (e.g., significant vs insignificant, positive vs negative) according to the type of association between greenspace and health indicators andtheir relation to spatial data and methods; and 3. To identify the limitations and prospects of spatial data and analytics in representing and associating greenspace,human health.Email of the Corresponding Author: sm.labib@manchester.ac.ukDOI: 10.1016/j.envres.2019.108869Participants/ PopulationType: Various demographic groups including adults, children, and older adults.Setting: Urban environments.Age: Adults (18-65 years), children, and older adults.Gender: Not specified.InterventionExposure to green and blue spacesComparison / CompetitorAny comparatorOutcomesMental health including depression, anxiety, and stressStudy designCross-sectional and longitudinalQuality and BiasNot reportedGeneral NoteFundings: First author is funded by the School of Environment, Education and Development (SEED) Postgraduate Research Scholarship at the University ofManchester. Elements of this work were carried out as part of the Green Infrastructure and the Health and Well-Being Influences on an Ageing Population (GHIA)project (2016–2019)Conflict of interest: The Authors declare no conflict of interests.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 41 40Mental health benefits of nature-based recreation: a systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-based recreation is typically associated with mental health improvements, including reduced anxiety and stress, improved affect,and increased well-being. Most studies observed at least one significant positive relationship between nature-based recreation and mental health benefits.Lackey, N. Q., et al. (2019)IdentificationFirst Author’s Name: N. Qwynne LackeyYear: 2019Place: USADate of the search: February 2018.Objective: to review available research regarding the potential mental-health benefits of nature-based recreationEmail of the Corresponding Author: n.q.lackey@utah.eduDOI: 10.1080/11745398.2019.1655459Participants/ PopulationType: General human populationSetting: Various settings including national parks, urban green spaces, and wilderness areas.Age: Predominantly adults.Gender: Approximately equal numbers of males and females.InterventionParticipation in outdoor recreation (e.g. river rafting, hiking, fly-fishing), exposure to natural greenspaces (such as wilder- ness areas or forests) or participation in astructured wilderness program, (such as Outward Bound programs), forest bathing and exposure to urban greenspaces (including city parks, workplace courtyards, orhome backyards) or as natural visualization.Comparison / CompetitorAny non-participating or control groupOutcomesMental health benefits including, anxiety and/or stress reduction, positive affect and posttraumatic stress disorderStudy designQuantitative, qualitative, and mixed-method studies.Quality and BiasNot reportedGeneral NoteFundings: Not reportedConflict of interest: No potential conflict of interest was reported by the authors.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) N2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 42 41Using the natural environment to address the psychosocial impact of neurological disability: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Engaging with gardens and gardening programs significantly improved emotional health, reducing depression and anxiety among peoplewith dementia. Some studies showed significant improvements, others found no significant changes, indicating heterogeneity in the outcomes.Lakhani, A., et al. (2019)IdentificationFirst Author’s Name: Ali LakhaniYear: 2019Place: AustraliaDate of the search: June 2017.Objective: 1. To Identify and synthesize research investigating the impact of engaging with the natural environment on the psychosocial health of people who have aneurological disability. 2. To Identify how the natural environment has been used, and the out- comes that have been addressed.Email of the Corresponding Author: a.lakhani@griffith.edu.auDOI: 10.1016/j.healthplace.2018.12.002Participants/ PopulationType: People with dementia, brain injury, and stroke.Setting: Various settings including green care farms, gardens, and forest therapy.Age: Not specified.Gender: Not specified.InterventionEngaging with the natural environment (gardens, forest therapy, green care farms).Comparison / CompetitorTraditional care facilities or urban settings.OutcomesPsychosocial health outcomes including psychological, emotional, and social health.Study designQuantitative, qualitative and mixed methodsQuality and BiasMcMasters methodological rating tool.General NoteFundings: Not reportedConflict of interest: The authors report no conflicts of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no/p) YOverall confidence: High ### Page 43 42Alleviating mental health disorders through doses of green spaces: an updated review in times of the COVID-19 pandemicNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Higher levels of greenness surrounding an individual’s residence are linked to fewer symptoms of depression and anxiety. Some studiesfound that living close to a park or green space can be a negative predictor of mental health for certain groups, such as mothers.Lanza-León, P., et al. (2023)IdentificationFirst Author’s Name: Paloma Lanza-LeónYear: 2023Place: SpainDate of the search: …………Objective: To analyze the literature on the potential direct impact of the natural environment on mental health disorders.Email of the Corresponding Author: paloma.lanza@unican.eDOI: /10.1080/09603123.2021.2005780Participants/ PopulationType: General population, students, physicians, breast cancer patients, older adults, mothers.Setting: Various green spaces environmentsAge: Not specified for all studies but includes a range of ages.Gender: Both males and females.InterventionExposure to green spaces.Comparison / CompetitorNon-exposure or less exposureOutcomesAny mental health disorder.Study designObservational cohort and cross-sectional studies.Quality and Biaswe used the quality assessment tool for observational cohort and cross-sectional studies from the National Heart, Lung, and Blood Institute (National Heart, Lung, andBlood Institute 2021).General NoteFundings: This research has received no external funding.Conflict of interest: No potential conflict of interest was reported by the author(s).Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) P5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 44 43Life Course Nature Exposure and Mental Health Outcomes: A Systematic Review and Future DirectionsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found that early-life exposure to nature is generally associated with reduced psychiatric symptoms, including stress anddepression, although the evidence is inconsistent and often depends on contextual factors.Li, D., et al. (2021)IdentificationFirst Author’s Name: Dongying LiYear: 2021Place: USADate of the search: June 2020.Objective: To critically assess empirical observational studies reporting relationships between early-life exposure to nature and later-life mental health outcomes acrossall age ranges.Email of the Corresponding Author: dli@arch.tamu.edDOI: 10.3390/ijerph18105146Participants/ PopulationType: Various populations across different studies, including children, adolescents, adults, and older adults.Setting: Various settings in different countriesAge: Ranges from children to older adults.Gender: Not specified.InterventionEarly life nature exposureComparison / CompetitorNonparticipating or not exposed to nature during early life courseOutcomesLater life mental health outcomes including subjective well-being, cognitive function, behavioral problems and incidence of mental disorders that was both objectivelymeasured and/or self-reported.Study designLongitudinal studies and cross-sectional studies with retrospective measures of childhood nature exposure.Quality and BiasStudy Quality Assessment Tool developed by the National Heart, Lung, and Blood Institute (NHLBI).General NoteFundings: This research received no external funding.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) N2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 45 44Psychological benefits of green exercise in wild or urban green spaces: A meta-analysis of controlled trialsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Green exercise is associated with lower anxiety, anger, confusion, fatigue, and depression. Higher levels of vigor, comfort, natural feeling,and relaxation were observed in green exercise. Wild environments may be more effective than urban greenspaces in improving vigor and comfort during green exercise.Li, H., et al. (2022)IdentificationFirst Author’s Name: Hansen LiYear: 2022Place: ChinaDate of the search: July 2021.Objective: To reveal the psychological benefits of green exercise compared to non-green ordinary exercise and to compare the benefits of green exercise in wildenvironments and urban greenspaces.Email of the Corresponding Author: yang.cao@oru.seDOI: 10.1016/j.ufug.2022.127458Participants/ PopulationType: General populationSetting: Natural environments vs. non-natural environments.Age: Various, including young, middle-aged, and elderly participants.Gender: Both males and females.InterventionAny type of physical activity in natural environments.Comparison / CompetitorPhysical activity in non-natural environments.OutcomesAnxiety, tension, anger, depression, and fatigue, positive moods and emotions, including vigor, comfort, natural feeling, and relaxation.Study designRandomized controlled trials (RCTs) and crossover designs.Quality and BiasThe “Effective Public Health Practice Project” (EPHPP) was applied for quality assessment of the included studies (Thomas et al., 2010). The EPHPP tool can be usedfor various studies, including observational, cross-sectional, pre-post, cohort, and randomized controlled trial designs (Armijo-Olivo et al., 2012).General NoteFundings: Not reportedConflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)N16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 46 45Impact of “blue-green diet” on human health and wellbeing: A systematic review of potential determinants in shaping the effectiveness of blue-greeninfrastructure (BGI) in urban settingsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review highlights that blue-green infrastructure (BGI) can reduce stress and anxiety, and improve mental health by providingrestorative environments and promoting physical activitiesLi, J. and Z. Trivic (2024)IdentificationFirst Author’s Name: Jingyi LiYear: 2024Place: SingaporeDate of the search: September 2023.Objective: To understand the mechanisms and determinants of blue-green exposure and its health-related impacts for promoting health and wellbeing.Email of the Corresponding Author: jingyili@u.nus.eduDOI: 10.1016/j.scitotenv.2024.171397Participants/ PopulationType: General human populationSetting: Urban settings with blue-green infrastructureAge: Not specifiedGender: Not specifiedInterventionExposure to blue and green natureComparison / CompetitorNon-exposure, control, and/or alternative exposure/ interventionOutcomes1. Direct impacts on human health and wellbeing2. Health impacts from blue-green exposure (from landscape appreciation aspect)Study designExperimental, observational, and empirical research (qualitative, quantitative, and mix-method studies).Quality and BiasThe QualSyst assessment tool, which consists of a 14-point framework for quantitative studies and 10-point framework for qualitative studies (Kmet et al., 2004).General NoteFundings: The first author is partially supported by the DoA Graduate Stu- dentship (GOSF05000024 DOA PhD TF Subsidy N295000005001) offered by theDepartment of Architecture, National University of Singapore. The funding source was not involved in the conduct of the research and preparation of the article.Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the workreported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 47 46Assessing the Relationship between Urban Blue-Green Infrastructure and Stress Resilience in Real Settings: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Urban green infrastructure promotes stress recovery. Well-designed green infrastructure enhances stress resilience. Existing research lackscomprehensive measurements and calls for innovative approaches.Li, L. and K. W. Lange (2023)IdentificationFirst Author’s Name: Liwen LiYear: 2023Place: GermanyDate of the search: February 2022.Objective: To examine the relationship between stress reduction and urban blue-green infrastructure, focusing on empirical studies conducted in real urban settings.Email of the Corresponding Author: liwen.li@ur.de, klaus.lange@ur.deDOI: 10.3390/su15129240Participants/ PopulationType: Healthy participants, including high school and university students, local full-time employed workers and professionals, socially disadvantaged groups, homeand allotment gardeners, park visitors, and retired elderly individuals.Setting: Urban landscapesAge: Ranged from 14 to 85 years (mean 33.4 years).Gender: Both male and female, with some studies including only female or male participants.InterventionThe effects of urban landscape exposure on stress response in humans with both physiological parameters and psychological scales.Comparison / CompetitorNon-participating and/or control groupsOutcomesPsychological and physiological stress measures, including cortisol levels, heart rate variability, and self-reported stress scales.Study designRandomized controlled trials (RCTs), cross-sectional studies (CST), and quasi-experimental designs.Quality and BiasNo specific tool to assess bias was reportedGeneral NoteFundings: This research received no external fundingConflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) P8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no/ no meta-analysis) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 48 47Green space exposure on depression and anxiety outcomes: A meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Increased green space exposure is associated with a reduced risk of depression but has a slight effect on anxiety.Liu, Z., et al. (2023)IdentificationFirst Author’s Name: Ziquan LiuYear: 2023Place: ChinaDate of the search: July 2022.Objective: To integrate present evidence from observational studies to define the association of exposure to green space with depression and anxiety.Email of the Corresponding Author: yingqidao@163.comDOI: 10.1016/j.envres.2023.116303Participants/ PopulationType: General populationSetting: Various locations, including developed and developing nations.Age: No restrictions on the age of participants.Gender: Both male and female participants.InterventionExposure to green natureComparison / CompetitorNon-exposed and/or control or alternative exposureOutcomesDepression and anxietyStudy designObservational studies of longitudinal and cross-sectional design.Quality and BiasThe Agency for Healthcare Research and Quality (AHRQ)General NoteFundings: his work was supported by The Scientific Research Translational Foundation of Wenzhou Safety (Emergency) Institute of Tianjin University(TJUWYY2022019, TJUWYY2023001); the National Key R&D Program of China (2021YFC3002205); Natural Science Foundation of Tianjin Science andTechnology Program (21JCYBJC00830); Funda- mental Research Funds for the Central Universities, Nankai University (NO. 63221058).Conflict of interest: The authors declared that they have no known competing financial interests or personal relationships that could have appeared to influence thework reported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 49 48Do Mental Health Changes in Nature Co-occur with Changes in Heartrate Variability and Executive Functioning? A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Spending time in nature can increase heartrate variability, improve mental health, and enhance executive functioning.LoTemplio, S., et al. (2023)IdentificationFirst Author’s Name: Sara LoTemplioYear: 2023Place: USADate of the search: May 2020.Objective: To assess how nature exposure impacts mental health symptomology, executive functioning, and heart rate variability (HRV) when these variables areevaluated together.Email of the Corresponding Author: Sara.lotemplio@colostate.eduDOI: 10.1007/s40572-023-00407-6Participants/ PopulationType: Adults with mental illness and symptoms of mental illness.Setting: Natural settings including urban parks, urban woods, and relatively undisturbed natural sites.Age: Not specifiedGender: Not specifiedInterventionExposure to green spaces, such as well-maintained urban parks, urban forests, and relatively untouched natural areasComparison / CompetitorUrban environments or control groups.OutcomesMental health symptomology, executive functioning, and heart rate variabilityStudy designRandomized trials and non-randomized trials.Quality and BiasRisk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized trials.General NoteFundings: While there was no funding to support the research, Dr. Bettmann received funding from Nature Human Health Utah to disseminate these and other findingsat national conferences.Conflict of interest: The authors declare no competing interests.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 50 49Does exposure to greenness improve children's neuropsychological development and mental health? A Navigation Guide systematic review ofobservational evidence for associationsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nearly all studies showed a positive association between exposure to greenness and improvements in children’s neuropsychologicaldevelopment and mental health, including reductions in stress, anxiety, and depression.Luque-García, L., et al. (2022)IdentificationFirst Author’s Name: L. Luque-GarcíaYear: 2022Place: SpainDate of the search: October 2021.Objective: To review the observational evidence assessing the effect of exposure to greenness on children’s neuropsychological development and mental health.Email of the Corresponding Author: LLuque001@ikasle.ehu.eusDOI: 10.1016/j.envres.2021.112599Participants/ PopulationType: Children between 6 and 12 years old.Setting: Various locations including home, school, and neighborhood.Age: 6 to 12 years old.Gender: Not specified.InterventionExposure to greenness (trees, shrubs, grass, parks, forest, gardens, etc.) assessed via objective (vegetation indices, land use/land cover data, etc.) or subjective (scales,questionnaires, surveys, etc.) methods.Comparison / CompetitorComparatively lower levels of exposure or lack of exposureOutcomesNeuropsychological development or mental health assessed via validated tools.Study designObservational studies (longitudinal, cross-sectional, and ecological).Quality and BiasThe Navigation Guide approachGeneral NoteFundings: This study was funded by a grant from Instituto de Salud Carlos III (FIS-PI18/01237 include FEDER funds).Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the workreported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 51 50Horticultural therapy for stress reduction: A systematic review and meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Horticultural therapy significantly reduces stress, with more pronounced effects on psychological indicators than physiological ones.Thetherapy is particularly effective for educational stressors, males, and individuals over 60 years old.Lu, S., et al. (2023)IdentificationFirst Author’s Name: Shan LuYear: 2023Place: ChinaDate of the search: January 2023.Objective: To identify the physiological and psychological impacts of horticultural therapy on stress reduction, compare the impact on different groups of people,evaluate the impact of various environmental settings, and evaluate the impact of various types of intervention.Email of the Corresponding Author: ccxfcn@sina.comDOI: 10.3389/fpsyg.2023.1086121Participants/ PopulationType: General human populationSetting: Indoor, outdoor, and combined gardensAge: Ranged from 7 to 93 yearsGender: Both male and female participantsInterventionHorticultural therapy/gardeningComparison / CompetitorNo restrictions on control groupOutcomesStress-related physiological and psychological indicatorsStudy designRandomized controlled trials (RCTs) and quasi-experimental studiesQuality and BiasCochrane bias risk assessment tool and Joanna Briggs Institute (JBI) critical appraisal tools to assess studies with quasi- experimental designs.General NoteFundings: This study was supported by the Beijing Municipal Science and Technology Commission (project no. Z201100008020004).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 apotential conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 52 51Effectiveness of nature-based walking interventions in improving mental health in adults: a systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-based walking interventions significantly improve mood, reduce stress, anxiety, and negative rumination.Compared to urbanwalking, nature-based walking shows greater benefits for anxiety and rumination.Ma, J., et al. (2023)IdentificationFirst Author’s Name: Jingni MaYear: 2023Place: UKDate of the search: January 2023.Objective: To evaluate the evidence regarding the effectiveness of nature-based walking interventions in the improvement of mental health outcomes in adults.Email of the Corresponding Author: s1608391@ed.ac.uk; Jm2066york@gmail.comDOI: 10.1007/s12144-023-05112-zParticipants/ PopulationType: General populationSetting: Various natural settings including forests, urban parks, and other green spaces.Age: Mean age ranged from 19.6 to 40.34 years.Gender: Both male and female participants, with more males than females overall.InterventionNature-based walking intervention, walking in green spaces, such as urban parks, farmland, forests, national parks, hills, landscape fields (including places such asgolf courses)Comparison / CompetitorNon-green outdoor spaces, such as urban area without significant greeneryOutcomesMental health was defined broadly to include measures such as: mood, mindfulness, anxiety, depression, subjective well-being, quality of lifeStudy designRandomized controlled trials (RCT), non-randomized controlled designs (quasi-experimental design), within-subjects and between-subjects with pre-post-testsQuality and BiasThe Revised Cochrane Risk of Bias Tools for Randomized Trials (ROB-2), SIGN 50 Checklist for non-randomized studies.General NoteFundings: This study did not receive any fundings.Conflict of interest: There is no conflict of interest to disclose for this manuscript.