The Efficacy of Local Versus Overseas Natural Environments in 360-Degree Virtual Reality Video for Improving Mental...

Objective: This study aimed to compare the efficacy of immersive 360-degree Virtual Reality (VR) videos depicting local (Malaysian) versus overseas (Western European) natural environments on the mental health of medical students. The primary outcome was overall mental well-being (WHO-5), and the co-secondary outcomes were changes in anxiety, stress, and depression symptoms (DASS-21). Methods: A two-arm parallel randomized trial was conducted with 84 fourth-year and fifth-year medical students. Participants were randomized into two groups (n = 42 each) using a custom, gender-balancing minimization algorithm: Group 1 viewed local environments, and Group 2 viewed overseas environments. Each participant underwent two 15-min VR sessions spaced two weeks apart. Outcomes were measured at baseline (T0), after the first intervention (T1), and at the primary time point after the second intervention (T2). Data were analyzed using a repeated-measures ANOVA with Greenhouse-Geisser and Bonferroni corrections. Results: The VR intervention demonstrated a statistically significant improvement in well-being (p < 0.001, ηp2 = 0.380) and a significant reduction in anxiety (p < 0.001, ηp2 = 0.255) and stress (p < 0.001, ηp2 = 0.311) across all participants over time. No significant change was observed in depression scores (p = 0.122, ηp2 = 0.028). Notably, there were no statistically significant differences between the local and overseas groups for well-being (p = 0.399, ηp2 = 0.011), anxiety (p = 0.593, ηp2 = 0.005), stress (p = 0.945, ηp2 < 0.001), or depression (p = 0.546, ηp2 = 0.006). Conclusions: A two-session immersive VR nature intervention is effective for improving well-being and reducing anxiety and stress in medical students. The geographical familiarity of the environment did not significantly impact therapeutic effectiveness, suggesting that the restorative effects of virtual nature may generalize across different environmental and cultural contexts. Trial Registration: NCT07447310; retrospectively registered on 25 February 2026.