Can Even a Small Amount of Greenery Be Helpful in Reducing Stress? A Systematic Review

A positive experience of nature triggers beneficial mental and physical responses. Today, we live in a rapidly urbanizing world where access to nature is often limited. Against this backdrop, this systematic review investigated studies on the effectiveness of small-scale greenery for stress reduction. We searched EMBASE, Cochrane, Web of Science, Scopus, PubMed, and Science Direct, searching databases from inception to April 2022. Studies were screened against predetermined criteria, and the risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions for RCTs and The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Of the 2500 records identified, we screened 1817 citations for eligibility, which included 13 RCT studies and 6 non-RCT studies. The studies were conducted in eight different countries. The study populations included office workers, students, senior citizens, and patients with specific diseases. Research has mainly focused on indoor greening, with relatively little research on small-scale outdoor greening. All included studies assessed the impact of the intervention on various stress reduction-related outcomes, with the most common stress measures being blood pressure and the State Trait Anxiety Inventory (STAI). Various beneficial effects of the interventions on human health were reported in all 19 studies, 15 of which reported positive effects on stress reduction. All included studies were at high risk of bias. It is recommended that future studies in this area take appropriate measures to reduce bias and improve quality in order to build a strong evidence-based medical foundation. According to our findings, even very small-scale greening, including indoor green walls and potted plants, may provide effective help for stress relief. Understanding the physiological and psychological benefits of small-scale greenery can help better provide more opportunities for urban residents to engage with nature in the context of dense urban trends, as well as provide some reference for urban design planning.