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 53 52Does Access to Green Space Impact the Mental Well-being of Children: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Access to green space was associated with lower levels of stress, anxiety, and depression in children. It promotes attention restoration,memory, competence, supportive social groups, self-discipline, and moderated stress. Green space also improves behaviors and symptoms of ADHD.McCormick, R. M. S. N. (2017)IdentificationFirst Author’s Name: Rachel McCormickYear: 2017Place: USADate of the search: 2017Objective: To examine the association between access to green space and the mental well-being of children.Email of the Corresponding Author: Rachmcc127@gmail.comDOI: 10.1016/j.pedn.2017.08.027Participants/ PopulationType: Children aged 0–18 years.Setting: Various locationsAge: 0–18 years.Gender: Not specified.InterventionAccess to Green SpaceComparison / CompetitorNo exposure or no access or less access to natureOutcomesMental well-being, overall health, cognitive development, attention restoration, memory, competence, supportive social groups, self-discipline, moderated stress,improved behaviors, and symptoms of ADHD.Study designEleven quantitative research and one qualitative studyQuality and BiasNot reportedGeneral NoteFundings: Not reportedConflict of interest: Not reportedQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) N5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no)Overall confidence: Critically low ### Page 54 53Does nature-based social prescription improve mental health outcomes? A systematic review and meta-Note. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-based social prescriptions significantly improve mental health outcomes, particularly in reducing stress, anxiety, and depression.The interventions showed varying effect sizes, with some studies indicating strong positive effects while others had smaller or non-significant effects.Menhas, R., et al. (2024)IdentificationFirst Author’s Name: Rashid MenhasYear: 2024Place: ChinaDate of the search: March 2023.Objective: To analyze existing studies and conduct a meta-analysis to determine the overall effect size of the nature-based social prescriptions (NBSP’s) outcomes onmental health.Email of the Corresponding Author: 3200006@zju.edu.cnDOI: 10.3389/fpubh.2024.1228271Participants/ PopulationType: Participants with mental health conditions such as anxiety, depression, and stress.Setting: Various locations worldwide.Age: Various age groups, including children, adults, and elderly.Gender: Both male and female participants.InterventionNature-based social prescription, ecotherapy, green therapy, green exercise, and activities performed or related to green spaces or green prescriptions on mental healthoutcomesComparison / CompetitorControl or alternative interventionsOutcomesMental health outcomes such as depression, anxiety, stress, or overall psychological well-being;Study designExperimental studies, controlled studies, pilot studies, surveys, repeated measure design, and treatment.Quality and BiasNo tools or clarification are reportedGeneral NoteFundings: There is no external funding for this review. (Reported in protocol)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 apotential conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) N12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) N14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 55 54Restorative effects of exposure to nature on children and adolescents: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Exposure to nature has significant restorative effects on reducing stress, anxiety, and depression among children and adolescents.Moll, A., et al. (2022)IdentificationFirst Author’s Name: Adrian MollYear: 2022Place: SpainDate of the search: April 2021.Objective: we conducted a systematic review aiming at systematically summarizing the accumulated evidence about the restorative effects of nature exposure onchildren and adolescents and reporting the main findings in terms of the restoration of (1) cognitive, (2) emotional, (3) social or (4) behavioral resources.Email of the Corresponding Author: adrian.moll@uam.esDOI: 10.1016/j.jenvp.2022.101884Participants/ PopulationType: Children and adolescents.Setting: Various settings including residential, school, parks/forests, and simulated nature.Age: 0 to 19 years.Gender: Not specified.InterventionExposure to natureComparison / CompetitorNon-exposed, control and/or alternative exposure or interventionOutcomesRestoration of (1) cognitive, (2) emotional, (3) social or (4) behavioral resources.Study designCross-sectional, longitudinal, cohort, pre-post, and intervention studies.Quality and BiasNational Heart, Lung, and Blood Institute (NHLBI) quality assessment tool.General NoteFundings: This work was supported by the Spanish Ministry of Science, Innovation and Universities (grant number: PGC2018-095502-B-I00).Conflict of interest: Author statement, JC, SC, AM: Conceptualization. AM: Data curation, Formal analysis, Methodology. SC, JC, AM: Project administration,Visualization. AM: Writing - original draft. JC, SC, HS: Supervision, Validation, Visualization, Writing - review & editing. JC, SC: Funding acquisition. All authorshave read and agreed to the current version of the manuscript.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) N12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)N13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) N14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)N16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 56 55A Systematic Review of Arts-Based Interventions Delivered to Children and Young People in Nature or Outdoor Spaces: Impact on Nature Connectedness, Health andWellbeingNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Arts-in-nature interventions led to reductions in stress, anxiety, and depression among children and young people.The quality ofquantitative evidence is still at its infancy, requiring further research.Moula, Z., et al. (2022)IdentificationFirst Author’s Name: Zoe MoulaYear: 2022Place: UKDate of the search: April 2021.Objective: To synthesize the literature surrounding the interconnectedness between arts and nature, and their impact on the health and wellbeing of children and youngpeople.Email of the Corresponding Author: z.moula@imperial.ac.ukDOI: 10.3389/fpsyg.2022.858781Participants/ PopulationType: Children and young peopleSetting: Nature or outdoor spaces such as forests, woodlands, beaches, parks, fields, gardens, and school playgrounds.Age: Younger than 18 years old.Gender: Not specifiedInterventionArts-based interventions delivered in nature or outdoor spaces.Comparison / CompetitorNature- or outdoor-based interventions that do not include engagement with the artsArts-based interventions that are not delivered in nature or outdoor spacesOutdoor interventions primarily based on recreational activities (e.g., hiking, camping, air or water sports) but not artsOutcomes not related to health and wellbeingOutcomesHealth and wellbeing including stress, anxietyStudy designRandomized controlled trials (RCTs), pilot-, cluster-, or quasi-RCTs, quasi-experimental studies, controlled before and after studies, surveys, observational,ethnographic, narrative, phenomenographic, and grounded theory studiesQuality and BiasROBIS toolGeneral NoteFundings: This project was funded by AHRC with project reference number AH/S006206/1. The Open Access publication fees were provided by UCL Institute ofEducation.Conflict of interest: ZM: first reviewer, conceptualization, design, data collection and analysis, quality appraisal, writing of original draft, and visualization. KP: secondreviewer, data collection and analysis, quality appraisal, and review of written report. NW: third reviewer in case of discrepancies, review of written report. All authorscontributed to the article and approved the submitted version.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 57 56Effects of public green space on acute psychophysiological stress response: A systematic review and meta-analysis of the experimental and quasi-experimental evidenceNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Immersion in natural environments enhances heart rate variability more than control conditions. The empirical support for stress-reducingeffects of nature is tentative due to small sample sizes and methodological weaknesses.Mygind, L., et al. (2021) AIdentificationFirst Author’s Name: Lærke MygindYear: 2021Place: Denmark.Date of the search: May 2017.Objective: To synthesize and critically assess the evidence on the effects of public green space on psychophysiological stress response.Email of the Corresponding Author: laerke.mygind.groenfeldt@regionh.dkDOI: 10.1177/0013916519873376Participants/ PopulationType: Various, including university students, healthy adults, individuals with hypertension, and individuals with major depressive disorder.Setting: Public green spaces excluding private gardens, indoor nature and views to nature and virtual nature.Age: Ranges from junior high school students to elderly individuals.Gender: Both male and female participants.InterventionDirect experience of public, predominantly green space, excluding private gardens, indoor nature and views to nature and virtual nature.Comparison / CompetitorFor within-subject studies: similar exposure or activity in a predominantly synthetic environment, for example, indoor or urban. For between-subjects studies: a notreatment or treatment as usual condition.OutcomesPsychophysiological stress response markers, not predefinedStudy designExperimental and quasi-experimental designs, including randomized controlled trials (RCTs), crossover trials, and controlled before-and-after studiesQuality and BiasEffective Public Health Practice Project (EPHPP) quality assessment toolsGeneral NoteFundings: The research is funded by a grant from the Danish Outdoor Council, Denmark (ID 105821).Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Moderate ### Page 58 57Landscapes of becoming social: A systematic review of evidence for associations and pathways between interactions with nature and socioemotionaldevelopment in childrenNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The study found consistent evidence that spending time in green spaces is associated with improved socioemotional function in children,including reduced stress, anxiety, and depression.Mygind, L., et al. (2021) BBIdentificationFirst Author’s Name: Lærke MygindYear: 2021Place: DenmarkDate of the search: September 2019.Objective: To investigate the association between the availability of or spending time in nature and socioemotional function and development in children under theage of 12 years.Email of the Corresponding Author: laerke.mygind.groenfeldt@regionh.dkDOI: 10.1016/j.envint.2020.1062384Participants/ PopulationType: Children under the age of 12 years.Setting: Various settings including residential areas, schools, and childcare centersAge: Under 12 years.Gender: Not specified.InterventionTime spending in nature/ nature exposureComparison / CompetitorNo-treatment or treatment-as-usual control conditions or comparatively lower or no exposure to natural environmentsOutcomesSocioemotional function and development, including proximal outcomes like cognition, play, movement behaviors, screen time, healthy weight, stress, stress, mood,physical wellbeing, motor skills, language and communication skills, birth outcomes, allergy, and asthma.Study designExperimental and observational studiesQuality and BiasThe NTP-OHAT Risk of Bias Assessment Tool (National Institute of Environmental Health Sciences, 2015)General NoteFundings: Lærke Mygind is supported by Deakin University [PhD scholarship, without grant number]. Peter G. Enticott is supported by a Future Fellowship from theAustralian Research Council [FT160100077].Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the workreported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 59 58Green Space Quality and Health: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Green spaces with greater tree canopy were associated with improved psychological wellbeing, including reduced stress, anxiety, anddepression. However, evidence was inconsistent for grassland and other vegetation types.Nguyen, P. Y., et al. (2021)IdentificationFirst Author’s Name: Phi-Yen NguyenYear: 2021Place: AustraliaDate of the search: June 2021.Objective: To examine whether particular green space types and qualities provide health benefits, and if so, which specific types and qualities, and which healthoutcomes.Email of the Corresponding Author: phiyen.nguyen@unsw.edu.auDOI: 10.3390/ijerph182111028Participants/ PopulationType: Green space users of all ages and gendersSetting: Various urban and rural settingsAge: Ranges from 4.5 to 76.5 years.Gender: Both male and female participants, with some studies focusing exclusively on females or specific age groups.InterventionAll types of natural and man-made green environments, including parks, streetscape greenery, urban open spaces, playgrounds, coastal parks with vegetation, etc.,were included as long as they were defined by authors as green space.Comparison / CompetitorNon-exposed, less exposed and/or control or alternative exposureOutcomesHealth outcomes including cardiometabolic, respiratory, reproductive, neurological, psychological health, and child development.Study designCross-sectional studies, ecological studies, cohort studies, before-after studies, quasi-experimental studies, case-crossover studiesQuality and BiasStudy Quality Assessment Tools of The National Heart, Lung, and Blood Institute (NHLBI)General NoteFundings: This study was supported by a National Health and Medical Research Council Boosting Dementia Research Leader Fellowship 1140317 (Astell-Burt) andthe National Health and Medical Research Council Career Development Fellowship 1148792 (Feng). Astell-Burt and Feng were also jointly supported by grant1101065 from the National Health and Medical Research Council project and grant GC15005 from the Green Cities Fund—Hort Innovation Limited, with co-investment from the University of Wollongong Faculty of Social Sciences, the University of Wollongong Global Challenges initiative, and the Australian Government.The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, orapproval of the manuscript; and the decision to submit the manuscript for publicationConflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 60 59The Effects of Outdoor versus Indoor Exercise on Psychological Health, Physical Health, and Physical Activity Behaviour: A Systematic Review ofLongitudinal TrialsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Limited evidence suggests outdoor exercise may have benefits for psychological health, but findings are hindered by high risk of bias andoutcome heterogeneity.Noseworthy, M., et al. (2023)IdentificationFirst Author’s Name: Matt NoseworthyYear: 2023Place: CanadaDate of the search: March 2021.Objective: This systematic review aimed to compare the effects of exercise in outdoor environments versus indoor environments on psychological health, physicalhealth, and physical activity behavior.Email of the Corresponding Author: teresa.ambrose@ubc.caDOI:10.3390/ijerph20031669Participants/ PopulationType: General populationSetting: Various outdoor and indoor environments.Age: Mean ages ranges from 11 to 80 years.Gender: Mixed, with some studies having all males, all females, or a mix.InterventionTwo or more exercise bouts in an outdoor environment.Comparison / CompetitorTwo or more exercise bouts performed indoors with no exposure to actual or simulated natureOutcomesPrimary: at least one outcome related to physical or psychological health. Secondary: any outcomes related to physical activity behaviorStudy design:Randomized controlled trials, non-randomized trials, and a cluster-randomized, crossover trial.Quality and BiasRevised Cochrane risk of bias (RoB) tool for randomized trials (RoB-2).General NoteFundings: This research received no external funding. T.L.-A is a Tier 1 Canada Research Chair in Healthy Aging. E.P. is a Tier 2 Canada Research Chair in PhysicalActivity and Health.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 61 60Health and well-being benefits of spending time in forests: Systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest therapy showed promising therapeutic benefits for stress, anxiety, and depression. However, the evidence is insufficient due tomethodological design flaws. More robust RCTs are warranted.Oh, B., et al. (2017)IdentificationFirst Author’s Name: Byeongsang OhYear: 2017Place: AustraliaDate of the search: December 2016.Objective: This review evaluated the physical and psychological benefits of a specific type of exposure to nature, forest therapy.Email of the Corresponding Author: byeong.oh@sydney.edu.auDOI: 10.1186/s12199-017-0677-9Participants/ PopulationType: Young healthy university students to elderly people with chronic disease.Setting: Forest environments in China, Korea, and Sweden.Age: 20 to 79 years.Gender: Both males and females.InterventionSpending time in forests, forest therapyComparison / CompetitorUrban environment interventions.OutcomesImpact on hypertension, cardiac and pulmonary function, immune function, inflammation, oxidative stress, stress, stress hormone, anxiety, depression, and emotionalresponse.Study design:Randomized controlled trials (RCTs).Quality and BiasThe Cochrane risk of bias (ROB) tool.General NoteFundings: NoneConflict of interest: The authors declare that they have no competing interests.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) P5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 62 61The Effects of Nature Exposure Therapies on Stress, Depression, and Anxiety Levels: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found limited evidence supporting nature-based therapeutic interventions as a primary approach to reducing stress, depression,and anxiety. Significant differences in cortisol levels were observed in some studies, but not all. The overall quality of evidence was poor, with significant methodologicalvariations across studies.Paredes-Céspedes, D. M., et al. (2024)IdentificationFirst Author’s Name: Diana Marcela Paredes-CéspedesYear: 2024Place: ColombiaDate of the search: September 2021.Objective: To assess the impact of nature exposure therapies on stress, depression, and anxiety levels.Email of the Corresponding Author: noridavelezc@gmail.comDOI: 10.3390/ejihpe14030040Participants/ PopulationType: Healthy participants aged 18 years or older.Setting: Natural settings including forests, natural parks, urban parks, urban green areas, cultivated fields, or gardens.Age: 18 years or olderGender: Not specifiedInterventionNature-based therapeutic interventionsComparison / CompetitorVarious control groups, including no intervention or urban settingsOutcomesStress, depression, and anxiety levels.Study design:Randomized clinical trialsQuality and BiasCochrane risk of bias toolGeneral NoteFundings: This research was funded by the Ministerio de Trabajo of Colombia, Fondo de Riesgos Laborales.Conflict of interest: The authors declare no conflicts of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)N16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 63 62A systematic review of audit tools for evaluating the quality of green spaces in mental health researchNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: High-quality green spaces are associated with lower levels of stress, anxiety, and depression.Park, H., et al. (2024)IdentificationFirst Author’s Name: Hyunseo ParkYear: 2024Place: USADate of the search: August 2023.Objective: To evaluate audit tools for green space quality in mental health research and identify specific aspects of green space quality associated with mental healthbenefits.Email of the Corresponding Author: apearson@msu.eduDOI: 10.1016/j.healthplace.2024.103185Participants/ PopulationType: Individuals engaging with real-world green spacesSetting: Various locations and geographical regionsAge: Not specifiedGender: Not specifiedInterventionEvaluation of green space quality using audit tools.Comparison / CompetitorControl and/or alternative intervention or exposureOutcomesMental health as an outcome measure, with a broad definition encompassing stress, anxiety, and overall health if the metric included an aspect of mental healthStudy design:Cross-sectional and longitudinal studiesQuality and BiasNot reportedGeneral NoteFundings: Funding: This study was funded by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under grant R01 CA239187 (Pearson),the Detroit Medical Center, Michigan State Uni- versity’s Clinical Translational Science Initiative, and the Vice President for Research and Graduate Studies and theProvost Undergraduate Research Initiative.Conflict of interest: Hyunseo Park: Writing – review & editing, Writing – original draft, Visualization, Project administration, Methodology, Formal analysis, Datacuration, Conceptualization. Catherine D. Brown: Writing – re- view & editing, Formal analysis. Amber L. Pearson: Writing – review & editing, Supervision, Fundingacquisition.