Nature-based interventions for enhancing resilience in children: a systematic review and meta-analysis

Despite increasing interest in nature-based interventions (NBIs) for mental health, no or very few prior reviews have quantitatively synthesised their effects on children's resilience, a key developmental outcome. This study systematically reviews and meta-analyses available evidence following PRISMA guideline. The Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, Education Resources Information Center, Medline, APA PsycArticles, SPORTDiscus, and Web of Science were searched from inception to November 28, 2024. For additional studies, Google Scholar and references from included studies were searched. The review included randomised clinical trials, controlled trials, and single-group pre-post studies reporting resilience. Findings not synthesised quantitatively were summarised narratively. A total of 13 articles involved 15 studies with 2,571 participants (mean age 15.57 years; range 13 to 17 years; 1315 [53%] female). Random-effect meta-analysis indicated significant moderate-to-large short-term effects of NBIs on children's resilience (standardised mean difference, 0.64; 95% confidence level, 0.36 to 0.91; p <.001). Substantial heterogeneity of intervention effects was observed (I² = 98%). This review provides preliminary evidence that NBIs may be associated with short-term improvements in resilience among children, though results should be interpreted cautiously due to study limitations. This early evidence highlights a community-based approach that may support resilience development through nature. Sailing showed some promise as an early observation noted in subgroup analysis and narrative synthesis emphasising nature-human kinship. High-quality trials are needed to evaluate the effects of sailing on resilience and address gaps: the long-term effect of NBIs and their impact on children outside the 13-17 age range. Trail registration: PROSPERO database (CRD42025634371).