title: The effects of forest therapy on depression and anxiety in patients with chronic stroke.
abstract: OBJECTIVE
  To assess whether forest therapy is effective for treating depression and anxiety in patients with chronic stroke by using several psychological tests. We measured reactive oxygen metabolite (d-ROM) levels and biological antioxidant potentials (BAPs) associated with psychological stress.
  
  
  METHODS
  Fifty-nine patients with chronic stroke were randomly assigned to either a forest group (staying at a recreational forest site) or to an urban group (staying in an urban hotel); the duration and activities performed by both groups were the same. Scores on the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D17), Spielberger State-Trait Anxiety Inventory (STAI), d-ROMs and BAPs were evaluated both before and after the treatment programs.
  
  
  RESULTS
  In the forest group, BDI, HAM-D17 and STAI scores were significantly lower following treatment, and BAPs were significantly higher than baseline. In the urban group, STAI scores were significantly higher following treatment. Moreover, BDI, HAM-D17 and STAI scores of the forest group were significantly lower, and BAPs were significantly higher following treatment (ANCOVA, p <0.05).
  
  
  CONCLUSIONS
  Forest therapy is beneficial for treating depression and anxiety symptoms in patients with chronic stroke, and may be particularly useful in patients who cannot be treated with standard pharmacological or electroconvulsive therapies.
authors.affiliation: a 1 Department of Physical Medicine and Rehabilitation, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Min Ho
authors.initials: MH
authors.lastname: Chun
authors.affiliation: a 1 Department of Physical Medicine and Rehabilitation, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea.
authors.forename: Min Cheol
authors.initials: MC
authors.lastname: Chang
authors.affiliation: b 2 Department of Integrative Medicine, College of Medicine , Korea University , Seoul , Republic of Korea.
authors.forename: Sung-Jae
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology* / Q000534:rehabilitation*; D002908:Chronic Disease; D013790:Climatotherapy / Q000592:standards*; D003863:Depression / Q000209:etiology*; D005260:Female; D065928:Forests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
keywords: anxiety; depression; forest therapy; stroke