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) N2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 64 63Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature exposure, particularly access to gardens and green spaces, was associated with improved mental health outcomes such as reducedanxiety, depression, and stress during the COVID-19 pandemic. However, the overall quality of evidence was very low, and high levels of bias were observed in thestudies.Patwary, M. M., et al. (2024)IdentificationFirst Author’s Name: Muhammad Mainuddin PatwaryYear: 2024Place: BangladeshDate of the search: March 2024.Objective: To investigate associations between nature exposure and mental health during the COVID-19 pandemic and determin the quality of evidence and risk ofbias of empirical studies.Email of the Corresponding Author: raju.es111012@gmail.comDOI: 10.1016/j.envpol.2024.124284Participants/ PopulationType: Human participants with no restrictions on age, sex, and specific area.Setting: Various settings including indoor and outdoor nature exposure.Age: No specific age restrictions.Gender: No specific gender restrictions.InterventionBoth objective and subjective measures of indoor and outdoor nature exposure, including blue and green space, natural outdoor space, indoor greenery, vegetationindices, window views of outdoor natural landscapes, gardens, parks, forests, and tree canopy; however, simulated exposures (i.e., virtual reality) of nature wereexcluded.Comparison / CompetitorGroups without exposure or less exposure to nature served as a comparison or control group.OutcomesPrevalence, incidence, or continuously measured level of a mental health construct, including anxiety, depression, stress, general mental health, mood state, positiveand negative affect, loneliness, emotional distress, well-being, and happiness during the COVID-19 pandemic; physical health outcomes were excluded.Study design:Cross-sectional, ecological, case-control, and cohort studies.Quality and BiasThe Navigation Guide Systematic Review Methodology, (Woodruff & Sutton, 2014) and Grading of Recommendations Assessment Development and Evaluation(Guyatt et al., 2008).General NoteFundings: Angel M. Dzhambov is supported by the “Strategic research and innovation program for the development of Medical University – Plov- div” N◦ BG-RRP-2.004-0007-C01, funded under the European Union - NextGenerationEU (Recovery and resilience mechanism) – “A program to accelerate economic recovery andtransformation through science and innovation”, Pillar 2 “Establishment of a network of research universities in Bulgaria.”Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence thework reported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 65 64Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematicNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature prescriptions had a moderate to large effect on reducing depression and anxiety scores. The results showed evidence ofcardiometabolic and mental health benefits and increases in walking.Phi-Yen, N., et al. (2023)IdentificationFirst Author’s Name: Phi-Yen NguyenYear: 2023Place: AustraliaDate of the search: July 2021.Objective: to identify and synthesize evidence for effective nature prescriptions and to determine the factors that are important for their success. We examine whethernature prescriptions improve social, mental, and physical health; the design characteristics of nature prescriptions; and the potential channels to dispense a natureprescription.Email of the Corresponding Author: xiaoqi.feng@unsw.edu.auDOI: 10.1016/S2542-5196(23)00025-6Participants/ PopulationType: Various, including adults, older adults, children, and socioeconomically disadvantaged groups.Setting: Forests, nature reserves, parks, small community or home gardens, botanical gardens, and beaches.Age: Mainly adults (18-65 years) and older adults (65+ years).Gender: Both male and female participants.InterventionNature prescriptions involving health or social professionals recommending spending time in nature.Comparison / CompetitorControl conditions with no nature-based intervention.OutcomesPhysical, psychological, or cognitive health, and behavioral outcomesStudy designRandomized controlled trials (RCTs) and non-randomized controlled studies.Quality and BiasROBINS-I tool for nonrandomized studies and the ROB 2.0 tool for randomized trials.General NoteFundings: The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All aspects related to theconduct of this study, including the views stated and the decision to publish the findings are those of the authors only.Conflict of interest: We declare no competing interests.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 66 65Experiences of outdoor nature-based therapeutic recreation programs for persons with a mental illness: a qualitative systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: These programs help reduce stress, anxiety, and depression by providing a psychologically safe environment that fosters socialrelationships and meaningful connections. Participants also reported increased self-esteem and a greater sense of identity.Picton, C., et al. (2020)IdentificationFirst Author’s Name: Caroline PictonYear: 2020Place: AustraliaDate of the search: January 2018.Objective: The objective of this review was to identify, appraise, and synthesize the best available evidence related to participation in outdoor nature-based therapeuticrecreation programs for adults with a mental illness.Email of the Corresponding Author: Caroline Picton, cjp977@uowmail.edu.auDOI: 10.11124/JBISRIR-D-19-00263Participants/ PopulationType: Adults with a diagnosis of a mental illness and referred to a therapeutic recreation program by mental health services.Setting: Nature-based community settingsAge: Adults aged 18 years or overGender: Not specifiedInterventionNature-based recreation activities included adventure camps; TR; sporting, gardening, and community-based leisure programs; and healthy lifestyle programs that areprimarily focused on the use of recreation to enhance mental health recovery.Comparison / CompetitorNo intervention or intervention taking place in a non-nature settingOutcomesEnjoyment, social inclusion, formation of meaningful relationships, enhanced psychological well-being, increased physical activity, greater self-esteem, and enhancedsense of identity.Study designPhenomenology, ethnography, thematic content analysis, mixed methods, and qualitative description.Quality and BiasJBI Qualitative Assessment and Review Instrument and ConQual approachGeneral NoteFundings: Not reportedConflict of interest: Not reportedQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) NOverall confidence: Moderate ### Page 67 66Effects of forest walking on physical and mental health in elderly populations: a systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest walking and other forest therapy activities significantly reduced stress, anxiety, and depression levels in elderly populations.Psychological benefits included reductions in depression and stress levels and improvements in quality of life.Piva, G., et al. (2024)IdentificationFirst Author’s Name: Giovanni PivaYear: 2024Place: ItalyDate of the search: December 2021.Objective: To explore the physiological and psychological benefits of different forest therapies on healthy and pathological elderly populations (>60 years).Email of the Corresponding Author: nicola.lamberti@unife.itDOI: 10.1515/reveh-2022-0093Participants/ PopulationType: Elderly populations (>60 years)Setting: Natural environments, specifically forests.Age: 60 years and olderGender: Both males and femalesInterventionForest walking and other forest therapy activitiesComparison / CompetitorWalking in the city or usual life activitiesOutcomesPhysical and mental health including reductions in blood pressure, heart rate, and improvements in cardiopulmonary and neurochemical parameters, as well asreductions in depression, stress levels, and improvements in quality of life.Quality and BiasAssessment Tool for Studies with Diverse Designs (QATSDD)Study design:Exploratory studies, randomized controlled trials, non-randomized controlled trialsGeneral NoteFundings: None declared.Conflict of interest: Authors state no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) AN14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 68 67The impact of nature-led recovery initiatives for individual and community health post disaster: A systematic literature reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-led recovery initiatives provide positive psychological benefits, reduce stress, and support emotional resilience.Porter, J. E., et al. (2023)IdentificationFirst Author’s Name: Joanne E. PorterYear: 2023Place: AustraliaDate of the search: February 2022.Objective: To systematically explore the literature on the impact of nature-led recovery initiatives on individual and community health following a disaster.Email of the Corresponding Author: joanne.porter@federation.edu.auDOI: 10.1515/reveh-2022-0061Participants/ PopulationType: Various populations affected by disasters in the USA, New Zealand, Australia, Italy, Japan, and Thailand.Setting: Community settings affected by disasters such as hurricanes, earthquakes, bushfires, tsunamis, and nuclear disasters.Age: Ranges from 18 to 87 years.Gender: Both males and femalesInterventionNature-led recovery initiativesComparison / CompetitorAlternative activitiesOutcomesPsychological and mental benefits, community connectedness, and resilience.Study designQualitative case studies, mixed methods, and quantitative cross-sectional surveys.Quality and/or BiasThe Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included studies.General NoteFundings: None declaredConflict of interest: Authors state no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) P8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 69 68The Effects of Forest Therapy on the Blood Pressure and Salivary Cortisol Levels of Urban Residents: A Meta-AnalysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest therapy significantly reduced systolic blood pressure (SBP), diastolic blood pressure (DBP), and salivary cortisol concentration(SCC).Older participants and those with higher baseline BP levels had greater BP-lowering effects. Longer-term forest therapy programs (≥20 min) resulted in greaterreductions in BP and SCC.Qiu, Q., et al. (2023)IdentificationFirst Author’s Name: Quan QiuYear: 2023Place: ChinaDate of the search: December 2021.Objective: To systematically verify forest therapy’s effects on bood pressure and mental stress of urban residents, we conducted meta-analyses to assess the changesin systolic blood pressure (SBP), diastolic blood pressure (DBP), and salivary cortisol concentration (SCC; a stress biomarker) between the forest therapy group andurban control group.Email of the Corresponding Author: guangyu.wang@ubc.caDOI: 10.3390/ijerph20010458Participants/ PopulationType: Adults living in urban areas, regardless of their health status.Setting: Forest-based seated viewing, walking, or multi-session programsAge: 18+Gender: Both male and female participants includedInterventionAll types of forest therapy activities (forest-based seated viewing, walking, or multi-session program)Comparison / CompetitorVisiting urban environments (urban environment-based seated viewing, walking, or multi-session program)OutcomesMeasurement of the participants’ SBP, and/or DBP, and/or SCC after interventionStudy design:Randomized controlled trials (RCT) and non-randomized controlled trials (Non-RCT).Quality and BiasNon-randomized studies were assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool and Cochrane Risk of Bias tool forrandomized trials (RoB 2).General NoteFundings: The authors declare no conflict of interest.Conflict of interest: This research was supported by the Forestry Science and Technology Innovation Fund Project of Guangdong Province (No. 2018KJCX012),APFNet (No. 2017SP2-UBC), and China Scholar- ship Council (No. 202008440171; No. 202108680002).Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 70 69Green Space and Health in Mainland China: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15Summary of Major Findings: Green space exposure was associated with significant improvements in mental health outcomes, including reduced stress, anxiety, anddepression.Rahimi-Ardabili, H., et al. (2021)IdentificationFirst Author’s Name: Hania Rahimi-ArdabiliYear: 2021Place: Australia.Date of the search: November 2020.Objective: to determine the degree of association between green space and health outcomes in China.Email of the Corresponding Author: hania.rahimi@gmail.comDOI: 10.3390/ijerph18189937Participants/ PopulationType: Healthy or unhealthy subjects of any age or sex in China.Setting: Green spaces in Mainland China.Age: Any ageGender: Both men and women.InterventionExposure to a high level of green space in countries in mainland China directly measured green space, objectively or subjectivelyComparison / CompetitorExposure to a low level of green space in countries in mainland ChinaOutcomesObjective and subjective physical and mental health outcomes (positive health outcomes reported or negative)Study design:Cross-sectional, cohort, randomized controlled trial (RCT), ecological, case–control, before–after, quasi-experimental.Quality and BiasThe National Heart, Lung, and Blood Institute quality toolGeneral NoteFundings: This study was supported by a National Health and Medical Research Council Boosting Dementia Research Leader Fellowship 1140317 (Astell-Burt) andNational Health and Medical Research Council Career Development Fellowship 1148792 (Feng). Astell-Burt and Feng were also jointly supported by grant 1101065from the National Health and Medical Research Council project and grant GC15005 from the Green Cities Fund—Hort Innovation Limited, with co-investment fromthe University of Wollongong Faculty of Social Sciences, the University of Wollongong Global Challenges initiative, and the Australian government. The fundingsources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of themanuscript; and the decision to submit the manuscript for publication.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no)15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 71 70Living environment and its relationship to depressive mood: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Adverse house/built environment, lack of green areas, noise, and air pollution are related to depressive mood. Urbanization and populationdensity results were inconsistent. Walkability and availability of services showed mixed results.Rautio, N., et al. (2018)IdentificationFirst Author’s Name: Nina RautioYear: 2018Place: FinlandDate of the search: October 2016.Objective: In this systematic review, we aimed to study whether the living environment is related to depressive mood.Email of the Corresponding Author: nina.rautio@oulu.fiDOI: 0.1177/0020764017744582Participants/ PopulationType: General human populationSetting: Various living environmentsAge: Adolescents to older adults.Gender: Not specified.InterventionMeasures of urbanization, population density, aesthetics of living environment, house/built environment, green areas, walkability, noise, air pollution, and services.Comparison / CompetitorNo exposure or less exposureOutcomesDepressive moodStudy design:Cross-sectional and longitudinal studiesQuality and BiasWe constructed a five-item checklist, modified based on previous recommendations (Downs & Black, 1998) for assess- ing the quality of the articles.General NoteFundings: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supportedby the Academy of Finland (268336) and the European Union’s Horizon 2020 research and innovation pro- gramme (under grant agreement No 633595) for theDynaHEALTH action and by the European Commission (Grant LifeCycle – H2020 – 733206). This work was also a part of The Six City Strategy. The Six CityStrategy runs between 2014 and 2020 with the aim of creating new know-how, business and jobs in Finland. It is part of Finland’s structural fund program forsustainable growth and jobs 2014–2020. It is funded by the European Regional Development Fund, the European Social Fund, the Finnish Government and theparticipating cities.Conflict of interest: Not reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) N9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 72 71Linking public urban green spaces and human well-being: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Public urban green spaces help reduce stress. Green spaces contribute to mental well-being, reducing anxiety. Access to green spaces islinked to lower levels of depression.Reyes-Riveros, R., et al. (2021)IdentificationFirst Author’s Name: Rosa Reyes-RiverosYear: 2021Place: ChileDate of the search: November 2020.Objective: To analyze the relationships between green spaces’ specific characteristics and human well-being components.Email of the Corresponding Author: r.reyes04@ufromail.clDOI: 10.1016/j.ufug.2021.127105Participants/ PopulationType: General populationSetting: Public urban green spacesAge: Not specifiedGender: Not specifiedInterventionCharacteristics of public urban green spaces.Comparison / CompetitorNon-exposed or control and/or alternative treatment or exposure.OutcomesEffects on human well-being dimensions such as health, security, good social relations, and freedom of choice and action.Study design:Cross-sectional, longitudinal, randomized, non-randomized, with and without control groups.Quality and BiasNot reportedGeneral NoteFundings: This research was supported by funding from Fondecyt grants 1171445, 11191021, 1200733, and 1211051. R. Reyes-Riveros received a PhD grantfrom CONICYT program. The authors are also grateful for the support of the Research Office of Universidad de La Frontera.Conflict of interest: The authors report no declarations of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 73 72Natural Environments in University Campuses and Students’ Well-BeingNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found that increased campus greenness may alleviate test anxiety, improve mood, and reduce symptoms of stress, anxiety, anddepression among university students.Ribeiro, H., et al. (2024)IdentificationFirst Author’s Name: Helena RibeiroYear: 2024Place: BrazilDate of the search: February 2023.Objective: Our aim was to verify if and how the natural environment in campuses is focused on programs to cope with the issue of mental health and well-being amongstudents.Email of the Corresponding Author: keilla@usp.brDOI: 10.3390/ijerph21040413Participants/ PopulationType: University studentsSetting: University campusesAge: Young adults (18-29 years old)Gender: Not specifiedInterventionExposure to natural environments in university campusesComparison / CompetitorNon-exposure or less exposureOutcomesStudents’ well-BeingStudy design:Cross-sectional studies, surveys, and field experiments.Quality and BiasNot reportedGeneral NoteFundings: This research was funded by CNPq productivity grant 1A, to H.R.; post-doctoral scholarship from Fapesp to K.V.S.S. Post–doctoral scholarship fromCAPES to S.L.O.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) P8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 74 73Nature in the Office: A Systematic Review of Nature Elements and Their Effects on Worker Stress ResponseNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The selected studies suggest that strategies such as access to outdoor environments or the creation of outdoor areas are effective in reducingstress in the workplace.Ríos-Rodríguez, M. L., et al. (2023)IdentificationFirst Author’s Name: María Luisa Ríos-RodríguezYear: 2023Place: SpainDate of the search: July 2023.Objective: To identify which elements of biophilic design in the workplace affect workers’ stress response.Email of the Corresponding Author: mlurios@uma.esDOI: 10.3390/healthcare11212838Participants/ PopulationSetting: Office workersType: Workplace environmentsAge: Not specifiedGender: Not specifiedInterventionBiophilic design elements in the workplaceComparison / CompetitorAlternative designsOutcomesRegarding the outcome variables, studies that assessed stress, burnout, or anxiety were included, both through self-report measures and physiological indicators. Sincethe interest was to understand the effect on occupational stress, articles focused on clinical aspects, such as depression, post-traumatic stress, generalized anxietydisorders, etc., were excluded.Study design:Observational studies (cross-sectional survey, prospective cohort, longitudinal repeated measures), Experimental or quasi-experimental studies (laboratory conditions,field studies)Quality and BiasNot reportedGeneral NoteFundings: The article was funded by the University of Málaga.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) N14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 75 74Benefits for emotional regulation of contact with nature: a systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Contact with nature is associated with better emotional regulation and lower perceived stress. Emotional regulation mediates therelationship between nature connectedness and stress reduction.Ríos-Rodríguez, M. L., et al. (2024)IdentificationFirst Author’s Name: María Luisa Ríos-RodríguezYear: 2024Place: SpainDate of the search: October 2023.Objective: To analyze the evidence of the relationship between contact with nature and emotional regulation.Email of the Corresponding Author: crosales@ull.edu.esDOI: 10.3389/fpsyg.2024.1402885Participants/ PopulationType: general populationSetting: Various locationAge: 16 to 85 years oldGender: Higher proportions of women in most studiesInterventionContact with nature (direct or indirect)Comparison / CompetitorNon-exposure, control and/or alternative intervention or treatment or exposureOutcomesEmotional regulation, stress reduction, mental health improvementStudy design:Cross-sectional, experimental, quasi-experimentalQuality and BiasThe Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional StudiesGeneral NoteFundings: The author(s) declare that no financial support was received for the research, authorship, 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 apotential conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 76 75Nature activities and wellbeing in children and young people: a systematic literature reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Contact with nature helps to restore depleted ability to concentrate and impacts on stress reduction. Some children may experience natureas threatening, leading to feelings of anxiety. Reconnecting to the natural world can alleviate symptoms of anxiety and depression.Roberts, A., et al. (2020)IdentificationFirst Author’s Name: Anna RobertsYear: 2020Place: UKDate of the search: March 2018.Objective: To identify the effects of experiences of nature in childhood on wellbeing and provide a summary of the empirical research over the last 40 years.Email of the Corresponding Author: drannaroberts@gmail.comDOI: 10.1080/14729679.2019.1660195Participants/ PopulationType: Children and young people.Setting: Various natural environments including school gardens, woodlands, and wilderness areas.Age: Up to 21 years oldGender: Both male and femaleInterventionNature activities including a variety of natural environments, including forest and woodlands, parks and gardens and areas of greenspace (defined as being comprisedof vegetation and associated with natural elements.Comparison / CompetitorNon-exposure, control and /or alternative exposureOutcomesWellbeing outcomes including self-esteem, confidence, positive and negative affect, stress reduction, social benefits, and resilienceStudy design:Quantitative (pretest-posttest, randomized controlled trial) and qualitative (interviews, case studies)Quality and BiasThe Effective Public Health Practice Project (EPHPP, 2010) quality assessment tool and the Qualitative studies were appraised using the critical appraisal templatefrom the Critical Appraisal Skills Program (CASP, 2017).General NoteFundings: The research was funded by the UK National Health Service (NHS).Conflict of interest: No potential conflict of interest was reported by the authors.