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Article(id=1324050893636776790, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509342, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1758297600000, receivedDateStr=2025-09-20, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607932719, onlineDateStr=2026-11-02, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607932719, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607932719, creator=13701087609, updateTime=1793607932719, updator=13701087609, issue=Issue{id=1324050876230415089, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607928569, creator='13701087609', updateTime=1793670049253, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311429322507008, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311429322507009, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2048, endPage=2053, ext={EN=ArticleExt(id=1324050893867463511, articleId=1324050893636776790, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of horticultural therapy on depressive symptoms among older adults in nursing homes: a moderated mediation model, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

Horticultural therapy (HT), a widely adopted non-pharmacological intervention, mitigates depressive symptoms among older adults. Given China’s aging population, examining the effect of HT on depressive symptoms among older adults in nursing homes is of practical significance.

Methods

Based on three-wave longitudinal panel data from 2022 to 2024 among older adults in Shanghai J Nursing Group facilities, propensity score matching was employed to control for confounding variables and analyze the mechanism of HT’s effect on depressive symptoms among older adults in nursing homes.

Results

HT had a significant predictive effect on depressive symptoms among older adults in nursing homes (β=-1.582, P<0.001). Psychological resilience partially mediated the relationship between HT and depressive symptoms (β=-0.501, 95% CI: -0.772~-0.287), accounting for 31.7% of the total effect. Sleep quality moderated the impact of HT on psychological resilience (β=0.077, P<0.05).

Conclusion

Government departments should promote the integration of HT into standard elderly care protocols and establish a combined model focusing on horticultural therapy, psychological resilience, and sleep health management to improve psychological well-being among older adults in nursing homes.

, authors=Han-wei LI, Jing ZHOU, authorsList=Han-wei LI, Jing ZHOU, authorCompany=null, correspAuthors=Jing ZHOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324050896526652257, articleId=1324050893636776790, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=园艺疗法对机构老年人抑郁症状的影响研究——有调节的中介模型, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

园艺疗法是国际上广泛用于改善老年人抑郁症状的非药物干预手段，在积极应对人口老龄化的背景下，研究园艺疗法对我国机构老年人抑郁症状的影响具有重要的现实意义。

方法

基于2022—2024年上海J养老集团旗下养老机构老年人的三期追踪面板数据，运用倾向得分匹配法控制混杂变量，分析园艺疗法对机构老年人抑郁症状的影响机制。

结果

园艺疗法对机构老年人抑郁症状的预测作用显著（β=-1.582，P<0.001）；心理韧性在园艺疗法与机构老年人抑郁症状之间起到部分中介作用（β=-0.501， 95%CI：-0.772～-0.287），占比为31.7%；睡眠质量在园艺疗法对心理韧性的预测作用中起到调节作用（β=0.077，P<0.05）。

结论

政府部门应推动养老机构及社区照护体系将园艺疗法纳入老年人常规照护方案，建立融合园艺疗法、心理韧性与睡眠健康管理的综合干预模式，从而更好促进机构老年人的心理健康水平。

, authors=李含伟, 周境, authorsList=李含伟, 周境, authorCompany=null, correspAuthors=周境, authorNote=

