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Non-suicidal self-harm is a serious issue. Adolescents with depression are among the high-risk groups for non-suicidal self-harm behavior. Therapeutic gardening uses plant cultivation and corresponding gardening activities as the medium of action, allowing patients to obtain therapeutic benefits by participating in gardening activities such as planting, maintaining, and harvesting plants. Therefore, this study will apply therapeutic gardening based on the healing system to adolescents with depression who have non-suicidal self-harm behavior, in order to improve their non-suicidal self-harm behavior, negative emotions, emotional expression disorders, self-efficacy, sleep quality, and loneliness.
Based on the theories of positive psychology and the healing system theory framework, referring to relevant domestic and foreign literature and consulting books such as "Introduction to Horticultural Therapy", "Horticultural Rehabilitation Therapy Techniques", and "Horticultural Therapy: Growing Good Health for the Body and Mind", an intervention plan was formulated under the guidance of experts. A randomized controlled trial design was adopted. It is planned to carry out therapeutic horticulture based on the healing system for adolescent patients with depression who have non-suicidal self-harming behaviors, according to the intervention plan. By evaluating and comparing the changes and differences in indicators such as non-suicidal self-harming behaviors, emotions, physical functions, skills, and social interaction of the experimental group and the control group before and after the intervention, the actual effect of therapeutic horticulture based on the healing system in reducing the occurrence of non-suicidal self-harming behaviors among adolescent patients was verified. Finally, data analysis and paper writing were conducted.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | Other | Routine treatment and nursing |
|
| Therapeutic Horticulture group | Experimental | Routine treatment and nursing and Therapeutic Horticulture |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Therapeutic Horticulture | Behavioral | Therapeutic Horticulture uses plant cultivation and related gardening activities as the medium of action, allowing patients to participate in gardening activities such as planting, maintenance, and harvesting of plants. |
| Measure | Description | Time Frame |
|---|---|---|
| The level and frequency of non-suicidal self-injury | The adolescent self-harm questionnaire was used to measure.This questionnaire is a self-assessment form, consisting of 19 items. Among them, the frequency of non-suicidal self-injury behavior is scored using the Likert 4-point scale: "0 times" is scored 0 points, "1 time" is scored 1 point, "2-4 times" is scored 2 points, and "5 times or more" is scored 3 points. The degree of physical harm caused is scored using the Likert 5-point scale: "No" is scored 0 points, "Mild" is scored 1 point, "Moderate" is scored 2 points, "Severe" is scored 3 points, and "Extremely severe" is scored 4 points. NSSI equivalence is equal to the product of the NSSI frequency score and the NSSI severity score. The higher the score, the more severe the condition. | Day 1 and Day 14 |
| Measure | Description | Time Frame |
|---|---|---|
| depressive symptom | Hamilton Depression Rating Scale-17 was used to measure.There are a total of 17 items. The lowest score of the Hamilton Depression Scale - 17 items (HAMD-17) is 0, and the highest score is 52. A total score of ≥ 24 may indicate severe depression; a score of 17 ≤ total score < 24 may indicate mild or moderate depression; a total score of ≤ 7 may indicate no depression. The higher the score, the more severe the depressive symptoms. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Lei Huang, bachelor degree | Contact | 0086-13660135023 | huanglei8126@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Zhichun Xia | The Affiliated Brain Hospital of Guangzhou Medical University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Affiliated Brain Hospital, Guangzhou Medical University | Guangzhou | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42325965 | Derived | Huang L, Hong TD, Liang SC, Huang ZJ, Liang YX, Shen LF, Xia ZC. The effect of therapeutic horticulture on non-suicidal self-injury in adolescents with major depressive disorder: protocol for a randomized controlled trial. Front Psychiatry. 2026 Jun 4;17:1790759. doi: 10.3389/fpsyt.2026.1790759. eCollection 2026. |
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| Routine treatment and nursing | Other | The conventional treatment mainly involves the use of antidepressant drugs, supplemented by physical therapy, psychological therapy, and rehabilitation training, etc. The routine care includes admission introduction, health education (manifestations, hazards, treatment methods of depression and non-suicidal self-harm, as well as the importance of following medical advice for treatment), medication guidance, discharge guidance, and psychological care, etc. |
|
| Day 1 and Day 14 |
| sleep quality | The Pittsburgh Sleep Quality Index was used to measure.This scale is used to assess an individual's recent sleep quality. It consists of 19 self-assessment items and 5 other-rater items. The 19th self-assessment item and the 5 other-rater items do not contribute to the scoring. The first 18 items cover subjective sleep quality, sleep onset time, sleep duration, sleep efficiency, sleep disorders, hypnotic drugs, and daytime functional impairment. Each factor is scored on a scale of 0 to 3, and the total score of all factors is the PSQI total score. The total score ranges from 0 to 21, and a higher PSQI total score indicates poorer sleep quality. | Day 1 and Day 14 |
| alexithymia | The Toronto Alexithymia Scale was used to measure.The scale consists of 20 items, including three factors: inability to identify emotions, inability to describe emotions, and extroverted thinking. It uses a 5-point scale from 1 (completely disagree) to 5 (completely agree), with a total score range of 20 to 100. The higher the score, the more severe the alexithymia is. | Day 1 and Day 14 |
| loneliness | The UCLA loneliness Scale was used to measure.This scale is used to assess an individual's level of loneliness, consisting of 20 items, with a 4-point rating scale ranging from 1 to 4. Some of the items are reverse-scored. The total score is the sum of the scores of each item. The total score ranges from 20 to 80, with a higher total score indicating a stronger sense of loneliness. | Day 1 and Day 14 |
| self-efficacy | The general self-efficacy scale was used to measure.This scale consists of 10 items. It uses a 4-point rating system, where "completely incorrect" is scored as 1 point, "somewhat correct" as 2 points, "mostly correct" as 3 points, and "completely correct" as 4 points. The highest score is 40 points and the lowest score is 10 points. The higher the score, the higher the level of self-efficacy. | Day 1 and Day 14 |
| ID | Term |
|---|---|
| D003863 | Depression |
| ID | Term |
|---|---|
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D058611 | Horticultural Therapy |
| D009729 | Nursing |
| ID | Term |
|---|---|
| D000529 | Complementary Therapies |
| D013812 | Therapeutics |
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
| D011364 | Professional Practice |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
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