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 77 76The effect of short-term exposure to the natural environment on depressive mood: A systematic review and meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: A small effect was found for reduction in depressive mood following exposure to the natural environment. The quality of evidence wasrated very low to low. The high risk of bias and low quality of studies limits confidence in the results.Roberts, H., et al. (2019)IdentificationFirst Author’s Name: Hannah RobertsYear: 2019Place: NetherlandsDate of the search: March 2018.Objective: To conduct a comprehensive systematic review and meta-analysis of the evidence for the effect of short-term exposure to the natural environment ondepressive mood.Email of the Corresponding Author: h.e.roberts@uu.nlDOI: 10.1016/j.envres.2019.108606Participants/ PopulationType: Any human adult populationSetting: Natural environment vs. built environmentAge: Not specifiedGender: Not specifiedInterventionExposure to the natural environmentComparison / CompetitorExposure to the built environmentOutcomesDepressive moodStudy design:Randomized crossover, non-randomized crossover, parallel groups, factorial design, single-group crossoverQuality and BiasThe Cochrane Risk of Bias (ROB) Tool 1.0 and (ROBINS-I) tool were used. Quality of evidence was assessed using the Grading of Recommendations Assessment,Development, and Evaluation (GRADE) guidelines (GRADE).General NoteFundings: This project has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program(grant agreement No. 714993).Conflict of interest: The authors have no conflict of interest to declare.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 78 77Why a new research agenda on green spaces and health is needed in Latin America: Results of a systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found associations between green spaces and improved mental health outcomes, including reduced non-psychotic mentaldisorders and improved cognitive functions. However, some studies did not find significant associations.Rojas-Rueda, D., et al. (2021)IdentificationFirst Author’s Name: David Rojas-RuedaYear: 2021Place: USADate of the search: September 2020.Objective: This study aimed to review the epidemiological evidence on green spaces and health outcomes in Latin America.Email of the Corresponding Author: david.rojas@colostate.eduDOI: 10.3390/ijerph18115839Participants/ PopulationType: Various populations across Latin America, including adults, older adults, children, and the whole population.Setting: Urban environments in Latin America.Age: Ranges from children to older adultsGender: Both males and femalesInterventionExposure to green spaces as the physical environment, such as nature, vegetation, parks, and green areas.Comparison / CompetitorNon-exposed or alternative exposure.OutcomesHealth outcomes were defined as morbidity, mortality, life expectancy, and quality of life.Study design:Cross-sectional studies, ecological studies, and cohort studies.Quality and BiasNational Institutes of Health (NIH) Quality Assessment tool for Observational Cohort and Cross-Sectional Studies.General NoteFundings: The present work was funded by Pan American Health Organization under the project “Green spaces and health as a climate mitigation strategy for LatinAmerica.Conflict of interest: There are no competing financial interests. Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarilyreflect the opinion or policy of PAHO.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 79 78Forest therapy can prevent and treat depression: Evidence from meta-analysesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest therapy significantly reduces depressive symptoms, with participants in forest therapy being 17 times more likely to achieveremission compared to no intervention/usual care.Rosa, C. D., et al. (2021)IdentificationFirst Author’s Name: Claudio D. RosaYear: 2021Place: BrazilDate of the search: April 2021.Objective: To provide a comprehensive summary of the effect of forest therapy on depression.Email of the Corresponding Author: claudio2008ilheus@hotmail.comDOI: 10.1016/j.ufug.2020.126943Participants/ PopulationType: Humans, healthy or notSetting: Forest environmentsAge: Most participants were older than 39 years oldGender: BothInterventionForest therapy involving a combination of forest-based activitiesComparison / CompetitorNo intervention/usual care, similar activities in a hospital or urban area, diet plus forest-based exercise, walking in a forest.OutcomesChanges in depressive symptoms, remission, response to treatment, adherence to treatment, adverse effectsStudy designRandomized controlled trials (RCTs), cross-over trials, non-randomized controlled trials (NRCTs)Quality and/or BiasROBIS, RoB 2, ROBINS-IGeneral NoteFundings: This manuscript was partially supported by the Spanish Ministry of Science, Education and Universities (PGC2018-095502-B-I00).Conflict of interest: The authors report no declarations of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 80 79The Effect of Nature-Based Adventure Interventions on Depression: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: NBA interventions generally showed a reduction in depressive symptoms, with mountain-based and surfing interventions being particularlyeffective. However, the effects were highly variable, and some studies reported increases in depressive symptoms.Rosa, C. D., et al. (2023)IdentificationFirst Author’s Name: Claudio D. RosaYear: 2023Place: BrazilDate of the search: April 2021.Objective: To synthesize evidence of the effect of nature-based adventure (NBA) interventions on depressive symptoms. What is the effect of NBA interventions ondepressive symptoms as compared to alternative interventions (or no intervention)?Email of the Corresponding Author: claudio2008ilheus@hotmail.comDOI: 10.1177/00139165231174615Participants/ PopulationType: General populationSetting: Various natural settings including mountains, beaches, and forestsAge: All ages, including children, adolescents, adults, and older adultsGender: Both genders includedInterventionNature-based adventure activities such as hiking, camping, surfing, rock climbing, and skiingComparison / CompetitorNo intervention, waiting list, usual care, non-adventure leisure activities, and other NBA interventionsOutcomesChanges in depressive symptoms, patient adherence, and adverse eventsStudy designRandomized studies, non-randomized controlled trials (NRCTs), and one-group studies.Quality and/or BiasROBINS-I and RoB 2 toolGeneral NoteFundings: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was partiallyfunded by the Spanish Ministry of Science, Education and Universities (PGC2018-095502-B-I00) and by the Coordenação de Aperfeiçoamento de Pessoal de NívelSuperior—Brazil (CAPES)—Finance Code 001.Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)N16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 81 80A Systematic Review of Mechanisms Underpinning Psychological Change Following Nature Exposure in an Adolescent PopulationNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest environments significantly reduces stress levels, as evidenced by lower diastolic blood pressure and heart rate. Nature exposureleads to decreased anxiety and depression, with significant reductions in tension, anxiety, and negative affect, and increases in positive affect and vitality.Rowley, M., et al. (2022)IdentificationFirst Author’s Name: Megan RowleyYear: 2022Place: UKDate of the search: September 2021.Objective: The aim of the current review was to identify any mechanisms of psychological change following exposure to nature within an adolescent population.Email of the Corresponding Author: m.rowley@hotmail.co.ukDOI: 10.3390/ijerph191912649Participants/ PopulationType: Adolescents with an average age of twenty-four and under.Setting: Various natural environmentsAge: 10-24 yearsGender: MixedInterventionExposure to all types of natureComparison / CompetitorControl groups with no nature exposure or different types of environmentsOutcomesPsychological outcomes such as mood, mental health, wellbeing, perceived restoration, stress, energy, cognitive functioning, resilience, self-concept, and pro-socialbehavior.Study designExperimental or quasi-experimentalQuality and/or BiasThe Effective Public Health Practice Project (EPHPP) quality assessment toolGeneral NoteFundings: This research received no external funding.Conflict of interest: The authors declare no conflict of interestQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 82 81Well-Being Benefits of Horticulture-Based Activities for Community Dwelling People with Dementia: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Horticulture-based activities led to positive impacts on engagement, social interactions, and mental and physical well-being in peopleliving with dementia. However, no conclusive evidence was found for improvement in cognitive function.Scott, T. L., et al. (2022)IdentificationFirst Author’s Name: Theresa L. ScottYear: 2022Place: AustraliaDate of the search: June 2022.Objective: To synthesize evidence on the health and well-being benefits of horticulture-based activities for community-dwelling people with dementia.Email of the Corresponding Author:DOI: 10.3390/ijerph1917105233Participants/ PopulationType: People living with dementia in the community.Setting: Community settings.Age: Not specified (age open).Gender: Not specifiedInterventionHorticulture-based activitiesComparison / CompetitorAlternative activitiesOutcomesEngagement, social interactions, mental and physical well-being, cognitive functionStudy designMixed methods, CRT, case study, quasi-experimentalQuality and/or BiasThe Mixed Methods Appraisal Tool (MMAT) version 2018.General NoteFundings: This research received no external fundingConflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 83 82Effects of nature-based programs for workers in Korea: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-based programs significantly reduced job stress. Programs showed improvement in anxiety levels. Significant reduction indepression was observed.Shin, J. Y. and W. S. Shin (2020)IdentificationFirst Author’s Name: Jong-Yeon ShinYear: 2020Place: KoreaDate of the search: March 2019.Objective: The aim of this study was to review previous literature to determine the effects of nature-based programs for workers.Email of the Corresponding Author: shinwon@chungbuk.ac.krDOI: 10.11628/ksppe.2020.23.2.125Participants/ PopulationType: Full-time workersSetting: Workplace and communityAge: Not specifiedGender: Not specifiedInterventionNature-based programs (forest therapy, horticultural therapy)Comparison / CompetitorWorkers who maintained daily life without participating in nature-based programs.OutcomesMental health including stress, depression, serum cortisol, and stress-response.Study designRandomized controlled trials (RCTs), non-randomized controlled trials (N-RCTs), and one-group pretest-posttest designs.Quality and/or BiasUsing the Cochrane Risk of Bias (RoB) tool for RCTs and the Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies (RoBANS)General NoteFundings: Not reportedConflict of interest: Not reportedQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) NOverall confidence: Low ### Page 84 83Effect of nature exposure on perceived and physiologic stress: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: While most studies showed positive effects, one study did not find a significant decrease in self-reported stress with increased access togreen space, highlighting some variability in the results.Shuda, Q., et al. (2020)IdentificationFirst Author’s Name: Quincy ShudaYear: 2020Place: USADate of the search: November 2019.Objective: to evaluate the effect nature exposure has on stress as measured by physiological markers and self-reports.Email of the Corresponding Author: rkass@usf.eduDOI: 10.1016/j.ctim.2020.102514Participants/ PopulationType: Male and female volunteers exposed to nature interventionsSetting: Various natural environmentsAge: Not specifiedGender: Both male and femaleInterventionNature exposureComparison / CompetitorControl or alternative exposureOutcomesPerceived stress and physiologic stress markersStudy designRandomized control trials and cross-sectionalQuality and BiasCochrane risk of bias tool for randomized control trials.General NoteFundings: The authors report no external funding source for this study.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)P10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 85 84The effects of forest bathing on psychological well-being: A systematic review and meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest bathing significantly reduces symptoms of depression and anxiety but shows fewer benefits for physiological outcomes. Significantreductions in depression and anxiety were observed.Siah, C. J. R., et al. (2023)IdentificationFirst Author’s Name: Chiew Jiat Rosalind SiahYear: 2023Place: SingaporeDate of the search: March 2021.Objective: To evaluate the effects of forest bathing on psychological and physiological outcomes.Email of the Corresponding Author: nurgys@nus.edu.sgDOI: 10.1111/inm.13131Participants/ PopulationType: Adults older than or equal to 18 years, excluding those diagnosed with psychological conditions or cognitive impairment.Setting: Various settings including universities, community health centers, and hospitals.Age: Mean age ranged from 21.7 to 70.6 years.Gender: Both genders included, with percentages ranging from 0% to 100%.InterventionAny type of activities conducted physically in the forest or natural settingsComparison / CompetitorControl groups that either did not receive any intervention or received the same activity in an urban setting.OutcomesThe primary outcomes explored in this review were psychological, including anxiety, depression, mood and quality of life. The secondary outcomes were physiologicaloutcomes such as blood pressure and heart rate.Study designRandomized controlled trials, cluster-randomized trials, crossover trials, and quasi-experimental studies.Quality and BiasJBI Critical Appraisal Checklist for randomized controlled trials and quasi-experimental studies.General NoteFundings: Community Foundation of Singapore: Mind the Gap 200 – Mental Health FundConflict of interest: None declared by the authorsQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 86 85Nature and human well-being: a systematic review of empirical evidence from nature-based interventionsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-based interventions significantly reduce perceived stress levels. Positive impacts on reducing anxiety symptoms. Improvementsin mood states and reductions in depressive symptoms.Silva, A., et al. (2023)IdentificationFirst Author’s Name: Ana SilvaYear: 2023Place: PortugalDate of the search: July 2020.Objective: we conducted a systematic review in order to i) collate and synthesize available evidence regarding the effects of direct outdoor interaction with nature onhuman overall well-being (physical, psychological, social); ii) analyze procedures, identifying methodological strengths and weaknesses; iii) identify relevantrecommendations for future research and nature-based interventions.Email of the Corresponding Author: marianagoncalves@psi.uminho.ptDOI: 10.1080/09640568.2023.2227761Participants/ PopulationType: Various, including university students, general population, children, adolescents, elderly, and specific groups like military veterans and domestic violencevictims.Setting: Various natural placesAge: Ranges from children to elderly.Gender: Both male and female participants.InterventionNature-based interventions (NBIs) involving direct contact with nature, such as walking, hiking, gardening, and viewing wildlife.Comparison / CompetitorControl and/or alternative interventionsOutcomesMental health, mood states, perceived levels of stress, physiological (e.g., physiological stress, neurocognitive function).Study designExperimental, quasi experimental, surveys, mixed methods, qualitativeQuality and/or BiasWe structured an 8-item checklist (Table 4) based on the quality assessment tools applied by Hanson and Jones (2015), Lachowycz and Jones (2011), and Thomas etal. (2004).General NoteFundings: This study was partially conducted at the Psychology Research Centre (CIPsi), School of Psychology, University of Minho, supported by the Foundationfor Science and Technology (FCT) through the Portuguese State Budget (Ref.: UIDB/PSI/01662/2020)Conflict of interest: No potential conflict of interest was reported by the authors.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 87 86Urban blue spaces and human health: A systematic review and meta-analysis of quantitative studiesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Living closer to urban blue spaces is associated with higher self-reported mental health and wellbeing, lower reports of depressivesymptoms and anxiety, and fewer depressive symptoms in older adults.Smith, N., et al. (2021)IdentificationFirst Author’s Name: Niamh SmithYear: 2021Place: UKDate of the search: August 2019.Objective: to systematically review the evidence for the relationship between blue space and health and quantify this relationship specifically in urban environments.Email of the Corresponding Author: niamh.smith@gcu.ac.ukDOI: 10.1016/j.cities.2021.1034134Participants/ PopulationType: Various populations across different studies, including adults, older adults, children, and young people.Setting: Urban environmentsAge: Ranges from children to older adultsGender: Not specifiedInterventionExposure to urban blue spaces (e.g., coasts, rivers, lakes, canals, ponds, fountains).Comparison / CompetitorDistance to blue space or presence of blue space vs. no exposure.OutcomesPhysical health (e.g., obesity, mortality), mental health (e.g., self-reported mental health and wellbeing, depressive symptoms, anxiety)Study designCross-sectional studies, longitudinal studies, prospective studies, randomized controlled trials, cross-over trials, natural experiments, quasi-experimental studies.Quality and/or BiasThe quality assessment tool designed by Gascon et al. (2017) specifically to assess research on blue spaces and health.General NoteFundings: This work was funded by Scottish Canals and Glasgow Caledonian University.Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the workreported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 88 87Restorative Effects from Green Exposure: A Systematic Review and Meta-Analysis of Randomized Control TrialsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Green space exposure significantly reduced stress levels, as indicated by lower HR and In LF/HF levels. Exposure to green spacesignificantly reduced anxiety, with large effect sizes for reducing tension and confusion. Green space exposure had a moderate effect on reducing depression, though notstatistically significant.Song, S., et al. (2022)IdentificationFirst Author’s Name: Song SongYear: 2022Place: ChinaDate of the search: January 2022.Objective: To determine the intensity of the effects of direct green space exposure on restorative indices of physical and mental health.Email of the Corresponding Author: yqxiao@scut.edu.cnDOI: 10.3390/ijerph192114506Participants/ PopulationType: General populationSetting: Public green spacesAge: 19–48 yearsGender: Mixed gender, with some studies all-female, all-male, or not specifying gender.InterventionExposure to green space and activities such as walking, viewing, and cycling.Comparison / CompetitorNon-green space exposure or normal daily life activities.OutcomesThe restorative benefits (physical or psychological)Study designRandomized Controlled Trials (RCTs)Quality and/or BiasThe Cochrane Risk of Bias Assessment Tool (RoB) 2.0.General NoteFundings: This research was funded by Fundamental Research Funds for the Central Universities (QNMS202212), National Natural Science Foundation of China(No. 52078214) and Guangdong Basic and Applied Basic Research Foundation (No. 2019A1515011831).Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 89 88Stress Regulation via Being in Nature and Social Support in Adults, a Meta-analysis.Note. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Being in nature significantly reduces stress (Hedges’ g = -0.60 after bias correction). Emotional social support initially showed an effect,but it disappeared after correcting for publication bias.Sparacio, A., et al. (2023)IdentificationFirst Author’s Name: Alessandro SparacioYear: 2023Place: CzechDate of the search: 2022Objective: To investigated whether being in nature and emotional social support are reliable strategies to downregulate stress.Email of the Corresponding Author: ale.sparacio92@gmail.comDOI: 10.1525/collabra.77343Participants/ PopulationType: General Adults populationSetting: Natural environments and social support contextsAge: Mean age 31.70 years.Gender: Both male and femaleInterventionBeing in nature (nature walking, nature viewing, mixed)Comparison / CompetitorUrban environment or passive control for being in nature; active or passive control for emotional social supportOutcomesStress reduction, affective, cognitive, and physiological components of stress.Study designRandomized control trials and observational studies.Quality and BiasCochrane risk of bias tool for randomized trials (RoB 2)General NoteFundings: The preparation of this work was partly funded by a French National Research Agency “Investissements d’avenir” program grant (ANR-15-IDEX-02) anda grant from the MIBODA project both awarded to Hans IJzerman; PRIMUS/20/HUM/009, APVV-17-0418, and NPO Systemic Risk Institute (LX22NPO5101 fundedby European Union – Next Generation EU) grants awarded to Ivan Ropovik. The preparation of this work was also funded by Swansea University Strategic PartnershipsResearch Scholarships (SUS- PRS) in 2019, awarded to Dr Gabriela Jiga-Boy from School of Psychology, Swansea University. The funding sources had no role inthe study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. It covered funding for ajoint PhD degree awarded by Swansea University (UK) and Universite Grenoble Alpes (France).Conflict of interest: We have no competing interest to declare.