李含伟（1983—），男，博士，教授，研究方向：社会保障、老龄化、养老服务

, correspAuthorsNote=
周境，E-mail：
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Geriatrics & Gerontology International, 2021, 21(6): 538-539., articleTitle=Indoor horticultural therapy for older adults living in a nursing home: Bedside structured floral arrangement program, refAbstract=null), Reference(id=1324050902725833623, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, doi=null, pmid=null, pmcid=null, year=2023, volume=123, issue=5, pageStart=761, pageEnd=769.e3, url=null, language=null, rfNumber=[13], rfOrder=15, authorNames=Veldheer S, Tuan WJ, Al-Shaar L, journalName=Journal of the Academy of Nutrition and Dietetics, refType=null, unstructuredReference=Veldheer S, Tuan WJ, Al-Shaar L, et al. Gardening is associated with better cardiovascular health status among older adults in the United States: analysis of the 2019 behavioral risk factor surveillance system survey[J]. Journal of the Academy of Nutrition and Dietetics, 2023, 123(5): 761-769.e3., articleTitle=Gardening is associated with better cardiovascular health status among older adults in the United States: analysis of the 2019 behavioral risk factor surveillance system survey, refAbstract=null), Reference(id=1324050902801331096, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, doi=null, pmid=null, pmcid=null, year=2024, volume=23, issue=5, pageStart=e59, pageEnd=e60, url=null, language=null, rfNumber=[14], rfOrder=16, authorNames=Lambrinou E, Protopapas A, Kyriakou, journalName=European Journal of Cardiovascular Nursing, refType=null, unstructuredReference=Lambrinou E, Protopapas A, Kyriakou, et al. From single advanced nursing interventions to a comprehensive advanced clinical role: the way to go?[J]. European Journal of Cardiovascular Nursing, 2024, 23(5): e59-e60., articleTitle=From single advanced nursing interventions to a comprehensive advanced clinical role: the way to go?, refAbstract=null), Reference(id=1324050902868439961, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, doi=null, pmid=null, pmcid=null, year=2023, volume=11, issue=1, pageStart=171, pageEnd=null, url=null, language=null, rfNumber=[15], rfOrder=17, authorNames=Rezaie L, Norouzi E, Bratty AJ, journalName=BMC Psychology, refType=null, unstructuredReference=Rezaie L, Norouzi E, Bratty AJ, et al. Better sleep quality and higher physical activity levels predict lower emotion dysregulation among persons with major depression disorder[J]. BMC Psychology, 2023, 11(1): 171., articleTitle=Better sleep quality and higher physical activity levels predict lower emotion dysregulation among persons with major depression disorder, refAbstract=null)], funds=[Fund(id=1324050901354296199, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, awardId=21BRK006, language=CN, fundingSource=国家社会科学基金项目(21BRK006), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324050896778310498, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, xref=null, ext=[AuthorCompanyExt(id=1324050896786699107, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, companyId=1324050896778310498, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Management, Shanghai University of Engineering Science, Shanghai 201620, China), AuthorCompanyExt(id=1324050896795087716, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, companyId=1324050896778310498, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=上海工程技术大学管理学院，上海 201620)])], figs=[ArticleFig(id=1324050898317620087, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=EN, label=Figure 1, caption=The moderating effect of sleep quality on the relationship between horticultural therapy and psychological resilience, figureFileSmall=wrFb0CApNIDK2FnonEYjmw==, figureFileBig=IE6zcnFHvZFOFEc1INhYKA==, tableContent=null), ArticleFig(id=1324050898376340344, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=CN, label=图1, caption=睡眠质量在园艺疗法与心理韧性之间的调节作用, figureFileSmall=wrFb0CApNIDK2FnonEYjmw==, figureFileBig=IE6zcnFHvZFOFEc1INhYKA==, tableContent=null), ArticleFig(id=1324050898581861241, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=EN, label=Table 1, caption=

