Benefits of Outdoor Walks in Reducing Depressive Symptoms

Not Applicable

Recruiting

• Conditions: Depressive Symptoms

• Registration Number: NCT06989801
• Lead Sponsor: University of Washington

Brief Summary

The goal of this clinical trial is to determine whether outdoor walking in different environments-urban or natural-can reduce depressive symptoms among college students. The study also tests whether providing prompts for active engagement during nature walks enhances the benefits compared to unstructured nature walks.

Participants will be randomly assigned to one of three groups: (1) urban walk, (2) nature walk, or (3) active nature walk with guided interaction. Each participant will walk for 30 minutes, twice a week, for 3 weeks, complete questionnaires, and participate in interviews.

Our primary outcome (PHQ-9) will be used to test the following two primary hypotheses:

* Hypothesis 1: Participants in both nature walk conditions (combined) will show greater reductions in depressive symptoms (PHQ-9) than those in the urban walk group.

* Hypothesis 2: Participants in the active nature walk will show greater reductions than those in the regular nature walk.

Detailed Description

The investigators aim to compare how walking in different outdoor environments influences depressive symptoms among college students. Specifically, the investigators will assess:

1. walking in an urban environment (like a busy city street),

2. walking in a natural environment regularly (e.g., walking without specific guidance), and

3. walking in a natural environment with guided interaction prompts (e.g., noticing birds, listening to sounds, touching flowers).

Standardized questionnaires will measure changes in depressive symptoms, anxiety, affect, cognitive flexibility, nature connection, and Presence across all three groups.

The investigators will also explore potential mechanisms behind any observed effects, including interaction patterns, presence, cognitive changes, and emotional responses to the different environments.

Study Timeline

• Study Start: 2025-04-11
• Study First Submitted: 2025-04-11
• Status Verified: 2025-05
• Study First Submitted QC: 2025-05-22
• Last Update Submitted: 2025-05-22
• Study First Posted: 2025-05-25
• Last Update Posted: 2025-05-25
• Primary Completion: 2025-12-17
• Study Completion: 2025-12-27

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 180

Inclusion Criteria

• College students in Seattle
• Aged over 18.
• Having depressive symptoms with self-rated Patient Health Questionnaire-9 (PHQ-9) scored higher than 5.
• Normal or corrected-to-normal visual acuity.
• No identified hearing impairment.
• No history of neurological or mental disorders.

Exclusion Criteria

• Receiving clinical psychiatric treatment or psychological counseling.
• Failing in providing consent form.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Patient Health Questionnaire	Right before the first walking session, immediately after the sixth walking session, and one month after the sixth walking session.	Patient Health Questionnaire measures the severity of depressive symptoms. It includes nine items that evaluate symptoms such as persistent sad, loss of interest or pleasure in activities, fatigue, and lack of energy. Each item is rated on a 4-point Likert scale, ranging from 0 (not at all) to 3 (nearly every day). Higher scores indicate more severe symptoms of depression.

Secondary Outcome Measures

Name	Time	Method
Presence Scale	Immediately after each walking session.	Presence Scale measures the state of being in which conditioned thinking ceases, and the mind is open, aware, non-reactive, and still; and often a witness of itself. Participants rated each item on a 7-point Likert scale, ranging from 1 (not at all) to 7 (completely). Higher scores indicate higher levels of Presence.
Generalized Anxiety Disorder 7-item scale	Right before the first walking session, immediately after the sixth walking session, and one month after the sixth walking session.	Generalized Anxiety Disorder 7-item scale measures the severity of anxiety. It includes seven items, such as persistent nervousness, excessive worrying, difficulty relaxing, feeling restless, and becoming easily irritated. Each item is rated on a 4-point Likert scale, ranging from 0 (not at all) to 3 (nearly every day). Higher scores indicate more severe anxiety.
Positive and Negative Affect Scale	Right before the first walking session, immediately after the sixth walking session, and one month after the sixth walking session.	Positive and Negative Affect Scale measures positive and negative affect. The scale consists of 20 items, with 10 assessing positive affect (e.g., "passionate," "excited") and 10 assessing negative affect (e.g., "distressed," "upset"). Participants rated how strongly they experienced each emotion on a 5-point Likert scale, from 1 (very slightly or not at all) to 5 (very strongly).
Cognitive Flexibility Inventory	Right before the first walking session, immediately after the sixth walking session, and one month after the sixth walking session.	Cognitive Flexibility Inventory measures individuals' ability to adapt to changing situations and consider multiple perspectives. Participants rated each item on a 5-point Likert scale, ranging from 1 (never) to 5 (always). Higher scores indicate greater cognitive flexibility.
Extended Inclusion of Nature in Self scale	Right before the first walking session, immediately after the sixth walking session, and one month after the sixth walking session.	Extended Inclusion of Nature in Self scale measures individuals' perceived connection with nature, which refers to the degree to which individuals incorporate nature into their self-concept. Each item consists of seven pictures, scored on a 7-point scale, with higher scores indicating a stronger connection to nature.

Trial Locations

Locations (2)

Condon Hall; 🇺🇸 Seattle, Washington, United States

Merrill Hall; 🇺🇸 Seattle, Washington, United States