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 90 89Nature-based interventions for physical health conditions: A systematic review and meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found positive effects of nature exposure on mental health, including reductions in depression, anxiety, and stress.Struthers, N. A., et al. (2024)IdentificationFirst Author’s Name: Nicole A. StruthersYear: 2024Place: CanadaDate of the search: June 2024.Objective: To identify and synthesize the evidence of the effect of nature-based interventions (NBIs) on physical health outcomes and biomarkers of physical healthconditions.Email of the Corresponding Author: nstruth2@uwo.caDOI: 10.1016/j.envres.2024.119421Participants/ PopulationType: Human participants with physical health conditionsSetting: Various natural settings such as greenspaces.Age: Average age across all studies is 54 years.Gender: 56% of participants were female.InterventionOutdoor, NBIs instructed by a health provider (e.g., physicians, physical therapists) or researcher.Comparison / CompetitorAny comparison including no intervention, other outdoor NBIs, indoor NBIs, or an intervention taking place in a non-nature-based settingOutcomesPhysical health outcomes and biomarkers related to physical health conditions.Study designRandomized controlled trials (RCTs).Quality and/or BiasCochrane Collaboration’s Risk of Bias 2 (RoB 2) tool.General NoteFundings: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the workreported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 91 90The effects of forest bathing on self-criticism, self-compassion, and self-protection: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest bathing can reduce stress, anxiety, and depression, and improve well-being and self-compassion. However, the methodologicalquality of the included studies was generally low, with small sample sizes and lack of control groups. More rigorous research is needed to confirm these findings.Szitás, D., et al. (2024)IdentificationFirst Author’s Name: Dagmar SzitásYear: 2024Place: SlovakiaDate of the search: December 2022.Objective: To synthesize evidence for the effects of forest bathing on transdiagnostic cognitive psychological processes, specifically negative and positive innerdialogues within self in terms of self-criticism or self-compassion/self-protection.Email of the Corresponding Author: julia.halamova@gmail.comDOI: 10.1016/j.jenvp.2024.1023724Participants/ PopulationType: Adults, university students, and adolescentsSetting: Natural setting or other forms of forest bathing.Age: 15 years or olderGender: Not specifiedInterventionForest bathingComparison / CompetitorControl/ and/or alternative interventionsOutcomesSelf-criticism, self-compassion, self-protection, rumination, well-being, anxiety, depression, positive affect, mindfulness, nature connectedness, body appreciation,blood pressure.Study designRandomized controlled trials (RCT), cross-sectional studies, quasi-experimental designs.Quality and/or BiasCochrane Collaboration’s guidelines and the GRADE framework.General NoteFundings: Writing this work was supported by the Vedecka´ grantova´ agentúraVEGA under Grant 1/0054/24Conflict of interest: The authors declare that they have no potential conflicts of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 92 91Influence of External Natural Environment Including Sunshine Exposure on Public Mental Health: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Exposure to sunlight, spending time in green spaces, and physical activity positively impact mental health, reducing depression, anxiety,and stress. Moderate physical activity in environments with sunlight or green spaces is particularly beneficial.Taniguchi, K., et al. (2022)IdentificationFirst Author’s Name: Keita TaniguchiYear: 2022Place: JapanDate of the search: December 2021.Objective: To comprehensively review the effects of external factors (such as sunlight and green spaces) and internal factors (such as physical activity and lifestyle)on mental health.Email of the Corresponding Author: yoshi-tms@keio.jpDOI: 10.3390/psychiatryint3010008Participants/ PopulationType: Human subjectsSetting: Various settings.Age: Participants ranged from adolescents to the elderly.Gender: Both males and females were included.InterventionExternal natural environment including sunshine exposureComparison / CompetitorNo intervention / usual care, non-nature-based intervention, control and or other interventionsOutcomesMental health including depression, anxiety, and stress states.Study designCross-sectional studies, longitudinal studies, cohort studies, case-control studies, intervention studies, crossover design, and clinical trials.Quality and/or BiasNot reportedGeneral NoteFundings: This research received no external fundingConflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 93 92Nature-Based Interventions for Psychological Wellbeing in Long-Term Conditions: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: NBIs have shown positive impacts on reducing stress, anxiety, and depression in people with LTCs. Forest therapy and horse-ridingtherapy were particularly effective in improving mood and reducing anxiety and depression.Taylor, E. M., et al. (2022)IdentificationFirst Author’s Name: Eleanor M. TaylorYear: 2022Place: UKDate of the search: January 2022.Objective: To systematically appraise published evidence of the application of nature-based interventions (NBIs) to address psychological wellbeing for those livingwith long-term conditions (LTCs).Email of the Corresponding Author: et200@leicester.ac.ukDOI: 10.3390/ijerph19063214Participants/ PopulationType: People with long-term physical health conditions limited to cardiovascular disease, stroke, lung and liver disease, type II diabetes, and chronic kidney disease.Setting: Various settings including forest sites, urban areas, and hospitals.Age: Mean ages range from 51.2 to 73.7 years.Gender: Both males and females, with some studies specifying gender and others not.InterventionNature-based interventions such as forest therapy, forest walking, and horse-riding therapy.Comparison / CompetitorTreatment as usual, urban environments or no comparison.OutcomesEvaluation of effectiveness, as measured by improvements in psychological wellbeing and/or quality of life (QoL) including mood, anxiety, depressionStudy designRandomized controlled trials (RCTs), cohort studies, and qualitative studies.Quality and/or BiasThe BestBETs quality assessment checklist for quantitative studies and the qualitative study was assessed using a guide for reading qualitative studies presented bySandelowski and Barroso.General NoteFundings: A.C.S. and C.J.L. are grateful for research funding from the Stoneygate Trust. This report is independent research supported by the National Institute forHealth Research (NIHR) Leicester Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the Stoneygate Trust,National Health Service, NIHR or the Department of Health. This research has received no other external funding.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 94 93Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activityindoors? A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Outdoor exercise was associated with decreased tension, confusion, anger, and depression, and increased energy and positive engagement.However, feelings of calmness may be decreased following outdoor exercise.Thompson Coon, J., et al. (2011)IdentificationFirst Author’s Name: J. Thompson CoonYear: 2011Place: UKDate of the search: June 2010.Objective: To compare the effects on mental and physical wellbeing, health-related quality of life, and long-term adherence to physical activity, of participation inphysical activity in natural environments compared with physical activity indoors.Email of the Corresponding Author: jo.thompson-coon@pms.ac.uk.DOI: 10.1021/es102947tParticipants/ PopulationType: General adult populationSetting: Various settings including university campuses, sidewalks, forests, and country parks.Age: Mean age of participants was 25.22 years.Gender: Slightly more women (61%) than men.InterventionPhysical activity in natural environments.Comparison / CompetitorPhysical activity indoors.OutcomesMental wellbeing, attitude to exercise, enjoyment, and intent to repeat the activity, stress, anxiety and depression.Study designRandomized controlled trials, Nonrandomized comparative trials, SurveyQuality and/or BiasNot reportedGeneral NoteFundings: This systematic review was funded by the National Institute for Health Research through Peninsula CLAHRC.Conflict of interest: There was no competing interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no)15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 95 94Mental health benefits of interactions with nature in children and teenagers: a systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Interacting with nature is significantly positively associated with reduced stress. Most findings were non-significant with regard todepression.Tillmann, S., et al. (2018)IdentificationFirst Author’s Name: Suzanne TillmannYear: 2018Place: CanadaDate of the search: March 2017.Objective: This review focuses on how accessibility to, exposure to and engagement with nature affects the mental health of children and teenagers.Email of the Corresponding Author: jgillila@uwo.caDOI: 10.1136/ jech-2018-210436Participants/ PopulationType: Children and teenagersSetting: Various settings including green spaces, parks, and wilderness therapy programs.Age: Children and teenagers (0–18 years).Gender: Both male and femaleInterventionExposure to some elements of natureComparison / CompetitorControl or alternative interventionOutcomesMental health and emotional well-being, ADD/ADHD, overall mental health, self-esteem, stress, resilience, depression, and health-related quality of life.Study designCross-sectional, intervention, quasi-empirical, longitudinal, exploratory, pre-post experimental, single blind control trial, counterbalanced randomized cross-over.Quality and BiasNational Institutes of Health (NIH) Quality Assessment Tools.General NoteFundings: This systematic review was made possible through funding from The Lawson Foundation. ST and DT received trainee support from the Children’s HealthResearch Institute through funding from the Children’s Health Foundation.Conflict of interest: None declared.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)NA10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Moderate ### Page 96 95The Relationship Between Greenspace Exposure and Psychopathology Symptoms: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Greenspace exposure is associated with less severe symptoms of depression and anxiety. The relationship between greenspace and stressis not explicitly detailed.Tran, I., et al. (2022)IdentificationFirst Author’s Name: Ivy TranYear: 2022Place: USADate of the search: July 2020.Objective: To summarize and critically evaluate the literature on the relationship between greenspace exposure and psychopathology incidence and symptom severity,and to examine potential interactions between greenspace exposure and urban environmental features associated with poorer mental health.Email of the Corresponding Author: itran1@pride.hofstra.eduDOI: 10.1016/j.bpsgos.2022.01.004Participants/ PopulationType: Children and adultsSetting: Various locations with possibiblity to greenspace exposure.Age: Not specifiedGender: Not specifiedInterventionGreenspace exposure (objective and subjective assessments).Comparison / CompetitorUrban environmental features (e.g., pollution, population density)OutcomesPsychopathology symptoms including depression, anxiety and stressStudy designCross-sectional, longitudinal, and experimental studiesQuality and/or BiasNot reportedGeneral NoteFundings: From the Department of Psychology (IT), Hofstra University, Hempstead, New York; and the Department of Occupational Therapy (OS, JM), TuftsUniversity, Medford, Massachusetts.Conflict of interest: The authors report no biomedical financial interests or potential conflicts of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 97 96The Relationship Between Greenspace Exposure and Psychopathology Symptoms: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Four out of five studies reported significant improvements in mental health outcomes due to nature-based interventions, with effectsranging from small to medium. One study with psychosomatic patients did not find significant improvements.Trostrup, C., et al. (2019)IdentificationFirst Author’s Name: C. H. TrøstrupYear: 2019Place: DenmarkDate of the search: -Objective: To find the impact of nature interventions on mental well-being in humans with a physical disease.Email of the Corresponding Author: ct3@kp.dkDOI: 10.1007/s11136-019-02125-9Participants/ PopulationType: Adult patients diagnosed with a physical diseaseSetting: Various settings including hospitals and rehabilitation centers.Age: Not specifiedGender: The majority of participants were female.InterventionNature-based interventions on the mental well-being of patients who have been diagnosed with a physical diseaseComparison / CompetitorControl groups receive standard treatment or no nature-based intervention.OutcomesOutcome was self-reported mental well-being, broadly defined as a set of key constructs related to psychological functioning. We placed no restrictions on time fromdiagnosis to intervention participation and no limitations regarding the duration of the intervention.Study DesignRandomized controlled trials (RCTs) , quasi-experimental studies, evaluation studies.Quality and BiasThe Consort checklist for RCTs and the Joanna Briggs Institute and checklist for quasi-experimental studies.General NoteFundings: Not reportedConflict of interest: The authors declare that they have no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 98 97Health benefits of green spaces in the living environment: A systematic review of epidemiological studiesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found strong evidence for significant positive associations between the quantity of green space and perceived mental health,including stress, anxiety, and depression. Moderate evidence was found for perceived general health. The quality of green spaces showed inconclusive evidence due to alack of high-quality studies.van den Berg, M., et al. (2015)IdentificationFirst Author’s Name: Magdalena van den BergYear: 2015Place: NetherlandsDate of the search: October 2014.Objective: To systematically review the literature examining the relationship between the quantity and quality of green spaces in the living environment and threehealth outcomes: perceived general health, perceived mental health, and (all-cause) mortality.Email of the Corresponding Author: mm.vandenberg@vumc.nlDOI: 10.1016/j.ufug.2015.07.008Participants/ PopulationType: General adult populationSetting: Living environment (geographical area surrounding the place of residence).Age: Adults (specific age range not provided).Gender: Both male and femaleInterventionQuantity and quality of green spaces in the living environment.Comparison / CompetitorNon-exposed or less exposed to natureOutcomesPerceived general health, perceived mental health, and all-cause mortality.Study designObservational studies with either a cross-sectional or longitudinal design.Quality and/or BiasA methodological quality criteria list adapted from existing lists was used. It was developed for the quality assessment of observational studies (Ariëns, van, Bongers,Bouter & van der Wal, 2000; National Institute for Health and Clinical Excellence, 2006).General NoteFundings: his study was funded by the European Commission as part of the7th Framework project "Positive health effects of natural environment for human healthand well-being (PHENOTYPE)” (grant agreement no. 282996. We express our gratitude to René Otten, search specialist at the University Library of VU UniversityAmsterdam, for conducting the online literature search.Conflict of interest: Not reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) NOverall confidence: Low ### Page 99 98Nature in the indoor and outdoor study environment and secondary and tertiary education students’ well-being, academic outcomes, and possiblemediating pathways: A systematic review with recommendations for science and practiceNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found potentially promising leads on the associations between campus green space and improved quality of life, perceivedrestoration, and lower outdoor temperature. However, most studies had a high risk of bias, and no firm conclusions could be drawn.van den Bogerd, N., et al. (2020)IdentificationFirst Author’s Name: Nicole van den BogerdYear: 2020Place: The NetherlandsDate of the search: April 2020.Objective: To gather and assess scientific evidence on the effects of nature in the study environment on secondary and tertiary education students’ well-being, academicperformances, and outcomes related to the possible explanatory pathways of mitigation and restoration.Email of the Corresponding Author: n.vanden.bogerd@vu.nlDOI: 10.1016/j.healthplace.2020.102403Participants/ PopulationType: Secondary and tertiary education students.Setting: High schools, colleges, and universitiesAge: Minimal age of 12 years old.Gender: Not specifiedInterventionNature in the study environment (e.g., campus green space, indoor nature).Comparison / CompetitorNo or alternative interventions such as no exposure or less exposureOutcomesWell-being, academic performance, and outcomes related to mitigation and restorationStudy designExperimental and intervention studies and cross-sectional or cohort studies.Quality and/or BiasFor experimental and intervention studies, the Effective Public Health Practice Project (EPHPP) tool and for cross-sectional and cohort studies, the quality assessmenttool for observational cohort and cross-sectional studies of the National Heart, Lung, and Blood Institute were used.General NoteFundings: This study was funded by the Topsector Horticulture and Starting materials (KV-1604-050), with co-funding of the Triodos Foundation and RoyalFloraholland.Conflict of interest: The authors have no conflicts of interest to declare.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 100 99The impact of outdoor blue spaces on the health of the elderly: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found a positive correlation between outdoor blue spaces and the mental health of the elderly, including reduced stress, anxiety,and depression. However, the evidence is limited and lacks consistency.Wang, L. and N. Md Sani (2024)IdentificationFirst Author’s Name: Lixin WangYear: 2024Place: MalaysiaDate of the search: October 2023.Objective: To review the available evidence on outdoor blue spaces and health outcomes among older individuals and identify knowledge gaps.Email of the Corresponding Author: wanglixin2022@gmail.comDOI: 10.1016/j.healthplace.2023.103168Participants/ PopulationType: Elderly individualsSetting: Various locations with blue spacesAge: 50 years and overGender: Not specifiedInterventionExposure to outdoor blue spaces.Comparison / CompetitorNon-exposure or less exposure or alternative interventionsOutcomesGeneral health, physical health, mental health, and wellbeing.Study designQuantitative (longitudinal, cohort and cross-sectional) and qualitative studies.Quality and/or BiasThe quality assessment criteria developded by Gascon et al. (2017).General NoteFundings: Not reportedConflict of interest: Not reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) NOverall confidence: Critically Low ### Page 101 100Medical empirical research on forest bathing (Shinrin-yoku): A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest bathing activities significantly enhance emotional state, alleviate anxiety and depression, and improve physical and psychologicalrecovery. Randomized controlled trials showed higher methodological quality compared to non-randomized trials.Wen, Y., et al. (2019)IdentificationFirst Author’s Name: Ye WenYear: 2019Place: ChinaDate of the search: April 2019.Objective: To provide scientific guidance for the interdisciplinary integration of forestry and medicine by assessing the health efficacy of forest bathing on the humanbody and the methodological quality of individual studies.Email of the Corresponding Author: Jiujiuyl@163.com; Liuyq404@163.comDOI: 10.1186/s12199-019-0822-8Participants/ PopulationType: General human populationSetting: Forest environmentAge: Various, including young people aged 18-30 and middle-aged and elderly people over 45 years old.Gender: Both male and femaleInterventionForest bathing activities such as walking, meditation, yoga, Pilates, sightseeing, and crafts.Comparison / CompetitorUrban environment exposureOutcomesCardiovascular function, hemodynamic indexes, neuroendocrine indexes, immunity and inflammatory indexes, electrophysiological indexes, emotional state, physicaland psychological recovery, and alleviation of anxiety and depression.Study designRandomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs).Quality and/or BiasThe methodological quality was assessed using the Downs and Black checklist.General NoteFundings: This work was supported by funds from the National Natural Science Foundation of China (31660230).Conflict of interest: The authors declare that they have no competing interestsQuality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 102 101Psychological benefits of outdoor physical activity in natural versus urban environments: A systematic review and meta-analysis of experimental studiesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found that physical activity in natural environments generally led to greater reductions in anxiety and depression compared tourban environments. However, the results for stress were not explicitly detailed.Wicks, C., et al. (2022)IdentificationFirst Author’s Name: Claire WicksYear: 2022Place: UKDate of the search: September 2019.Objective: To compare the effects of physical activity undertaken in outdoor green natural environments versus outdoor urban environments on psychological healthoutcomes in adult general populations.Email of the Corresponding Author: cwicks@essex.ac.ukDOI: 10.1111/aphw.12353Participants/ PopulationType: Adults from non-clinical populations.Setting: Natural environments (e.g., forests, parks) and urban environments (e.g., commercial districts, residential streets)Age: Mean age ranged from 19 to 49.3 years.Gender: Mixed, with varying percentages of male and female participants across studies.InterventionPhysical activity in natural environments.Comparison / CompetitorPhysical activity in urban environments.OutcomesPsychological outcomes including anxiety, depression, anger/hostility, positive affect, positive engagement, energy/vigor/fatigue, tranquility, and calmness.Study designRandomized controlled trials, randomized trials, crossover trialsQuality and/or BiasRisk of bias was assessed using the Revised Cochrane risk-of-bias (RoB 2) tool for randomized trials and an adapted tool for crossover studies.General NoteFundings: This research was funded by a University of Essex PhD scholarship to the first author.Conflict of interest: Not reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)N16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 103 102The effects of neighbourhood green spaces on mental health of disadvantaged groups: a systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Neighborhood green space (GS) exposure significantly reduces stress levels in disadvantaged groups. The protective effect of GS onanxiety is less consistent but generally positive. GS exposure is associated with lower depression rates, particularly in low-SES populations.Xian, Z., et al. (2024)IdentificationFirst Author’s Name: Zheng XianYear: 2024Place: ChinaDate of the search: February 2023.Objective: To examine whether neighborhood green spaces (GS) can modify mental health associations in disadvantaged groups.Email of the Corresponding Author: kkunlliu@sdau.edu.cnDOI: 10.1057/s41599-024-02970-1Participants/ PopulationType: Disadvantaged groups, including those economically, racially, physically, psychologically, or functionally disadvantaged.Setting: Residential areas and surrounding greenery.Age: Various age groups including adults, pregnant women, older adults, children, and adolescents.Gender: Not specified.InterventionNeighborhood green spaces (GS) exposure.Comparison / CompetitorControl and/or alternative interventionsOutcomesMental health outcomes, including well-being, specific mental disorders, and overall mental distress.Study designQuantitative methods through observation or experimental design, Longitudinal studies, cross-sectional studies, quasi-experimental studies, and randomized trials.Quality and/or BiasNot reportedGeneral NoteFundings: Not reported.Conflict of interest: The authors declare no competing interests.