Baseline demographic characteristics, depressive symptoms, and psychological resilience scores of the control and intervention groups ［n=442，n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量控制组(n=270)处理组(n=172)
人数（%）抑郁症状心理韧性人数（%）抑郁症状心理韧性
年龄（岁）
60～7492（34.07）10.513±5.54928.665±3.34680（46.51）8.724±5.38730.048±3.399
75～8974（27.41）11.487±5.54028.332±3.16956（32.56）9.364±5.22929.737±3.115
90～120104（38.52）10.973±5.65828.073±4.24436（20.93）9.297±4.98529.223±3.960
户口
乡村58（21.45）10.870±5.79628.687±3.87680（46.23）8.343±5.08330.409±2.999
城市212（78.55）10.993±5.62128.218±3.61292（53.77）9.543±5.27129.288±3.167
性别
女性149（55.12）11.792±5.76027.818±4.08982（47.78）9.731±5.53929.416±3.442
男性121（44.88）9.984±5.36828.907±2.99590（52.22）8.423±4.85730.070±2.831
婚姻状况
未婚/离异/丧偶140（52.03）11.411±5.80728.098±3.97075（43.71）9.625±5.39929.516±2.805
已婚130（47.97）10.472±5.44328.554±3.29297（56.29）8.575±5.04229.958±3.372
受教育程度
文盲143 （52.90）11.654±5.77927.732±4.19948 （27.66）9.730±5.72929.063±3.358
小学88 （32.68）10.283±5.46928.861±2.95765 （38.10）8.802±4.88429.932±2.861
初中22 （8.26）9.458±5.22329.375±2.43831 （17.79）8.297±475629.932±3.207
高中或中专10 （3.58）10.188±5.61228.438±2.44917 （10.06）8.238±5.20230.500±2.671
大专及以上7 （2.59）12.625±4.86830.125±2.53211 （6.38）10.850±5.70630.700±3.962
经济来源
离退休金196（72.38）10.671±5.38528.446±3.555152（88.97）8.898±5.12229.823±3.199
子女给予34（12.58）11.553±6.07027.907±4.43314（7.93）9.714±5.86229.500±2.755
最低生活保障金23（8.63）12.024±6.12727.952±3.5755（2.71）11.667±6.35828.583±1.730
其他收入17（6.41）12.200±7.20328.000±3.2911（0.39）12.333±5.53827.734±3.408
患慢性病种类（种）
046（17.26）9.632±4.98329.832±2.99548（27.66）7.561±4.16330.509±2.594
1～2196（72.50）10.756±5.58128.259±3.557110（64.22）9.214±5.11829.756±2.976
≥328（10.23）14.266±5.88826.406±4.30814（8.12）12.051±7.03727.667±4.561
子女情况
无子女5（1.97）13.750±4.55527.833±2.6572（1.16）11.250±6.39727.000±2.944
独生子女32（11.96）12.388±5.98027.910±3.19012（8.90）10.486±5.00928.757±3.041
多子女233（86.07）10.703±5.59228.381±3.751155（89.94）8.867±5.21529.893±3.131
养老金
无38（14.06）13.267±6.46527.090±4.05317（9.67）11.087±6.11728.152±4.289
有232（85.94）10.537±5.38628.543±3.550155（90.33）8.780±5.05229.963±2.920
医疗保险
无32（11.71）11.359±6.10827.922±4.16411（6.38）11.250±5.62228.679±4.563
有238（88.29）10.918±5.59628.364±3.602161（93.62）8.874±5.16229.843±3.010
), ArticleFig(id=1324050898661553018, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=CN, label=表1, caption=

