Evaluation of Horticultural Therapy on the Emotional Improvement of Depressed Patients by Using Heart Rate Variability

심박변이도를 이용한 우울증 환자의 정서개선에 미치는 원예치료 효과 분석

  • Song, Mi-Jin (Department of Environmental Horticulture, University of Seoul) ;
  • Kim, Mi-Young (Department of Occupational Therapy, Seoul Metropolitan Eunpyeong Hospital) ;
  • Sim, Iee-Sung (Department of Environmental Horticulture, University of Seoul) ;
  • Kim, Wan-Soon (Department of Environmental Horticulture, University of Seoul)
  • 송미진 (서울시립대학교 환경원예학과) ;
  • 김미영 (서울시립은평병원 작업치료과) ;
  • 심이성 (서울시립대학교 환경원예학과) ;
  • 김완순 (서울시립대학교 환경원예학과)
  • Received : 2010.08.09
  • Accepted : 2010.09.24
  • Published : 2010.12.31


To evaluate the effect of horticultural therapy (HT) on the emotional improvement of depressed patients, computer-based heart rate variability (HRV) was compared with self-report scale (SRS) known as existing subjective evaluation method. SRS included four test areas: mental stress scale (MSS), physical stress scale (PSS), Beck anxiety inventory (BAI), and Beck depression inventory (BDI). HRV was itemized into four parameters: standard deviation of the N-N intervals (SDNN), square root of mean squared difference of successive N-N intervals (RMSSD), total power (TP), and low-frequency/high-frequency ratio (LF/HF ratio). Thirty patients with depression at the same mental hospital participated in this study. 15 patients of the treatment group received HT once a week for three months, but the control group did not during the same period. As a result, the emotional improvement in treatment group was clearly identified through HRV as well as SRS. The significant difference was shown at three test areas (MSS, BAI, and BDI, $p$ < 0.001) in SRS and at one parameter (total power, $p$ < 0.05) in HRV. There was noticeable increase in SDNN, RMSSD, and LF/HF ratio in treatment group after HT activity, but no significant difference. Although all parameters of HRV did not show significance, the possibility of HRV as an objective evaluation method to HT was recognized in this study. These results also implied that HT was efficient in the mental and physical regeneration of the depressed patients in both subjective and objective evaluation methods.


  1. Agelink, M.W., C. Boze, H. Ulrich, and J. Andrick. 2002. Relationship between major depression and heart rate variability: Clinical consequences and implications for antidepressive treatment. Psychiatry Res. 113:139-149. https://doi.org/10.1016/S0165-1781(02)00225-1
  2. Beck, A.T., N. Epstein, G. Brown, and R.A. Steer. 1988. An inventory for measuring clinical anxiety: Psychometric properties. J. Consulting Clinical Psychology 56:893-897.
  3. Beck, A.T., C. Ward, M. Mendelson, M. Mock, and J. Erbaugh. 1961. An inventory for measuring depression. Arch. Gen. Psychiatry 4:53-63.
  4. Binkley, P.D.F., E. Nunziata, J. Haas, D. Nelson, and J. Cody. 1991. Parasympathetic withdrawal is an integral component of autonomic imbalance in congestive heart failure: Demonstration in human subjects and verification in a paced canine model of ventricular failure. J. Am. Coll. Cardiol. 18:464-472. https://doi.org/10.1016/0735-1097(91)90602-6
  5. Carney, R., K.E. Freeland, P.K. Stein, J.A. Skala, P. Hoffman, and A.S. Jaffe. 2000. Change in heart rate and heart rate variability during treatment for depression in patients with coronary heart disease. Psychosom. Med. 62:639-647.
  6. Guinjoan, S.M. and J.L. Bernabo. 1995. Cardiovascular tests of autonomic function and sympathetic skin responses in patients with major depression. J. Neurol. Neurosurgery Psychiatry 58:299-302.
  7. Hjortskov, N., D. Rissen, A.K. Blangsted, N. Fallentin, U. Lundberg, and K. Sogaard. 2004. The effect of mental stress on heart rate variability and blood pressure during computer work. Eur. J. Appl. Physiol. 92:84-89. https://doi.org/10.1007/s00421-004-1055-z
  8. Huikuri, H.V., M.K. Linnaluoto, T. Seppänen, K.E. Airaksinen, K.M. Kessler, J.T. Takkunen, and R.J. Myerburg. 1992. Circadian rhythm of heart rate variability in survivors of cardiac arrest. Am. J. Cardiol. 70:610-615. https://doi.org/10.1016/0002-9149(92)90200-I
  9. Hwang, H.J., Y.A. Lee, J.E. Song, and K.C. Son. 2007. Effect of horticultural therapy based upon reality therapy on the reduction of depression the change in parental sense of competence and stress coping types of elementary student's mother. Kor. J. Hort. Sci. Technol. 25:268-276.
  10. Keeve, B.A., A.J. Erdmann, I. Lorge, H.G. Wolff, and H.B. Todd. 1949. The Cornell Medical Index: An adjunct to medical interview. J. Am. Med. Assoc. 140:530-534. https://doi.org/10.1001/jama.1949.02900410026007
  11. Khaykin, Y., P. Dorian, and B. Baker. 1998. Autonomic correlates of antidepressant treatment using heart rate variability analysis. Can. J. Psychiatry 43:183-186.
  12. Kim, K.H., H.R. Lee, M.O. Song, S.H. Chung, and H.J. Chung. 2006. Effects of horticultural therapy program on serum cortisol, pain, anxiety and depression of the hospice patients. Kor. J. Hort. Sci. Technol. 24:95-103.
  13. Lee, E.S., M.K. Cho, J.W. Yoon, and K.C. Son. 2008. Effect of horticultural therapy program based on reminiscence on the psychological and physiological improvement of the aged. Kor. J. Hort. Sci. Technol. 26:177-188.
  14. Lee, J.S. and K.C. Son. 1999. Effects of indoor plant and various colors' stimuli on the changes of brain activity and emotional responses. J. Kor. Soc. Hort. Sci. 40:772-776.
  15. Lee, M.K., Y.H. Lee, S.H. Park, C.H. Sohn, Y.C. Chung, and S.K. Hong. 1995. A standardization study of beck depression inventory I-Korean version (K-BDI): reliability and after analysis. Kor. J. Psychopathol. 4:77-95.
  16. O'Connor, M.F., J.J. Allen, and A.W. Kaszniak. 2002, Autonomic and emotion regulation in bereavement and depression. J. Psychosom. Res. 52:83-85.
  17. Seo, K.S., J.B. Choi, Y.S. Heo, B.C. Ahn, S.R. Kim, and Y.S. Kim. 2005. A pilot study of HRV (heart rate variability) in patient with urinary incontinence. J. Kor. Continence Soc. 9:150-134.
  18. Song, J.E. 2004. Changes in psycho physiological and stress responses of indoor workers according to interior plantscape. PhD. Diss. Konkuk Univ., Korea.