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 104 103Urban Green Space and Subjective Well-Being of Older People: A Systematic Literature ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Urban green spaces can mitigate stress and reduce anxiety and depression among older people.Xu, T., et al. (2022)IdentificationFirst Author’s Name: Tianrong XuYear: 2022Place: MalaysiaDate of the search: August 2022.Objective: 1. Which characteristics of urban green spaces may influence older people’s subjective well-being? 2. Which sociodemographic characteristics haveimplications for older people’s access to subjective well-being and perceptions of urban green spaces?Email of the Corresponding Author: nikmatul@um.edu.myDOI: 10.3390/ijerph192114227Participants/ PopulationType: Older adultsSetting: Urban green spacesAge: 60 years and olderGender: Not specifiedInterventionCharacteristics of urban green spacesComparison / CompetitorNon-exposure or limited exposureOutcomesSubjective well-being of older peopleStudy designQuantitative research methods (surveys, questionnaires, regression analysis), qualitative research methods (bibliometric methods, case studies, interviews), and mixedapproach (social prescribing approach).Quality and/or BiasNot reportedGeneral NoteFundings: This research received no external fundingConflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 105 104Impact of Exposure to Natural and Built Environments on Positive and Negative Affect: A Systematic Review and Meta-AnalysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found that exposure to natural environments significantly increased positive affect and decreased negative affect, suggestingpotential benefits for stress, anxiety, and depression. However, the evidence quality was rated as “low” to “very low” due to high heterogeneity and potential bias.Yao, W., et al. (2021)IdentificationFirst Author’s Name: Wenfei YaoYear: 2021Place: ChinaDate of the search: Not reportedObjective: to quantify the effect of natural and built environments on positive and negative effects.Email of the Corresponding Author: chenfei3913@126.com, yaowenfei8345604@163.comDOI: 10.3389/fpubh.2021.758457Participants/ PopulationType: Any human adult population.Setting: Natural and built environments.Age: Typically young, with 13 studies recruiting college or university students.Gender: Mixed, with some studies focusing on specific genders.InterventionExposure to natural environments.Comparison / CompetitorExposure to built environments.OutcomesPositive and negative affect.Study designMixed factorial design, between-subject design, within-subject design and grade systemQuality and/or BiasRisk of bias tool by Twohig-Bennett and Jones, and Ogilvie et al.General NoteFundings: This work was funded by the National Natural Science Foundation of China (No.32001367) and Open Fund of innovation institute for Sustainable MaritimeArchitecture Research and Technology (iSMART), Qingdao University of Technology (No. C2020-037)Conflict of interest: WY: conceptualization, project administration, funding acquisition, and writing. WY, SW, and XZ: assessment and analysis. WY and FC: dataretrieval, curation, and methodology. All authors made substantial contributions to the study. All authors contributed to the article and approved the submitted version.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 106 105The effect of exposure to the natural environment on stress reduction: A meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Exposure to natural environments significantly reduces salivary cortisol, systolic and diastolic blood pressure, and heart rate variability,indicating lower stress levels. The meta-analysis found that natural exposure was associated with decreased state-of-anxiety and self-reported stress, although the resultsfor anxiety were not statistically significant.Yao, W. F., et al. (2021) BIdentificationFirst Author’s Name: Wenfei YaoYear: 2021Place: ChinaDate of the search: March 2020.Objective: To provide a synthesis of the current research on the effect of exposure to the natural environment directly on stress reduction and to evaluate the qualityof the evidence available.Email of the Corresponding Author: chenfei3913@126.com, yaowenfei8345604@163.comDOI: 10.1016/j.ufug.2020.126932Participants/ PopulationType: General human populationSetting: Natural environment vs. built/urban environmentAge: No specific age restrictionsGender: Both male and female participants included.InterventionExposure to the natural environmentComparison / CompetitorExposure to the built/urban environmentOutcomesStress reduction measured quantitatively through physiological and psychological indicators.Study designRandomized crossover studies, non-randomized crossover studies, randomized parallel group studies, 2 × 2 factorial design, single-group crossover design.Quality and/or BiasRandomized studies: Cochrane Risk of Bias (ROB) Tool 1.0 , non-randomized studies: Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) toolGeneral NoteFundings: The authors report no declarations of interest.Conflict of interest: This work was funded by the National Natural Science Foundation of China (No. 32001367) and Philosophical and Social Science Program ofQingdao, China (No. QDSKL2001230).Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 107 106Greenspace and health outcomes in children and adolescents: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Most studies observed a statistically significant association between greenspace exposure and mental health outcomes, including reducedstress, anxiety, and depression. Greenspace may reduce harms from environmental hazards, promote physical activities and social cohesion, and afford restorativeexperiences and stress reduction.Ye, T., et al. (2022)IdentificationFirst Author’s Name: Tingting YeYear: 2022Place: AustraliaDate of the search: April 2022.Objective: To summarize the measurements of greenspace, compile the evidence of an association between exposure to greenspace and a wide range of early onsethealth outcomes in childhood and adolescence, and explore the research gaps on how greenspace affects human health at this early stage of life.Email of the Corresponding Author: shanshan.li@monash.eduDOI: 10.1016/j.envpol.2022.1201933Participants/ PopulationType: Children and adolescentsSetting: Various places, predominantly in highly urbanized regions.Age: ≤19 yearsGender: Both boys and girls, with some studies focusing only on boys.InterventionExposure to greenspaceComparison / CompetitorNon-exposure or less exposure.OutcomesVarious health outcomes including stress anxiety and depressionStudy designCross-sectional, Cohort, Case-control, EcologicalQuality and/or BiasRisk of bias was assessed using the Navigation Guide framework for systematic reviews of observational studies in environmental health.General NoteFundings: This study was supported by the Australian Research Council (DP210102076) and the Australian National Health and Medical Research Council(GNT2000581); YG by Career Development Fellowship (GNT1163693) and Leader Fellowship (GNT2008813) of the Australian National Health and MedicalResearch Council; SL by an Emerging Leader Fellowship of the Australian National Health and Medical Research Council (GNT2009866); TY, PY, BW, and WHby China Scholarship Council funds (#201906320051 for TY, #201906210065 for PY, #202006010043 for WB, #202006380055 for WH); ZY by Monash GraduateScholarship and Monash International Tuition Scholarship. We thank Dr. Amanda Johnson for assistance with proofreading the manuscript.Conflict of interest: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Michael J. Abramson reports financial support was provided by Pfizer, Boehringer-Ingelheim, Sanofi and GSK.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 108 107A systematic review of the relationship between natural environments and physiological and mental health during different stages of the COVID-19 pandemicNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Visiting natural environments reduced stress levels. Increased interaction with nature decreased anxiety. High-quality window views andprivate green spaces were associated with reduced depression.Yen, M. H., et al. (2024)IdentificationFirst Author’s Name: Min-Hsuan YenYear: 2024Place: TaiwanDate of the search: March 2023.Objective: To investigate the effects of natural environments on individuals’ physiological and mental health during various stages of the COVID-19 pandemic andidentify factors that mediated these effects.Email of the Corresponding Author: ycchiang@mail.ncyu.edu.twDOI: 10.1016/j.scitotenv.2024.171392Participants/ PopulationType: Individuals during different stages of the COVID-19 pandemic.Setting: Various natural environments including public green spaces, private green spaces, and coastal areas.Age: Not specifiedGender: Not specifiedInterventionInteraction with natural environments during various stages of the COVID-19 pandemic.Comparison / CompetitorLess interaction or no nitration with natureOutcomesWell-being including stress, depression, and anxietyTypes of Study Design Included: ThStudy designDifferent qualitative and quantitative designsQuality and/or BiasThe checklists of the Critical Appraisal Skills Program (CASP) were used to evaluate the rigorousness of the methodology adopted in each article.General NoteFundings: ……Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influencethe work reported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 109 108Indoor nature interventions for health and wellbeing of older adults in residential settings: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Indoor nature interventions showed inconsistent evidence for reducing stress, anxiety, and depression. Some higher-quality studies foundsignificant improvements, while others did not.Yeo, N. L., et al. (2020)IdentificationFirst Author’s Name: Nicola L. YeoYear: 2020Place: UKDate of the search: September 2018.Objective: To synthesize the health impacts of indoor nature exposure for older people in residential settings.Email of the Corresponding Author: ny240@exeter.ac.ukDOI: 10.1093/geront/gnz019Participants/ PopulationType: Adults aged 60+ living in residential settingsSetting: Residential settings including nursing homes, dementia units, and assisted living facilities.Age: 60+ years.Gender: Predominantly female (69%).InterventionIndoor gardening, horticulture programs, indoor gardens, plants, nature.Comparison / CompetitorNon-nature interventions (e.g., music groups, receiving visitors) or no-intervention controlsOutcomesHealth and wellbeing outcomes including cognition, psychological wellbeing, social outcomes, and life satisfactionStudy designRandomized controlled trials (RCT), cluster RCT, controlled clinical trials (CCT), crossover studies, and one-group pre/post studies.Quality and/or BiasThe Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies was used.General NoteFundings: This work was supported by The College of Medicine and Health, University of Exeter (which is currently funding the first author’s PhD); The BlueHealthproject which received funding from the European Union’s Horizon 2020 Research and Innovation Program under grant agreement no. 666773; and The NationalInstitute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHSFoundation Trust. Views expressed are those of the authors and not necessarily those of the University of Exeter, European Union, NHS, the NIHR, or the Departmentof Health.Conflict of interest: None reported.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 110 109Does Forest Therapy Have Physio-Psychological Benefits? A Systematic Review and Meta-Analysis of Randomized Controlled TrialsNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest therapy significantly reduces depression. However, the effect size was not significant for improving systolic and diastolic bloodpressure. The studies included in the meta-analysis were heterogeneous, particularly in the application of forest therapy, which limits the generalizability of the results.Yi, Y., et al. (2022)IdentificationFirst Author’s Name: Yunjeong YiYear: 2022Place: KoreaDate of the search: August 2021.Objective: To determine how forest therapy affects the physiological and psychological health of adults.Email of the Corresponding Author: jyan030@kiwu.ac.krDOI: 10.3390/ijerph191710512Participants/ PopulationType: Adults aged 19 or older who had previously participated in forest therapy.Setting: Forest environmentsAge: Adults (19 or older)Gender: Both male and femaleInterventionForest therapy, including walking in the forest, sensory experiences, meditation, yoga, and group activities.Comparison / CompetitorWalking or resting outside the forest, or without any intervention.OutcomesIndicators of physiological responses (e.g., blood pressure) and psychological responses (e.g., depression).Study designRandomized experimental studies.Quality and/or BiasQuality was assessed using the Cochrane risk of bias tool, and evidence quality was evaluated using the GRADE method.General NoteFundings: This research was funded by the Korea Forestry Promotion Institute, grant number 2021385A00-2123-0101.Conflict of interest: : The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data;in the writing of the manuscript; or in the decision to publish the results.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 111 110Health-promoting nature access for people with mobility impairments: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Nature-related activities help reduce stress. Participants experienced better mood and relaxation. Improved self-esteem and self-confidencewere noted.Zhang, G., et al. (2017)IdentificationFirst Author’s Name: Gaochao ZhangYear: 2017Place: DenmarkDate of the search: Not explicitly mentioned.Objective: To systematically evaluate the scientific evidence for health benefits of the use and design of natural environments for people with mobility impairments.Email of the Corresponding Author: gazh@ign.ku.dkDOI: 10.3390/ijerph14070703Participants/ PopulationType: Individuals of all ages with mobility impairmentsSetting: Various kinds of nature where natural elements are more prevalent than man-built featuresAge: All agesGender: Not specifiedInterventionNature-related activities and interventions and exposure to natureComparison / CompetitorAlternative and/or control intervention or no interventionOutcomesHealth impacts measured objectively or subjectively, including physical, mental, and social health benefitsStudy designQuantitative studies, qualitative studies, mixed methods studies (Cross-Sectional, Cohort Studies, Case-Control Studies, Randomized Controlled Trials (RCTs),Phenomenology, QUAN/Descriptive study)Quality and/or BiasEvaluated using the Mixed Methods Appraisal Tool (MMAT).General NoteFundings: This work has been supported by research grants from the Danish Nature Agency, Ministry of Environment and Food of Denmark (grant number NST-843.00021), the Bevica Foundation (grant number 2015-7018), 15. Juni Fonden (grant number 2015-A-66) and the Danish Outdoor Council (grant number 104052)and the first author has received financial support from the Chinese Scholarship Council.Conflict of interest: The authors declare no conflict of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretationof data; in the writing of the manuscript, and in the decision to publish the results.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) N6. Did the review authors perform data extraction in duplicate? (yes/no) N7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no)9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 112 111The pathways linking objectively-measured greenspace exposure and mental health: A systematic review of observational studiesNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Mixed evidence for the mediating role of perceived stress on the pathway from greenspace exposure to mental illness. Greenspace exposurehas a direct effect on reducing mental illness, including anxiety and depression, after adjusting for mediators.Zhang, R., et al. (2021)IdentificationFirst Author’s Name: Ru ZhangYear: 2021Place: ChinaDate of the search: March 2020.Objective: To synthesize current evidence on the pathways linking objectively measured greenspace exposure and mental health using a systematic review approach.Email of the Corresponding Author: ruzhang@m.scnu.edu.cnDOI: 10.1016/j.envres.2021.111233Participants/ PopulationType: General populationSetting: Various natural settingsAge: Ranges from teens to older adults, with specific studies focusing on different age groups.Gender: Both males and females, with some studies specifically focusing on females.InterventionGreenspace exposure measured using objective measures such as satellite-based vegetation indices and Geographic Information Systems.Comparison / CompetitorAny alternative exposureOutcomesMental health outcomes including mental illness (depression, anxiety, psychological distress, psychiatric morbidity, and negative mental health) and mental well-being.Study designCross-sectional and longitudinal studies (24 cross-sectional and 2 longitudinal).Quality and/or BiasStudy quality was assessed using a 16-criterion assessment tool adopted from the National Institutes for Health Quality Assessment Tool for Observational Cohortand Cross-Sectional Studies.General NoteFundings: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reportedin this paper.Conflict of interest: Chun-Qing Zhang is supported by the Sun Yat-sen University Talent 100 Program. Ryan E. Rhodes is supported by funds from the CanadianCancer Society, the Social Sciences and Humanities Research Council of Canada, and the Canadian Institutes for Health Research.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 113 112A systematic review of the anxiety-alleviation benefits of exposure to the natural environmentNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Exposure to natural environments significantly alleviates anxiety. Young people benefit more than middle-aged people. Shorter exposuretimes (<0.5 h) are more effective than longer periodsZhang, X., et al. (2023)IdentificationFirst Author’s Name: Xiaofeng ZhangYear: 2022.Place: ChinaDate of the search: August 2021.Objective: To explore the effects of exposure to the natural environment on human anxiety and summarize the influencing factors on the anxiety relief effect.Email of the Corresponding Author: yaowenfei8345604@163.comDOI: 10.1515/reveh-2021-0157Participants/ PopulationType: Any human adult.Setting: Natural environment vs. built/urban environment.Age: Adults (specific age groups mentioned: young people <45 and middle-aged people ≥45).Gender: Both males and femalesInterventionExposure to the natural environmentComparison / CompetitorExposure to the built/urban environmentOutcomesAnxiety alleviation.Study designRandomized crossover, non-randomized crossover, randomized parallel group, single-group crossover, 2 × 2 factorial design.Quality and/or BiasPEDro scaleGeneral NoteFundings: National Natural Science Foundation of China (32001367). This funding organization played on role in the collection and analysis.Conflict of interest: Authors state no conflict of interest. Informed consent: Informed consent was obtained from all individuals included in this study.