控制组与处理组基线人口学特征、抑郁症状及心理韧性得分 ［n=442，n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量控制组(n=270)处理组(n=172)
人数（%）抑郁症状心理韧性人数（%）抑郁症状心理韧性
年龄（岁）
60～7492（34.07）10.513±5.54928.665±3.34680（46.51）8.724±5.38730.048±3.399
75～8974（27.41）11.487±5.54028.332±3.16956（32.56）9.364±5.22929.737±3.115
90～120104（38.52）10.973±5.65828.073±4.24436（20.93）9.297±4.98529.223±3.960
户口
乡村58（21.45）10.870±5.79628.687±3.87680（46.23）8.343±5.08330.409±2.999
城市212（78.55）10.993±5.62128.218±3.61292（53.77）9.543±5.27129.288±3.167
性别
女性149（55.12）11.792±5.76027.818±4.08982（47.78）9.731±5.53929.416±3.442
男性121（44.88）9.984±5.36828.907±2.99590（52.22）8.423±4.85730.070±2.831
婚姻状况
未婚/离异/丧偶140（52.03）11.411±5.80728.098±3.97075（43.71）9.625±5.39929.516±2.805
已婚130（47.97）10.472±5.44328.554±3.29297（56.29）8.575±5.04229.958±3.372
受教育程度
文盲143 （52.90）11.654±5.77927.732±4.19948 （27.66）9.730±5.72929.063±3.358
小学88 （32.68）10.283±5.46928.861±2.95765 （38.10）8.802±4.88429.932±2.861
初中22 （8.26）9.458±5.22329.375±2.43831 （17.79）8.297±475629.932±3.207
高中或中专10 （3.58）10.188±5.61228.438±2.44917 （10.06）8.238±5.20230.500±2.671
大专及以上7 （2.59）12.625±4.86830.125±2.53211 （6.38）10.850±5.70630.700±3.962
经济来源
离退休金196（72.38）10.671±5.38528.446±3.555152（88.97）8.898±5.12229.823±3.199
子女给予34（12.58）11.553±6.07027.907±4.43314（7.93）9.714±5.86229.500±2.755
最低生活保障金23（8.63）12.024±6.12727.952±3.5755（2.71）11.667±6.35828.583±1.730
其他收入17（6.41）12.200±7.20328.000±3.2911（0.39）12.333±5.53827.734±3.408
患慢性病种类（种）
046（17.26）9.632±4.98329.832±2.99548（27.66）7.561±4.16330.509±2.594
1～2196（72.50）10.756±5.58128.259±3.557110（64.22）9.214±5.11829.756±2.976
≥328（10.23）14.266±5.88826.406±4.30814（8.12）12.051±7.03727.667±4.561
子女情况
无子女5（1.97）13.750±4.55527.833±2.6572（1.16）11.250±6.39727.000±2.944
独生子女32（11.96）12.388±5.98027.910±3.19012（8.90）10.486±5.00928.757±3.041
多子女233（86.07）10.703±5.59228.381±3.751155（89.94）8.867±5.21529.893±3.131
养老金
无38（14.06）13.267±6.46527.090±4.05317（9.67）11.087±6.11728.152±4.289
有232（85.94）10.537±5.38628.543±3.550155（90.33）8.780±5.05229.963±2.920
医疗保险
无32（11.71）11.359±6.10827.922±4.16411（6.38）11.250±5.62228.679±4.563
有238（88.29）10.918±5.59628.364±3.602161（93.62）8.874±5.16229.843±3.010
), ArticleFig(id=1324050898732856187, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=EN, label=Table 2, caption=

Balance test

, figureFileSmall=null, figureFileBig=null, tableContent=
变量匹配情况Mean偏差率（%）偏差降低比率
（%）		t检验
处理组控制组t值P值
年龄（岁）U1.5301.904-42.9-7.4700.000
M1.5321.5152.095.30.3400.732
户口U0.5380.781-53.0-9.5700.000
M0.5400.550-2.196.0-0.3100.755
性别U0.5220.45513.52.4000.017
M0.5240.5132.382.80.3700.709
婚姻状况U0.5630.48914.92.6300.009
M0.5650.567-0.497.4-0.0600.950
受教育程度U1.2940.71754.49.8200.000
M1.2871.2374.891.30.7100.477
经济来源U1.1451.442-44.1-7.3800.000
M1.1461.1262.993.50.6900.487
患慢性病种类（种）U1.8051.921-21.4-3.8200.000
M1.8041.835-5.773.2-0.8900.376
子女情况U2.8882.8539.41.6500.100
M2.8872.913-6.828.2-1.2600.209
养老金U0.9030.86711.52.0100.044
M0.9030.8855.552.50.9100.362
医疗保险U0.9360.89016.32.8100.005
M0.9360.953-6.261.8-1.2300.220
), ArticleFig(id=1324050898804159356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=CN, label=表2, caption=

平衡性检验

, figureFileSmall=null, figureFileBig=null, tableContent=
变量匹配情况Mean偏差率（%）偏差降低比率
（%）		t检验
处理组控制组t值P值
年龄（岁）U1.5301.904-42.9-7.4700.000
M1.5321.5152.095.30.3400.732
户口U0.5380.781-53.0-9.5700.000
M0.5400.550-2.196.0-0.3100.755
性别U0.5220.45513.52.4000.017
M0.5240.5132.382.80.3700.709
婚姻状况U0.5630.48914.92.6300.009
M0.5650.567-0.497.4-0.0600.950
受教育程度U1.2940.71754.49.8200.000
M1.2871.2374.891.30.7100.477
经济来源U1.1451.442-44.1-7.3800.000
M1.1461.1262.993.50.6900.487
患慢性病种类（种）U1.8051.921-21.4-3.8200.000
M1.8041.835-5.773.2-0.8900.376
子女情况U2.8882.8539.41.6500.100
M2.8872.913-6.828.2-1.2600.209
养老金U0.9030.86711.52.0100.044
M0.9030.8855.552.50.9100.362
医疗保险U0.9360.89016.32.8100.005
M0.9360.953-6.261.8-1.2300.220
), ArticleFig(id=1324050898892239741, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=EN, label=Table 3, caption=

