Bringing Nature Into a Psychiatric Ward: Virtual Travels for Inpatient Care in People With Lived Experience of a Severe Mental Disorder

The aim of this study is to investigate the effect of implementing a virtual reality travel into nature application (Toujours Dimanche) in an inpatient psychiatric unit servicing individuals with complex mood disorders. Via a head mounted device, the application allows individuals to immerse themselves into 360 natural environments and offers the possibility to interact with another individual through a private platform. Recruitment will take place on a psychiatric inpatient unit dedicated to individuals with complex mood disorders (e.g. bipolar disorder, unipolar depression). Flyers will be posted at the unit to recruit people hospitalized. Participants with lived experience will also be recruited through the reference of their health care providers at the unit (i.e. treating psychiatrists or other members of the staff). In all cases, the health care provider will obtain the clients' consent prior to being contacted by the research assistant. The research assistant will then meet the prospective participant in person at the unit to explain the research project (inclusion criteria, the consent and assessment procedures, and the application if the participant is interested in being included in the active group) and answer any questions or concerns. Each participant will be presented with the consent form. Additionally , we plan on organizing short presentations to the people hospitalized at the unit. Given the short-term hospitalization at the unit, the researchers want people to hear about the project, but also being able to ask their questions directly to the research team.

For health care providers, they will be recruited through staff meetings. The research coordinator will present the project to professionals during staff meetings and flyers will be posted at the nursing station.

Data Collection and Analysis:

The connectedness to nature scale (CNS) (Mayer & Frantz, 2004) will be administered at baseline only. The CNS is a 14 self-report item questionnaire that assesses individuals' trait levels of feeling emotionally connected to the natural world. The researchers expect that each participant will have a different perspective toward nature that could influence the potential use and effect of the application. The following questionnaires will be administered both at baseline and post-test. The Beck Anxiety Scale (BAI; (Beck et al., 1988)) is a self-report questionnaire that includes 21 items rated on a Likert scale of 0 (not at all) to 3 (Severely). Given that the goal of the Toujours Dimanche application is to reduce stress, the researchers believe it is important to measure anxiety before and after using the application. The BAI has adequate psychometric properties and is a well-recognized scale that encompasses the cognitive, emotional, and physical components of anxiety. The Kessler Psychological Distress Scale (K10) (Kessler et al., 2002) is a 10-item self-report questionnaire assessing distress through questions about anxiety and depression. The 10 items are rated on a Likert scale ranging from 1 (None of the time) to 5 (All the time). Regarding stress, the researchers included the Perceived Stress Scale (PSS), a 10-item self-report questionnaire assessing subjective stress using a Likert scale from 1 (never) to 5 (very often) (Cohen & Williamson, 1988). For the current study, the questionnaire will be modified to adjust the timeframe for the assessment of perceived stress from one month to two weeks. For depressive symptoms, the PHQ-9 (Kroenke et al., 2001) will be used. This 9-item self-report questionnaire assesses depressive symptoms in the last two weeks, rated on a Likert scale ranging from 0 (not at all) to 3 (nearly every day) and has good psychometric properties (Kroenke et al., 2001). Wellbeing will be assessed with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) (Tennant et al.2007), a 14-item self-report questionnaire using a Likert scale from 1 (never) to 5 (all the time) with good psychometric properties (Lloyd et al., 2012). This scale assesses wellbeing with an holistic approach in the last two weeks. Social isolation will be assessed through a measure of loneliness, and more specifically with the De Jong Gierveld Loneliness Scale - short version (DJGLS) (Gierveld & Tilburg, 2006). This 6-item self-report questionnaire assess overall, emotional, and social loneliness using a Likert scale ranging from 0 (not lonely) to 11 (extremely lonely).

At post-test, the research team will conduct a short semi-structured interview regarding the active group participants' opinion on the application as well as the barriers and facilitators to use it. The audio of this interview will be recorded (as specified in the consent form). The interview will then be transcribed and deleted. Psychiatric diagnosis, medication, duration of illness as well as the number and duration of hospitalizations will be collected from participants' medical records. The participants' consent to access personal information will be asked beforehand (non-mandatory), as part of the informed consent procedure. All measures of baseline will be administered in person at the unit. At post-test, the assessment will be conducted in person at the unit if the participant is still hospitalized. If the person was discharged from the unit, the participant will have the choice to complete the assessment in person at the Douglas, or remotely.