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 114 113The association between green space and adolescents mental well-being: A systematic reviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: The review found beneficial associations between green space exposure and reduced stress, positive mood, and less depressive symptomsin adolescents. Several studies indicated that the relationship varied by demographic and socio-economic factors.The limited number of studies and the risk of bias werethe main limitations.Zhang, Y., et al. (2020)IdentificationFirst Author’s Name: Yijun ZhangYear: October 2019.Place: New ZealandDate of the search: October 2019.Objective: To provide evidence for relationships between green space and adolescents’ mental well-being; to appraise and synthesize the evidence in relation to thequality of the studies included, and the consistency of results.Email of the Corresponding Author: yijun.zhang@auckland.ac.nzDOI: 10.3390/ijerph17186640Participants/ PopulationType: Adolescents aged 10-19 years.Setting: Various natural placeAge: 10-19 years.Gender: Not specifiedInterventionExposure to green spaceComparison / CompetitorNon-exposure or less exposureOutcomesMental well-being outcomes such as mood, stress, depression, emotional well-being, mental health, and behaviorStudy designCross-sectional studies, controlled experiments, longitudinal studiesQuality and/or BiasThe quality of included studies was evaluated using the Lachowycz and Jones methodological quality assessment tool.General NoteFundings: This research received no external funding.Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)Y3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: High ### Page 115 114Green spaces exposure and the risk of common psychiatric disorders: A meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Green spaces decrease the risk of psychiatric disorders, including depression, anxiety, dementia, schizophrenia, and ADHD. Thenormalized difference vegetation index (NDVI) is a significant factor. Further studies are needed to explore the mechanisms and confounding factors. Significant reductionin the risk of depression (OR = 0.89), anxiety (OR = 0.94), and dementia (OR = 0.95).Zhang, Y., et al. (2024)IdentificationFirst Author’s Name: Yimin ZhangYear: 2024Place: ChinaDate of the search: November 2023.Objective: To explore the effects of green spaces exposure on common psychiatric disorders.Email of the Corresponding Author: lizhen@nbu.edu.cnDOI: 10.1016/j.ssmph.2024.101630.Participants/ PopulationType: Individuals with common psychiatric disorders including depression, anxiety, dementia, schizophrenia, and ADHDSetting: Various locations from 21 countries.Age: Not specifiedGender: Both male and femaleInterventionExposure to green spaces.Comparison / CompetitorNon-exposure or alternative exposure.OutcomesRisk of psychiatric disorders including depression, anxiety, dementia, and schizophrenia.Study designObservational studies (cohort and cross-sectional studies).Quality and/or BiasNewcastle-Ottawa scale (NOS) and Joanna Briggs Institute (JBI) scores were used.General NoteFundings: This work was supported by the National Natural Science Foundation of China (grant numbers 81703189); Ningbo Natural Science Foundation (grantnumbers 2018A610237 and 202003N4113); Natural Science Foundation of Zhejiang Province (grant numbers LY21B070002 and ZCLY24H2601); and the KC WongMagna Fund of Ningbo University.Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence thework reported in this paper.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) N9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) Y11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)Y16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Low ### Page 116 115The Impact of Forest Therapy Programs on Stress Reduction: A Systematic ReviewNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Forest therapy programs significantly reduce stress levels. Significant reductions in state anxiety levels were observed. Improvements inmood states, including reductions in depression, were noted.Zhang, Y. W., et al. (2023)IdentificationFirst Author’s Name: Yawei ZhangYear: 2023Place: ChinaDate of the search: February 2023.Objective: To examine key findings of previous studies to explore how forest therapy programs impact stress reduction on physiological and psychological levels.Email of the Corresponding Author: ziliao_2005@163.comDOI: 10.3390/f14091851Participants/ PopulationType: Various groups including elderly hypertensive patients, males with high-normal blood pressure, patients with chronic stroke, middle-aged women, low-incomeelderly living alone etc.Setting: Real forest environments in various countries.Age: Ranges from young adults to elderly participants.Gender: Both male and female participants, with some studies focusing on specific genders.InterventionForest therapy programs involving activities like walking, meditation, breathing exercises, and sensory experiences in forest environments.Comparison / CompetitorUrban exposure or daily routine without additional interventions.OutcomesReduction in stress levels measured through physiological markers (e.g., cortisol levels, blood pressure) and psychological assessments (e.g., mood states, anxietylevels).Study designControlled Clinical Trials (CCT), Randomized Controlled Trials (RCT), Pre/Post Studies, Crossover StudiesQuality and/or BiasNot reported.General NoteFundings: This research was supported by the Shanghai Philosophy and Social Science Planning Project (2021ECK002)Conflict of interest: The authors declare no conflict of interest.Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the reportjustify any significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) N8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)N10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) NA12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)NA13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) NA14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) N15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)NA16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 117 116Effects of natural sound exposure on health recovery: A systematic review and meta-analysisNote. Y = Yes, N = No, P = Partial yes, NA = No meta-analysis conducted, R = rating, AMSTAR2 Critical domains (2,4,7,9,11,13,15)Summary of Major Findings: Natural sound exposure (NSE) significantly reduces anxiety, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure(DBP), and respiratory rate (RR). There was significant heterogeneity between studies, maily due to variations in study populations and methodologies.Zhu, R., et al. (2024)IdentificationFirst Author’s Name: Ruirui ZhuYear: 2024Place: ChinaDate of the search: December 2022.Objective: To quantitatively assess the impact of natural sound exposure (NSE) on health recovery using meta-analysis.Email of the Corresponding Author: zhuruirui@qut.edu.cnDOI: 10.1016/j.scitotenv.2024.171052Participants/ PopulationType: general human populationSetting: Various settings including laboratory and hospital rooms.Age: Ranges from children (8-12 years) to older adults (51-75 years)Gender: Both men and womenInterventionExposure to natural sounds (e.g., bird songs, water sounds)Comparison / CompetitorExposure to urban sounds or quiet environments.OutcomesEmotional changes, physiological reactions, cognitive performance.Study designRandomized controlled trials (RCTs) and non-randomized controlled trials.Quality and/or BiasCochrane Risk of Bias (ROB) tool 2.0 and Methodological Indicator for Non-randomized Studies (MINORS).General NoteFundings: This work was supported by the Natural Science Foundation of Shandong Province (China) [grant number ZR2020QC172].Conflict of interest: This work was supported by the Natural Science Foundation of Shandong Province (China) [grant number ZR2020QC172].Quality of Included Reviews (AMSTAR 2)AMSTAR 2 Items R1. Did the research questions and inclusion criteria for the review include the components of PICO? (yes/no) Y2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justifyany significant deviations from the protocol? (yes/partial yes/no)N3. Did the review authors explain their selection of the study designs for inclusion in the review? (yes/no) Y4. Did the review authors use a comprehensive literature search strategy? (yes/partial yes/no) Y5. Did the review authors perform study selection in duplicate? (yes/no) Y6. Did the review authors perform data extraction in duplicate? (yes/no) Y7. Did the review authors provide a list of excluded studies and justify the exclusions? (yes/partial yes/no) Y8. Did the review authors describe the included studies in adequate detail? (yes/partial yes/no) Y9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? (yes/partialyes/no)Y10.Did the review authors report on the sources of funding for the studies included in the review? (yes/no) N11.If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? (yes/no/no meta-analysis) Y12.If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or otherevidence synthesis? (yes/no/no meta-analysis)Y13. Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? (yes/no) Y14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? (yes/no) Y15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss itslikely impact on the results of the review? (yes/no/no meta-analysis)N16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? (yes/no) YOverall confidence: Critically low ### Page 118 117Supplementary Information | Appendix Description and Abbreviation ListList of Bias Tools: A catalog of the bias assessment tools.Full Extracted Data: The complete dataset extracted from each study, encompassing variables and key metrics used in the meta-analysis.Bibliographic Information: A reference list of all included studies in our systematic overview and meta-analysis.List of abbreviations used in the study:GRADE: Grading of Recommendations Assessment, Development and EvaluationRoB 2: Risk of Bias Tool 2RoB 1: Risk of Bias Tool 1NIH: National Institutes of HealthROBINS-I: Risk Of Bias In Non-randomized Studies - of InterventionsJBI: Joanna Briggs InstituteNR: Not ReportedEPHPP: Effective Public Health Practice ProjectDing: Ding et al. ToolNICE: National Institute for Health and Care ExcellenceIARC: International Agency for Research on CancerNOS: Newcastle-Ottawa ScaleSpano: Spano et al. ChecklistJHNEBP: Johns Hopkins Nursing Evidence-Based Practice Model and GuidelinesMMAT: Mixed Methods Appraisal ToolRoBANS: Risk of Bias Assessment Tool for Non-randomized StudiesMcMaster: McMaster University Quality Assessment Tool for Quantitative StudiesQualSyst: Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of FieldsAHRQ: Agency for Healthcare Research and QualityNavigation: Navigation GuideSIGN 50: Scottish Intercollegiate Guidelines Network 50NHLBI: National Heart, Lung, and Blood InstituteNTP-OHAT: National Toxicology Program - Office of Health Assessment and TranslationConQual: Confidence in the Quality of EvidenceQATSDD: Quality Assessment Tool for Studies with Diverse DesignsDowns: Downs & Black Quality Index ### Page 119 118Hanson: Hanson and Jones ToolGascon: Gascon et al. ToolBestBETs: Best Evidence TopicsCONSORT: Consolidated Standards of Reporting TrialsTwohig: Twohig-Bennett & Jones ToolCASP: Critical Appraisal Skills ProgrammePEDro: Physiotherapy Evidence Database ScaleLachowycz: Lachowycz and Jones’ ToolMINORS: Methodological Index for Non-Randomized Studies ### Page 120 119References of the included reviews.1 Annerstedt, M. & Währborg, P. Nature-assisted therapy: Systematic review of controlled andobservational studies. Scandinavian Journal of Public Health 39, 371-388 (2011).https://doi.org/10.1177/14034948103964002 Antonelli, M., Barbieri, G. & Donelli, D. Effects of forest bathing (shinrin-yoku) on levels of cortisolas a stress biomarker: a systematic review and meta-analysis. Int. J. Biometeorol. 63, 1117-1134(2019). https://doi.org/10.1007/s00484-019-01717-x3 Batterham, P. J. et al. Systematic review of quantitative studies assessing the relationship betweenenvironment and mental health in rural areas. Australian Journal of Rural Health 30, 306-320 (2022).https://doi.org/10.1111/ajr.128514 Bettmann, J. E., Speelman, E., Blumenthal, E., Couch, S. & Schmalz, D. L. Nature Exposure, Even asLittle as 10 Minutes, is Likely to Yield Short-Term Benefits for Adults with Mental Illness: A MetaAnalysis. Ecopsychology (2024). https://doi.org/10.1089/eco.2023.00635 Bolouki, A. Neurobiological effects of urban built and natural environment on mental health:Systematic review. Rev. Environ. Health 38, 169-179 (2023). https://doi.org/10.1515/reveh-2021-01376 Bray, I., Reece, R., Sinnett, D., Martin, F. & Hayward, R. Exploring the role of exposure to green andblue spaces in preventing anxiety and depression among young people aged 14-24 years living inurban settings: A systematic review and conceptual framework. Environ. Res. 214, 114081 (2022).7 Brito, H. S. et al. Benefits to Performance and Well-Being of Nature-Based Exercise: A CriticalSystematic Review and Meta-Analysis. 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C. A systematic review of the relationship between naturalenvironments and physiological and mental health during different stages of the COVID-19pandemic. Sci. Total Environ. 923 (2024). https://doi.org/10.1016/j.scitotenv.2024.171392 ### Page 127 126108 Yeo, N. L. et al. Indoor nature interventions for health and wellbeing of older adults in residentialsettings: A systematic review. Gerontologist 60, E184-E199 (2020).https://doi.org/10.1093/geront/gnz019109 Yi, Y., Seo, E. & An, J. Does Forest Therapy Have Physio-Psychological Benefits? A Systematic Reviewand Meta-Analysis of Randomized Controlled Trials. International Journal of EnvironmentalResearch and Public Health 19 (2022). https://doi.org/10.3390/ijerph191710512110 Zhang, G. et al. Health-promoting nature access for people with mobility impairments: A systematicreview. International Journal of Environmental Research and Public Health 14 (2017).https://doi.org/10.3390/ijerph14070703111 Zhang, R., Zhang, C. Q. & Rhodes, R. E. 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Forests 14, 19 (2023). https://doi.org/10.3390/f14091851116 Zhu, R. et al. Effects of natural sound exposure on health recovery: A systematic review and meta-analysis. Sci. Total Environ. 921 (2024). https://doi.org/10.1016/j.scitotenv.2024.171052 ### Page 128 Supplementary Table S1 | Summary of included systematic reviews.No Id Population Intervention Comparison Outcome Studies Quality and biasNo Study ID Country Type Age Gender Setting Type Type Mental healthoutcomeNo Bias/qualityToolsAMSTAR 21 Annerstedt, M.and P.Währborg(2011)Sweden Patients with adisease orconditionAll ages Both malesand femalesOutdoor environments Nature-assisted therapy No certain treatmentor activityStress anddepression38 GRADE system Low2 Antonelli,Barbieri, &Donelli (2019)*Italy Healthy generalparticipantsAll ages Both maleand femaleForest environments Forest bathing City environment Stress 8 NIH tools Low3 Batterham, P. J.,et al. (2022)Australia Residents of ruralareasAll ages Both maleand femaleRural green space areas Green space exposure Non-nature-basedexposureStress, anxietyand depression28 JBI tools Low4 Bettmann, J. E.,et al. (2024)USA Adults withmental illnessAll ages NotspecifiedNatural environments Exposure as anexperience in nature(therapeutic)Non-nature based/control or alternativeexposureStress, anxietyand depression41 RoB 2 andROBINS-ILow5 Bolouki, A.(2023)Iran General humanpopulationAll ages Both maleand femaleUrban and naturalenvironmentsExposure to naturalenvironmentsExposure to urbanenvironmentsStress, anxietyand depression18 Not reported Critically low6 Bray, I., et al.(2022)UK Young people 14-25 NotspecifiedUrban green and bluespacesExposure to green andblue natureNon-nature exposureor less exposureStress, anxietyand depression48 EPHPP tools Low7 Brito, H. S., etal. (2022)*Portugal GeneralpopulationAll ages Both maleand femaleOutdoor naturalenvironmentsPhysical activity in anynature-basedenvironmentIndoor physicalactivityStress andanxiety24 RoB 1 and Dinget al.Low8 Britton, E., etal. (2018)Ireland Individuals withdisabilitiesAll ages Both maleand femaleBlue spaceenvironmentsBlue space exposure(therapeutic)Control and/or non-exposureStress anddepression33 Not reported Critically low9 Cadman, T., etal. (2024)*Denmark Women withsingletondeliveriesNotspecifiedFemale Urban environment Exposure to green andblue spacesNon-exposure oralternative exposureDepression 12 Not reported Critically low10 Caponnetto, P.,et al. (2022)Italy Generalpopulation19-49 Both maleand femaleVarious naturalenvironmentsForest therapy Control and/or non-exposureStress anddepression7 Not reported Critically low11 Carver, A., et al.(2020)Australia Residents of agedcare facilitiesOlder adults NotspecifiedResidential aged carefacilitiesExposure to greenery Non-exposed or lessexposedStress anddepression9 Not reported Critically low12 Chun, H. R., etal. (2023)Korea Generalpopulation10-60 NotspecifiedVarious forestenvironmentsForest therapy Non-exposed oralternative exposureStress, anxietyand depression31 RoB 1 Critically low13 Corazon, S. S.,et al. (2019)Denmark Generalpopulation18+ Both maleand femaleOutdoors natural greenenvironmentsExposure to all kinds ofnatural environmentAll kinds ofcomparisonsStress 36 EPHPP tools Low14 Coventry et al.(2021)*UK GeneralpopulationAdults aged≥18 yearsNotspecifiedCommunity-based(non-hospital) settingsNature-based outdooractivitiesNon-nature basedequivalent activities,usual careStress, anxietyand depression51 RoB 1 and NICEChecklistHigh15 de Keijzer, C.,et al. (2020)Spain Older adults adults >35 NotspecifiedResidential outdoorgreenspaceLong-term exposure togreenspaceNone-exposed or lessexposedDepressionand Anxiety50 IARC Guidelines Critically low16 Di Nardo, F., etal. (2010)Italy GeneralpopulationNotspecifiedNotspecifiedUrban and ruralenvironmentsExposure to green orpublic open spacesNone-exposed or lessexposedStress 15 Not reported Critically low17 Ding, Y., et al.(2024)USA Higher educationstudents16 to 30yearsBoth maleand femaleUniversity/collegecampusesExposure to green andnatural spacesAlternative campusenvironmentsStress, anxietyand depression19 EPHPP tools Low18 Djernis, D., etal. (2019)Denmark Adults andadolescents12-89 Both maleand femaleNatural environments Nature-Based therapy Without exposure tonatureStress, anxietyand depression25 EPHPP tools High19 Fraser, M., et al.(2020)UK Individuals withtype 2 diabetesOver 18years oldBoth maleand femaleOutdoor exerciseenvironmentsOutdoor/green exercise Control and/oralternative treatmentsDepression 4 DBQI tool High20 Fyfe-Johnson,A. L., et al.(2021)USA Children 19 oryoungerNotspecifiedVarious naturalenvironmentsGreen space activityand exposureControl and/oralternative exposureStress, anxietyand depression296 RoB 2 ROBINS-Iand MMATHigh21 Gál, V. and Z.Dömötör (2023)Hungary GeneralpopulationNotspecifiedNotspecifiedVarious naturalenvironmentsExposure to nature andconnection with natureControl and/oralternative exposureStress 28 Not reported Critically low22 Gascon, M., etal. (2015)Spain Generalpopulation3 or older NotspecifiedResidential areas withgreen and blue spacesLongitudinal exposureto green and blue natureControl and/oralternative exposureStress, anxietyand depression28 IARC Guidelines Critically low ### Page 129 23 Gascon, M., etal. (2017)Spain GeneralpopulationAll ages NotspecifiedResidential and non-residential outdoorblue spacesOut-door blue spaceexposureControl and/oralternative exposureStress, anxietyand depression35 IARC Guidelines Critically low24 Geneshka, M.,et al. (2021)UK Generalpopulation18+ Both maleand femaleGreen/blue spacesenvironmentsGreen and/or blue spaceexposureAlternative exposure Stress, anxietyand depression44 NOS High25 Gert-Jan, V. andM. Danckaerts(2018)Belgium Children andadolescents25 oryoungerNotspecifiedResidential or schoolsurroundingsGreen space exposure Control and/oralternative exposureStress, anxietyand depression21 Not reported Critically low26 Gianfredi, V., etal. (2021)Italy Generalpopulation1NotspecifiedNotspecifiedUrban greenspaces Urban greenspacesexposureControl and/oralternative exposureStress, anxietyand depression34 NOS, RoB 2,NIH ToolLow27 Grassini, S.(2022)*Norway Generalpopulation18 to 72yearsBoth maleand femaleNatural environmentsfor walkingNature walking Urban walks or non-walkingDepressionand Anxiety7 NOS Low28 Gritzka, S., etal. (2020)Irland Employees 28 to 49 Both maleand femaleActual workplacesettingsAny type of nature-based interventionsNo intervention-control conditionsDepressionand Anxiety10 RoB 2 Low29 Gu, J., et al.(2022)China GeneralpopulationAll ages Both maleand femaleVarious indoors andoutdoors greeneryExposure to small-scalegreeneryNo greening or anyinterventionStress 19 RoB 1, ROBINS-ILow30 He, N., et al.(2024)China GeneralpopulationNotspecifiedNotspecifiedCommunityenvironmentsExposure to blue‐greenspacesControl and/oralternative exposureStress 64 Spano et alchecklistLow31 Heród, A., et al.(2022)Poland Older adults ≥60 years NotspecifiedVarious settings suchas elderly care facilitiesHorticultural therapyprogramsControl groups withno interventionDepressionand Anxiety35 JHNEBP Low32 Hsueh, Y. C., etal. (2022)UK GeneralpopulationAll ages NotspecifiedLocal communities Active engagement inlocal green spaces(mostly gardening)Control and/oralternative exposureStress anddepression7 MMAT High33 Kang, M. J., etal. (2022)Korea GeneralpopulationNotspecifiedNotspecifiedForest environment Forest therapy Control and/oralternative exposureDepressionand Anxiety6 RoB 2 Low34 Kim, E., et al.(2022)*Korea GeneralpopulationAdults Both maleand femaleForests or urban forests Structured activities inforests or urban forestsControl and/oralternative exposureStress, anxietyand depression19 RoB 2 andGRADEHigh35 Kim, S.-Y. andJ. Choi (2021)*Korea General adultpopulation18+ Both maleand femaleForest healingprogramsKorean forest healing Non-participating Stress 11 RoBANS Low36 Kondo, M. C.,et al. (2018)USA Urban residents NotspecifiedBoth maleand femaleUrban green areas Exposure to urbangreen spacesExposure to builturban spacesStress anddepression68 Not reported Critically low37 Kotera, Y., et al.(2021)UK GeneralpopulationAll ages Both maleand femaleNatural environments Nature walks only Urban walks or nowalksDepressionand Anxiety12 NOS Critically low38 Kotera, Y., et al.