Correlation analysis, variable means, and standard deviations

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 Pearson相关系数
抑郁症状心理韧性睡眠质量园艺疗法
抑郁症状10.001±5.3611.000
心理韧性29.166±3.422-0.378*1.000
睡眠质量20.804±6.214-0.322*0.299*1.000
园艺疗法0.436± 0.496-0.158*0.170*0.106*1.000
), ArticleFig(id=1324050898963542910, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=CN, label=表3, caption=

相关性分析、变量均值、标准差

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 Pearson相关系数
抑郁症状心理韧性睡眠质量园艺疗法
抑郁症状10.001±5.3611.000
心理韧性29.166±3.422-0.378*1.000
睡眠质量20.804±6.214-0.322*0.299*1.000
园艺疗法0.436± 0.496-0.158*0.170*0.106*1.000
), ArticleFig(id=1324050899047428991, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=EN, label=Table 4, caption=

Baseline regression results

, figureFileSmall=null, figureFileBig=null, tableContent=
变量（1）
未加入控制变量		（2）
加入控制变量
园艺疗法-1.702***(0.347)-1.582***(0.353)
年龄（岁）-0.416 (0.246)
户口0.658 (0.410)
性别-1.509*** (0.367)
婚姻状况-0.664 (0.440)
受教育程度0.536*** (0.203)
经济来源1.073*** (0.382)
患慢性病种类（种）1.408*** (0.377)
子女情况-1.536**(0.624)
养老金-1.667** (0.682)
医疗保险-1.914*** (0.944)
R20.0250.109
), ArticleFig(id=1324050900712567680, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=CN, label=表4, caption=

基准回归

, figureFileSmall=null, figureFileBig=null, tableContent=
变量（1）
未加入控制变量		（2）
加入控制变量
园艺疗法-1.702***(0.347)-1.582***(0.353)
年龄（岁）-0.416 (0.246)
户口0.658 (0.410)
性别-1.509*** (0.367)
婚姻状况-0.664 (0.440)
受教育程度0.536*** (0.203)
经济来源1.073*** (0.382)
患慢性病种类（种）1.408*** (0.377)
子女情况-1.536**(0.624)
养老金-1.667** (0.682)
医疗保险-1.914*** (0.944)
R20.0250.109
), ArticleFig(id=1324050900817425281, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=EN, label=Table 5, caption=

Robustness checks

, figureFileSmall=null, figureFileBig=null, tableContent=
匹配方式状态处理组控制组ATT标准误T值
匹配前9.07911.131-2.0520.304-6.750
1：1最近邻匹配后9.07410.489-1.4150.441-3.210
1：4最近邻匹配后9.07410.534-1.4610.420-3.470
局部线性回归匹配后9.07910.988-1.9090.442-4.320
), ArticleFig(id=1324050900897117058, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=CN, label=表5, caption=

稳健性检验

, figureFileSmall=null, figureFileBig=null, tableContent=
匹配方式状态处理组控制组ATT标准误T值
匹配前9.07911.131-2.0520.304-6.750
1：1最近邻匹配后9.07410.489-1.4150.441-3.210
1：4最近邻匹配后9.07410.534-1.4610.420-3.470
局部线性回归匹配后9.07910.988-1.9090.442-4.320
), ArticleFig(id=1324050900976808835, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050893636776790, language=EN, label=Table 6, caption=

Test of mediation effects

, figureFileSmall=null, figureFileBig=null, tableContent=
模型路径拟合指标系数显著性
RR2FP值β(95%CI)P值
园艺疗法→心理韧性0.3330.11110.493<0.0011.023（0.585～1.462）<0.001
园艺疗法→抑郁症状0.4430.19618.836<0.001-1.081（-1.743～-0.419）<0.001
心理韧性→抑郁症状-0.490（-0.586～-0.394）<0.001
园艺疗法→心理韧性→抑郁症状0.3300.10910.332<0.001总效应：-1.582（-2.271～-0.894）<0.001
间接效应：-0.501（-0.772～-0.287）<0.001
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中介效应检验

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模型路径拟合指标系数显著性
RR2FP值β(95%CI)P值
园艺疗法→心理韧性0.3330.11110.493<0.0011.023（0.585～1.462）<0.001
园艺疗法→抑郁症状0.4430.19618.836<0.001-1.081（-1.743～-0.419）<0.001
心理韧性→抑郁症状-0.490（-0.586～-0.394）<0.001
园艺疗法→心理韧性→抑郁症状0.3300.10910.332<0.001总效应：-1.582（-2.271～-0.894）<0.001
间接效应：-0.501（-0.772～-0.287）<0.001
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Test of a moderated mediation model

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模型拟合指标系数显著性
因变量自变量RR2FP值β(95%CI)P值
心理韧性园艺疗法0.794（0.363～1.224）<0.001
睡眠质量0.4030.16313.826<0.0010.133（0.098～0.168）<0.001
园艺疗法*睡眠质量0.077（0.009～0.144）0.026
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有调节的中介模型检验

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模型拟合指标系数显著性
因变量自变量RR2FP值β(95%CI)P值
心理韧性园艺疗法0.794（0.363～1.224）<0.001
睡眠质量0.4030.16313.826<0.0010.133（0.098～0.168）<0.001
园艺疗法*睡眠质量0.077（0.009～0.144）0.026
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园艺疗法对机构老年人抑郁症状的影响研究——有调节的中介模型
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李含伟 , 周境
现代预防医学 | 健康与社会行为 2026,53(11): 2048-2053
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现代预防医学 |健康与社会行为 2026 , 53 (11) : 2048 -2053
园艺疗法对机构老年人抑郁症状的影响研究——有调节的中介模型
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李含伟（1983—），男，博士，教授，研究方向：社会保障、老龄化、养老服务

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李含伟, 周境
作者信息
  • 上海工程技术大学管理学院，上海 201620
通讯作者:
周境，E-mail：
作者简介:

李含伟（1983—），男，博士，教授，研究方向：社会保障、老龄化、养老服务

The impact of horticultural therapy on depressive symptoms among older adults in nursing homes: a moderated mediation model
Han-wei LI, Jing ZHOU
Affiliations
  • School of Management, Shanghai University of Engineering Science, Shanghai 201620, China
出版时间: 2026-06-10 doi: 10.20043/j.cnki.MPM.202509342
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摘要
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目的

园艺疗法是国际上广泛用于改善老年人抑郁症状的非药物干预手段，在积极应对人口老龄化的背景下，研究园艺疗法对我国机构老年人抑郁症状的影响具有重要的现实意义。

方法

基于2022—2024年上海J养老集团旗下养老机构老年人的三期追踪面板数据，运用倾向得分匹配法控制混杂变量，分析园艺疗法对机构老年人抑郁症状的影响机制。

结果

园艺疗法对机构老年人抑郁症状的预测作用显著（β=-1.582，P<0.001）；心理韧性在园艺疗法与机构老年人抑郁症状之间起到部分中介作用（β=-0.501， 95%CI：-0.772～-0.287），占比为31.7%；睡眠质量在园艺疗法对心理韧性的预测作用中起到调节作用（β=0.077，P<0.05）。

结论

政府部门应推动养老机构及社区照护体系将园艺疗法纳入老年人常规照护方案，建立融合园艺疗法、心理韧性与睡眠健康管理的综合干预模式，从而更好促进机构老年人的心理健康水平。

园艺疗法  /  倾向得分匹配  /  抑郁症状  /  心理韧性
Objective

Horticultural therapy (HT), a widely adopted non-pharmacological intervention, mitigates depressive symptoms among older adults. Given China’s aging population, examining the effect of HT on depressive symptoms among older adults in nursing homes is of practical significance.