(2022)*UK Generalpopulation18-79 Both maleand femaleForest environments Shinrin-yoku (forestbathing)Urban settings and nointerventionDepressionand Anxiety20 NOS High39 Labib, S. M., etal. (2020)UK Generalpopulation18-65 NotspecifiedUrban greenenvironmentsExposure to green andblue spacesAny comparator Stress, anxietyand depression93 Not reported Critically low40 Lackey, N. Q.,et al. (2019)USA GeneralpopulationMostlyadultsBoth maleand femaleVarious natural spaces Participation in outdoorrecreationNon-participatingand/or controlStress, anxietyand depression51 Not reported Critically low41 Lakhani, A., etal. (2019)Australia People withdementiaNotspecifiedNotspecifiedVarious natural spaces Engaging with naturalenvironmentsTraditional carefacilities or urbansettingsStress, anxietyand depression18 McMaster tool High42 Lanza-León, P.,et al. (2023)Spain GeneralpopulationNotspecifiedBoth maleand femaleVarious greenenvironmentsExposure to greenspacesNon-exposed orcontrol group or lessexposedStress, anxietyand depression25 NHLBI’s Tools Critically low43 Li, D., et al.(2021)USA GeneralpopulationAll ages Both maleand femaleVarious green spaces Early life natureexposureNonparticipating ornot exposedStress, anxietyand depression29 NHLBI’s Tools High44 Li, H., et al.(2022)*China GeneralpopulationAll ages Both maleand femaleNatural wild and urbanenvironmentsPhysical activity innatural environmentsPhysical activity innon-naturalenvironmentsStress, anxietyand depression19 EPHPP tools Low45 Li, J., and Z.Trivic (2024)Singapore GeneralpopulationNotspecifiedNotspecifiedUrban settings withblue-greeninfrastructureGreen-blue exposure Non-exposed Stress, anxietyand depression60 QualSyst Low46 Li, L., and K.W. Lange(2023)Germany Generalpopulation14-85 Both maleand femaleUrban landscapes Urban landscapeexposure1Non-exposed/ controlgroupStress 19 Not reported Critically low47 Liu, Z., et al.(2023)*China GeneralpopulationAll ages Both maleand femaleVarious natural places Exposure to greennatureNon-exposed/ controlgroupDepressionand Anxiety18 AHRQ tools Low48 LoTemplio, S.,et al. (2023) SUSA Adults withmental illnessNotspecifiedNotspecifiedNatural settingsincluding urban parksExposure to greenspacesNon-exposed/ controlgroupDepressionand Anxiety13 RoB 2 andROBINS-ILow49 Luque-García,L., et al. (2022)Spain Children 6-12 NotspecifiedVarious natural places Exposure to greenness No exposure or lessexposureStress andanxiety34 Navigation Guide High ### Page 130 50 Lu, S., et al.(2023)*China Generalpopulation7-93 Both maleand femaleIndoor and outdoorgardensHorticultural therapy(gardening)Any comparison Stress 31 JBI Tools Low51 Ma, J., et al.(2023)UK Generalpopulation19-40 Both maleand femaleVarious natural settingssuch as urban parksNature-based walking Non-green outdoorspacesStress andanxiety17 RoB 2 and SIGN50High52 McCormick, R.M. S. N. (2017)USA Children 6-18 NotspecifiedVarious natural settings Exposure to greenspacesNo exposure or noaccessStress andanxiety12 Not reported Critically low53 Menhas, R., etal. (2024)China Participants withhealth conditionsAll age Both maleand femaleVarious natural places Nature-based socialprescriptionControl or alternativeinterventionStress, anxietyand depression28 Not reported Critically low54 Moll, A., et al.(2022)Spain Children andadolescents0 to 19years.NotspecifiedVarious settingsincluding residentialand school areasExposure to nature Control or alternativeintervention orexposureStress anddepression30 NHLBI’s Tools Critically low55 Moula, Z., et al.(2022)UK Children andyoung peopleYoungerthan 18NotspecifiedNature or outdoorspaces such as forests,woodlandsArt based exposure tonatureControl or alternativeintervention orexposureStress andanxiety11 ROBIS High56 Mygind, L., etal. (2021)*Denmark GeneralpopulationAll age Both maleand femalePublic green spaces Direct exposure topublic green spaceExposure to syntheticenvironmentStress 11 EPHPP’s tools High57 Mygind, L., etal. (2021)Denmark Children Under 12yearsNotspecifiedVarious natural places Direct exposure topublic green spacesExposure to mainlysynthetic environmentor no exposureStress 223 NTP-OHAT tools High58 Nguyen, P. Y.,et al. (2021)Australia Generalpopulation4-76 Both maleand femaleVarious urban and ruralsettingsExposure to nature Control or alternativeinterventionStress, anxietyand depression68 NHLBI’s Tools Low59 Noseworthy,M., et al. (2023)Canada Generalpopulation11-80 Both maleand femaleOutdoor environmentsfor exercisingExercise bouts in anoutdoor environmentExercise boutsperformed indoorsStress anddepression12 RoB 2 High60 Oh, B., et al.(2017)Australia Universitystudents20-79 Both maleand femaleForest environments Forest therapy/spendingtime in forestenvironmentUrban environmentinterventionsStress, anxietyand depression6 RoB 1 Critically low61 Paredes-Céspedes, D.M., et al.(2024)*Colombia Healthy generalparticipants18+ NotspecifiedNatural settingsincluding forests andnatural parksNature based therapy Various control groupsincluding nointerventionStress, anxietyand depression8 RoB 1 Low62 Park, H., et al.(2024)USA GeneralpopulationNotspecifiedNotspecifiedVarious locations andgeographical regionsNature exposure Control or alternativeintervention orexposureStress, anxietyand depression13 Not reported Critically low63 Patwary, M. M.,et al. (2024)*Bangladesh GeneralpopulationAll age Both maleand femaleIndoor and outdoornatural placesExposure to nature andgardeningGroups withoutexposure or lessexposure to natureStress, anxietyand depression113 NavigationGuide, GRADEHigh64 Phi-Yen, N., etal. (2023)*Australia Generalpopulation18-65 Both maleand femaleNatural places such asforests, nature reserves,parksNature-based therapy Non-naturealternatives or controlgroupsStress, anxietyand depression28 RoB 2 andROBINS-ILow65 Picton, C., et al.(2020)Australia Adults with amental illness18+ NotspecifiedNature-basedcommunity settingsNature-based recreationactivities (therapeutic)No intervention or in anon-nature settingStress, anxietyand depression18 JBI- ConQual Moderate66 Piva, G., et al.(2024)Italy Elderlypopulations60 yearsolderBoth maleand femaleNatural environments,specifically forestsForest walking andother forest therapyactivitiesWalking in the city orusual life activitiesStress, anxietyand depression10 QATSDD Critically low67 Porter, J. E., etal. (2023)Australia Disaster affectedpopulation18-87 Both maleand femaleCommunity settingsaffected by disasterssuch as hurricanes,earthquakesNature-led recoveryinitiativesAlternative activities Stress, anxietyand depression9 MMAT Critically low68 Qiu, Q., et al.(2023)*China Adult population 18+ Both maleand femaleForest-based seatedviewing and walkingprogramsAll types of foresttherapy activitiesVisiting and activitiesin urban environmentsStress 34 RoB 2 andROBINS-ILow69 Rahimi-Ardabili, H., etal. (2021)Australia GeneralpopulationAll age Both maleand femaleGreen spaces inMainland ChinaExposure to a high levelof green spaceExposure to a lowlevel of green spaceStress, anxietyand depression83 NHLBI’s Tools Low70 Rautio, N., etal. (2018)Finland GeneralpopulationAll age NotspecifiedVarious livingenvironmentsNature exposure Control or alternativeexposureDepression 57 Downs & Black’stoolCritically low71 Reyes-Riveros,R., et al. (2021)Chile GeneralpopulationNotspecifiedNotspecifiedPublic urban greenspacesUrban Nature exposure None-exposed orcontrol and/oralternativeStress, anxietyand depression153 Not reported Critically low72 Ribeiro, H., etal. (2024)Brazil Universitystudents18-29 NotspecifiedUniversity campuses Exposure to naturalenvironmentsNon-exposure or lessexposureStress, anxietyand depression32 Not reported Critically low ### Page 131 73 Ríos-Rodríguez, M.L., et al. (2023)Spain Office workers NotspecifiedNotspecifiedWorkplaceenvironmentsExposure to nature inthe workplace (nature-based designs)Alternative designs Stress 12 Not reported Critically low74 Ríos-Rodríguez, M.L., et al. (2024)Spain Generalpopulation16-85 Both maleand femaleVarious natural places Contact with nature(direct or indirect)Non-exposure, controlor alternativeexposureStress, anxietyand depression9 JBI’s tools Low75 Roberts, A., etal. (2020)UK Children andyoung people12-21 Both maleand femaleVarious naturalenvironments includingschool gardensNature-based activities Non-exposure, controlor alternativeexposureStress, anxietyand depression14 EPHPP’s tools Low76 Roberts, H., etal. (2019)*Netherlands GeneralpopulationNotspecifiedNotspecifiedNatural environmentvs. built environmentExposure to the naturaenvironmentExposure to the builtenvironmentDepression 33 RoB 1, ROBINS-I and GRADEHigh77 Rojas-Rueda,D., et al. (2021)USA GeneralpopulationAll ages Both maleand femaleUrban naturalenvironmentsExposure to greenspacesNone-exposed oralternative exposureStress, anxietyand depression19 (NIH) QualitytoolHigh78 Rosa, C. D., etal. (2021)*Brazil GeneralpopulationAll ages Both maleand femaleForest environments Forest therapy No intervention/usualcare, similar activitiesDepression 13 RoB 2 andROBINS-ILow79 Rosa, C. D., etal. (2023)*Brazil GeneralpopulationAll ages Both maleand femaleVarious natural placeslike mountains andforestsNature-based adventureactivities such as hikingNo intervention,waiting list, usual careDepression 42 RoB 2 andROBINS-ILow80 Rowley, M., etal. (2022)UK Adolescents 10-24 Both maleand femaleVarious naturalenvironmentsExposure to all types ofnatureAll comparisongroupsStress, anxietyand depression27 EPHPP’s tools Low81 Scott, T. L., etal. (2022)Australia People living withdementiaNotspecifiedNotspecifiedCommunity settings Horticulture-basedactivitiesAlternative activities Depressionand Anxiety8 MMAT High82 Shin, J. Y. andW. S. Shin(2020)Korea Full-time workers NotspecifiedNotspecifiedWorkplace andcommunityForest therapy,horticultural therapyWithout participatingin nature-basedprogramsStress, anxietyand depression16 RoB 1 andRoBANSLow83 Shuda, Q., et al.(2020)USA GeneralpopulationNotspecifiedBoth maleand femaleVarious naturalenvironmentsExposure to nature Control or alternativeexposureStress 12 RoB 1 Critically low84 Siah, C. J. R., etal. (2023)*Singapore General adultpopulation21-70 Both maleand femaleVarious settingsincluding universitiesAny types of actives inforestNo intervention oralternative activitiesStress, anxietyand depression36 JBI checklist Low85 Silva, A., et al.(2023)Portugal GeneralpopulationAll ages Both maleand femaleVarious natural places Nature-basedinterventionsControl and/oralternativeinterventionsStress, anxietyand depression38 Hanson andJones’s toolLow86 Smith, N., et al.(2021)UK GeneralpopulationAll ages NotspecifiedUrban environments Exposure to urban bluespacesDistance to blue spaceor no exposure.Stress, anxietyand depression4 Gascon et al.’toolHigh87 Song, S., et al.(2022)*China Generalpopulation19-48 Both maleand femalePublic green spaces Exposure to greenspacesNo exposure or lessexposure oralternative exposureStress anddepression24 RoB 2 High88 Sparacio, A., etal. (2023)*Czech General adultpopulation18+ Both maleand femaleNatural environmentsand social supportcontextsExposure to nature orbeing in natureExposure to urbanenvironmentStress 16 RoB 2 High89 Struthers, N. A.,et al. (2024)*Canada Participants withhealth conditionsAll ages Both maleand femaleVarious natural settingsand green spacesNature based therapy Control or non-nature-based interventionsStress 15 RoB 2 High90 Szitás, D., et al.(2024)Slovakia Generalpopulation15 years orolderNotspecifiedNatural setting or otherforms of forest bathing.Forest bathing Control or alternativeinterventionsStress, anxietyand depression12 RoB 1 andGRADELow91 Taniguchi, K.,et al. (2022)Japan GeneralpopulationAll ages Both maleand femaleVarious naturallocationsExposure to naturalenvironmentControl or non-nature-based interventionStress, anxietyand depression53 Not reported Critically low92 Taylor, E. M., etal. (2022)UK Participants withhealth conditions51-73 Both maleand femaleVarious naturalsettings, forest sites,urban areas, andhospitalsNature-basedinterventions withtherapeutic purposesTreatment as usual,urban environments orno comparison.Stress, anxietyand depression13 BestBETschecklistLow93 ThompsonCoon, J., et al.(2011)UK General adultpopulationAll ages Both maleand femaleVarious natural spacesincluding sidewalks,forestsOutdoor PhysicalactivityIndoor physicalactivityStress, anxietyand depression11 Not reported High94 Tillmann, S., etal. (2018)Canada Children andteenagers0-18 Both maleand femaleVarious natural settingsincluding green spaces,parksExposure to someelements of natureControl or alternativeexposureStress anddepression35 (NIH) QualitytoolModerate95 Tran, I., et al.(2022)USA GeneralpopulationNotspecifiedNotspecifiedVarious natural andurban settingsGreenspace exposure Urban environmentalfeaturesStress, anxietyand depression40 Not reported Critically low96 Trostrup, C., etal. (2019)Denmark Participants withhealth conditionsNotspecifiedBoth maleand femaleHospitals andrehabilitation centersNature-basedinterventions withtherapeutic purposesControl or alternativeinterventionsDepressionand Anxiety5 JBI andCONSORTchecklistsLow ### Page 132 97 van den Berg,M., et al. (2015)TheNetherlandsGeneral adultpopulationNotspecifiedBoth maleand femaleLiving environment(surrounding places ofresidence).Quantity and quality ofgreen space in the livingenvironmentNon-exposed or lessexposed to natureStress 19 NICE Guidelines Low98 van denBogerd, N., etal. (2020)TheNetherlandsHigh school anduniversity students12 yearsolderNotspecifiedSecondary and tertiaryeducationenvironmentsNature exposure ineducationalenvironmentsNo or alternativeinterventions such asno exposure or lessexposureStress, anxietyand depression37 EPHPP andNHLBI’s ToolsHigh99 Wang, L. andN. Md Sani(2024)Malaysia Elderlyindividuals50 yearsand overNotspecifiedVarious locations withblue spacesExposure to outdoorblue spacesNon-exposure or lessexposureStress, anxietyand depression22 Gascon et al.’toolCritically low100 Wen, Y., et al.(2019)China Generalpopulation18-30 Both maleand femaleForest environment Forest bathing Urban environmentexposureStress, anxietyand depression28 Downs & Black’stoolLow101 Wicks, C., et al.(2022)*UK General adultpopulation19-50 Both maleand femaleNatural environmentse.g., forests, parksPhysical activity innatural environmentsPhysical activity inurban environmentsStress, anxietyand depression24 RoB 2 Low102 Xian, Z., et al.(2024)China DisadvantagedgroupsAll ages NotspecifiedResidential areas andsurrounding greeneryExposure toneighborhood greenspaceNo exposure or lessexposureStress, anxietyand depression41 Not reported Critically low103 Xu, T., et al.(2022)Malaysia Older adults 60 yearsand olderNotspecifiedUrban green spaces Exposure to urbangreen spacesNone-exposure orlimited exposureStress, anxietyand depression65 Not reported Critically low104 Yao, W., et al.(2021)*China General adultpopulation18+ Both maleand femaleNatural and builtenvironmentsExposure to naturalenvironmentsExposure to builtenvironmentsPositive andnegative affect20 Twohig-Bennett& Jones, RoBToolHigh105 Yao, W. F., etal. (2021)*China General adultpopulationNotspecifiedBoth maleand femaleNatural environmentvs. built/urbanenvironmentExposure to naturalenvironmentsExposure to thebuilt/urbanenvironmentStress andanxiety31 RoB 1 andROBINS-ILow106 Ye, T., et al.(2022)Australia Children andadolescents2≤19 years Both maleand femaleVarious places inmostly urbanizedregionsNature exposure Non-exposure or lessexposureStress, anxietyand depression140 Navigation Guide Low107 Yen, M. H., etal. (2024)Taiwan People duringCOVID-19NotspecifiedNotspecifiedVarious naturalenvironmentsInteraction andexposure to naturalenvironmentsLess interaction or nointeraction with natureStress, anxietyand depression73 CASP Checklist Critically low108 Yeo, N. L., etal. (2020)UK Elderly people 60+ Both maleand femaleResidential settingsand assisted livingfacilitiesIndoor gardening,exposure andhorticulture activitiesNon-natureinterventions orcontrol groupsStress, anxietyand depression26 EPHPP’s tools High109 Yi, Y., et al.(2022)*Korea General adultpopulation19 years orolderBoth maleand femaleForest environments Forest therapy Walking or restingoutside the forest, orcontrol groupStress 8 RoB 1 andGRADELow110 Zhang, G., et al.(2017)Denmark Individuals withmobilityimpairmentsAll ages Both maleand femaleDifferent kinds ofnatural environmentNature-related activitiesand interventions andexposureAlternative and/orcontrol intervention orno interventionStress, anxietyand depression27 MMAT Critically low111 Zhang, R., et al.(2021)China GeneralpopulationAll ages Both maleand femaleDifferent kinds ofnatural settingNature exposure Any alternativeexposureStress, anxietyand depression26 NIH tool Low112 Zhang, X., et al.(2023)*China GeneralpopulationAll ages Both maleand femaleNatural environmentvs. built/urbanenvironmentExposure to the naturalenvironmentExposure to thebuilt/urbanenvironmentStress, anxietyand depression24 PEDro scale Low113 Zhang, Y., et al.(2020)New Zealand Adolescents 10-19 NotspecifiedNatural environment Nature exposure No exposure or lessexposureAnxiety 14 Lachowycz andJones’ s toolHigh114 Zhang, Y., et al.(2024)*China People withpsychiatricdisordersNotspecifiedBoth maleand femaleVarious green spaceenvironmentsExposure to greenspacesNon-exposure oralternative exposure.Stress, anxietyand depression59 NOS and JBI’stoolsLow115 Zhang, Y. W., etal. (2023)China GeneralpopulationAll ages Both maleand femaleReal forestenvironments invarious countriesForest therapyprogramsUrban exposure ordaily routineDepressionand Anxiety17 Not reported Critically low116 Zhu, R., et al.(2024)*China GeneralpopulationAll ages Both maleand femaleVarious settingsincluding laboratoryand hospital roomsExposure to naturalsoundsExposure to urbansounds or quietenvironmentsStress 15 RoB 2 andMINORSCritically low ### Page 133 Supplementary Table S4 | Moderator analysis for the reduction of negative outcomesModerator category k SMD SE 95% CI p-value df Omnibus Test (F) Omnibus p-valueIntervention F(4, Inf) = 0.86a 0.486Nature-based therapy 13 -1.06 0.68 [-3.08, 0.96] 0.205 3.4Forest bathing 20 -0.81 0.20 [-1.30, -0.33] 0.007** 5.9Gardening 7 -0.69 0.21 [-1.23, -0.14] 0.024* 4.5Exposure to nature 40 -0.59 0.17 [-0.95, -0.23] 0.003** 14.4Green exercise 17 -0.57 0.26 [-1.19, 0.05] 0.065. 6.6Blue space intervention 1 -0.49 0.17 [-0.86, -0.12] 0.014* 11.6Outcome F(7, Inf) = 0.80 0.588Anxiety 23 -0.83 0.17 [-1.19, -0.47] <0.001*** 20.4Stress 8 -0.81 0.39 [-1.78, 0.15] 0.084. 5.8Systolic blood pressure 9 -0.80 0.46 [-2.01, 0.40] 0.145 4.7Depressive 33 -0.72 0.16 [-1.05, -0.40] <0.001*** 22.4Heart rate 6 -0.70 0.19 [-1.17, -0.23] 0.012* 5.2Negative affect 5 -0.61 0.19 [-1.06, -0.15] 0.016* 6.2Diastolic blood pressure 9 -0.54 0.35 [-1.49, 0.42] 0.199 4.3Salivary cortisol 5 -0.25 0.36 [-1.38, 0.89] 0.537 3.0Dimension F(1, Inf) = 1.05 0.307Psychological 65 -0.73 0.18 [-1.11, -0.36] <0.001*** 27.8Physiological 33 -0.52 0.21 [-0.97, -0.08] 0.024* 17.0Quality F(2, Inf) = 0.24 0.786Critically low 8 -0.94 1.17 [-15.59, 13.72] 0.570 1.0Low 51 -0.76 0.29 [-1.36, -0.16] 0.017* 16.8High 39 -0.55 0.14 [-0.86, -0.24] 0.003** 8.4Year F(4, Inf) = 0.90 0.4652024 23 -1.60 1.09 [-4.52, 1.33] 0.210 4.32022 29 -0.66 0.15 [-1.00, -0.31] 0.003** 6.92021 23 -0.56 0.16 [-0.98, -0.14] 0.019* 5.02023 21 -0.46 0.13 [-0.76, -0.16] 0.009** 7.02019 2 -0.17 0.13 [-1.76, 1.41] 0.396 1.0Country F(9, Inf) = 1.39b 0.185Colombia 1 -7.87 0.00 NA NAd .Canada 3 -3.53 1.04 [-16.75, 9.68] 0.182d .South Korea 9 -0.96 0.19 [-1.93, 0.02] 0.051. 1.7Brazil 5 -0.77 0.41 [-5.94, 4.39] 0.310 1.0Singapore 5 -0.65 0.11 [-2.01, 0.71] 0.104d .China 35 -0.49 0.17 [-0.88, -0.09] 0.021* 8.9United Kingdom 16 -0.49 0.32 [-1.90, 0.91] 0.268 2.0Norway 4 -0.46 0.05 [-1.11, 0.20] 0.072.d .Czech Republic 1 -0.42 0.00 NA NAd .Australia 4 -0.38 0.52 [-6.93, 6.17] 0.595d . ### Page 134 Portugal 1 -0.36 0.00 NA NAd .Netherlands 1 -0.30 0.00 NA NAd .Denmark 5 -0.22 0.27 [-3.62, 3.17] 0.556 1.0Bangladesh 7 -0.10 0.07 [-1.01, 0.82] 0.414d .Italy 1 -0.05 0.00 NA NAd .Overall effect 98 -0.69 0.18 [-1.05, -0.33] <0.001*** 28.1Supplementary Table S4 (continued) | Moderator analysis for enhancement of positive effects.Moderator category k SMD SE 95% CI p-value df Omnibus Test (F) Omnibus p-valueIntervention F(1, Inf) = 0.01 0.937Exposure to Nature 7 0.88 0.16 [0.35, 1.42] 0.014* 4.1Green Exercise 16 0.91 0.35 [-0.12, 1.95] 0.070. 3.1Outcome F(6, Inf) = 3.95 <0.001***Systolic Blood Pressure 2 -0.00 0.46 [-0.98, 0.98] 0.999d .Diastolic Blood Pressure 2 0.09 0.50 [-0.97, 1.14] 0.866d .Heart Rate 3 0.28 0.14 [-1.46, 2.02] 0.293 1.0Posative affect 7 0.52 0.09 [0.28, 0.75] 0.002** 4.0Vigor and Vitality 5 1.52 0.56 [-0.23, 3.26] 0.070. 1.0Restorative Experience 2 1.63 0.69 [-6.35, 9.61] 0.247d .Ralaxation 2 2.85 0.47 [1.86, 3.84] <0.001d .Dimension F(1, Inf) = 5.55 0.018*Physiological 7 0.24 0.08 [-0.19, 0.67] 0.118 4.0Psychological 16 1.18 0.20 [0.66, 1.69] 0.002** 4.8Quality F(1, Inf) = 2.04 0.153High 13 0.58 0.17 [0.04, 1.13] 0.042* 4.0Low 10 1.33 0.39 [-0.45, 3.11] 0.082. 2.0Year F(1, Inf) = 3.39 0.066.2021 10 0.43 0.09 [-0.09, 0.96] 0.067. 3.02022 13 1.18 0.27 [0.40, 1.97] 0.015* 3.9Country F(4, Inf) = 4.50a 0.001**Portugal 2 0.31 0.85 [-1.47, 2.10] 0.716d .Denmark 2 0.41 0.86 [-1.40, 2.22] 0.643d .UK 8 0.99 0.77 [-8.81, 10.79] 0.422 1.0China 9 1.12 0.33 [-0.34, 2.58] 0.080. 2.0South Korea 2 1.21 0.87 [-0.61, 3.03] 0.180d .Overall Effect 23 0.90 0.23 [0.33, 1.46] 0.008** 6.4Analysis based on CHE Model (rho=0.6). k = Number of effect size estimates (ES). SMD = standardized meandifference. SE = standard ErrorCI: Confidence Interval. Robust 95% CI (CR2) reported unless based on k=1 study (see note d). ### Page 135 p-value: Significance level. Robust p-value reported unless based on k=1 study (see note d).df: Degrees of Freedom. df reported unless based on k=1 study (see note d).Omnibus Test (F): Robust Wald test comparing levels within moderatora: Omnibus test for Intervention excluded the 'Blue Space Intervention' category (based on k=1 study).b: Omnibus test for Country excluded categories based on k=1 study.d: For categories where all effect sizes came from only one study (k_studies=1), robust inference is not feasible.Reported SE, 95% CI, p-value, and df (.) are model-based (assuming correct model specification) and lackrobustness guarantees. Significance stars are omitted for these model-based p-values. ### Page 136 1C-low = critically lowSupplementary Figure S1 | Evidence and gap map of included studies. ### Page 137 1Supplementary Figure S2 | c n - a-analy c p v a y v nc . ### Page 138 Supplementary Figure S 3| Evidence overlap analysis using the OVErviews (GROOVE) tool. Matrix representingthe degree of primary study overlap between the 30 systematic reviews included in the SOMA. The CorrectedCovered Area (CCA) was calculated to assess redundancy, with colors indicating slight (<5%), moderate (5% to<10%), high (10% to <15%), and very high (>15%) overlap.