Methods

Based on three-wave longitudinal panel data from 2022 to 2024 among older adults in Shanghai J Nursing Group facilities, propensity score matching was employed to control for confounding variables and analyze the mechanism of HT’s effect on depressive symptoms among older adults in nursing homes.

Results

HT had a significant predictive effect on depressive symptoms among older adults in nursing homes (β=-1.582, P<0.001). Psychological resilience partially mediated the relationship between HT and depressive symptoms (β=-0.501, 95% CI: -0.772~-0.287), accounting for 31.7% of the total effect. Sleep quality moderated the impact of HT on psychological resilience (β=0.077, P<0.05).

Conclusion

Government departments should promote the integration of HT into standard elderly care protocols and establish a combined model focusing on horticultural therapy, psychological resilience, and sleep health management to improve psychological well-being among older adults in nursing homes.

Horticultural therapy  /  Propensity score matching  /  Depressive symptoms  /  Psychological resilience
李含伟, 周境. 园艺疗法对机构老年人抑郁症状的影响研究——有调节的中介模型. 现代预防医学, 2026 , 53 (11) : 2048 -2053 . DOI: 10.20043/j.cnki.MPM.202509342
Han-wei LI, Jing ZHOU. The impact of horticultural therapy on depressive symptoms among older adults in nursing homes: a moderated mediation model[J]. Modern Preventive Medicine, 2026 , 53 (11) : 2048 -2053 . DOI: 10.20043/j.cnki.MPM.202509342
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截至2024年末，我国60岁及以上人口达到31 031万人，占总人口的22.0%[1]。随着人口老龄化进程加速，长期照护需求持续攀升，推动越来越多的老年人从传统养老模式转向机构养老模式。然而，这一转变也使老年人面临环境适应困难和潜在社会孤立的双重挑战，进而引发适应不良、负面情绪增加等一系列问题[2]，对其心理健康构成了严峻考验。在此背景下，积极探索各种治疗方法的效果，以制定有效的策略来改善老年人的健康福祉，显得至关重要。
园艺疗法是一种融合园艺学、心理学与医学等多学科的非药物干预方法，旨在通过植物栽培与园艺实践活动来促进身心康复[3]。现有研究证实，园艺疗法能够显著降低儿童、青年人到老年人等不同年龄段人群的压力水平并提升其幸福感[4-5]；然而，目前关于园艺疗法的研究仍高度集中于其对心理障碍及精神分裂症患者的临床干预效果[6]，对普通健康与亚健康人群的研究尚不充分，尤其缺乏以老年人为对象的实证分析。同时，现有研究大多样本量有限，且多基于国外样本与数据库，限制了相关结论在我国老年人中的适用性与推广价值。
鉴于此，本研究基于上海J养老集团旗下养老机构的老年人调查数据开展分析，系统评估园艺疗法对国内机构老年人抑郁症状的影响机制。基于本土化样本与数据，旨在验证园艺疗法模式在中国语境下的适用性，进而为其在中国老年人中的推广应用提供扎实的本土化科学依据。
1　数据与方法
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1.1　数据来源
本研究的数据来源于上海J养老集团旗下养老机构老年人的追踪调查数据库，这是一项聚焦机构内部养老群体的年度例行问卷调查，持续观测入住老人身心健康、养老需求及服务质量评价的动态变化。基于养老机构园艺疗法项目启动时间，本研究选取2022—2024年三期面板数据，并按下列标准筛选：（1）年龄≥60岁；（2）2022年参与调查且2024年完成追踪调查；（3）知情同意，自愿参加。排除标准：（1）患有严重认知障碍、精神疾病或沟通障碍；（2）调查期间迁出或失访个体。在清理数据后，共纳入 442名老年人，合计1 326条观测记录。本研究使用的调查数据库已进行去标识化处理，数据信息无法直接或通过关联信息间接追溯到个人身份。本研究严格遵循《世界医学协会赫尔辛基宣言（2013）》所规定的伦理准则。
1.2　变量选取
1.2.1　抑郁症状
本研究使用Silverstein等人[7]修订的流调中心抑郁量表来评估老年人在过去一周内各种情绪的出现频率。量表包含9个条目，采用5级评分，为0（“从不”）～4（“总是”），评分范围为0～36分，得分越高，表明老年人抑郁症状风险越高。本研究中，该量表的Cronbach α系数为0.787。
1.2.2　园艺疗法
本研究中，园艺疗法是指由养老机构组织实施的一项为期12周、每周1～2次的团体身心干预项目，由专业园艺师与护理人员共同指导，内容包括植物辨识、多肉移栽、自然游览、手工制作，以及团队养护与分享。在变量处理上，依据问卷题项“您今年是否参加了本养老机构提供的园艺疗法项目？”进行测量，如果参加，则赋值为1；未参加，则赋值为0。控制组在同期未参与园艺疗法项目，仅进行养老机构的常规日常活动。
1.2.3　心理韧性
本研究使用Campbell-Sills等人[8]编制的简易心理韧性量表来评估老年人心理韧性水平。量表包含10个条目，采用5级评分，为0（“从不”）～4（“总是”），评分范围为0～40分，得分越高，表明老年人的心理韧性水平越高。本研究中，该量表的Cronbach α 系数为0.716。
1.2.4　睡眠质量
本研究使用Soldatos等人[9]编制的阿森斯失眠量表来评估老年人夜间睡眠质量。量表包含8个条目，采用4级评分，为0（“无问题”）～3（“严重问题”）。本研究将各条目得分进行反向计分，评分范围为0～24分，得分越高，表明老年人睡眠质量越好。本研究中，该量表的Cronbach α 系数为0.896。
1.2.5　协变量
参考已有文献[10]，本研究选取年龄、性别、户口、婚姻状态、受教育程度、经济来源、患慢性病种类、子女情况、养老金、医疗保险作为控制变量。
1.2.6　统计学方法
本研究使用STATA 18.0进行数据处理与回归分析，为控制混杂因素，采用倾向得分匹配法对基线人口学变量进行平衡处理，匹配方法为1∶1最近邻匹配，卡钳值设置为0.02，相关性分析采用Pearson方法，并使用SPSS 27.0进行有调节的中介效应分析，检验水准α=0.05。
2　结果
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2.1　描述性统计
本研究将2022—2024年从未参与园艺疗法项目的老年人设为控制组，将2022年未参与，但从2023—2024年持续参与园艺疗法项目的老年人设为处理组，控制组包括270人（810条观测），处理组包括172人（516条观测）。两组在抑郁症状、心理韧性及人口学特征上的基线情况见表1。两组样本均以城市户口、离退休金为主要经济来源、患1～2种慢性病、多子女家庭的老年人为主，且养老金与医疗保险覆盖率较高。两组在人口特征上存在差异，控制组中高龄老年人、女性、非在婚及文盲比例较高，处理组则以年轻老年人、男性、在婚及小学学历者居多。整体而言，处理组的抑郁症状平均得分均低于控制组，而心理韧性平均得分均高于控制组。
2.2　倾向性得分匹配
本研究使用10个协变量进行倾向得分匹配与平衡性检验，采用最邻近匹配法，设定卡钳值为0.02，执行无放回的1∶1匹配。如表2所示，匹配后两组倾向得分的分布差异显著减小，各变量在1%水平上均无显著差异，表明匹配有效降低了偏差，通过了平衡性检验。
2.3　相关性分析
Pearson相关分析结果显示，园艺疗法、睡眠质量和心理韧性均与抑郁症状呈负相关，睡眠质量、园艺疗法和心理韧性三者之间呈正相关。见表3。
2.4　基准回归
如表4所示，未加入控制变量时，回归系数为-1.702；引入控制变量后，回归系数为-1.582，且均在1%水平上显著，表明园艺疗法会负向预测机构老年人抑郁症状，回归结论具有稳健性。同时，性别、受教育程度、经济来源、患慢性病种类、子女情况、养老金和医疗保险等多个变量都与机构老年人抑郁症状有显著关联。
2.5　更换匹配方式的稳健性检验
为验证结论的稳健性，本研究分别采用1∶4最近邻和局部线性回归进行重新匹配。结果如表5所示，三种不同匹配方法下处理组的平均处理效应（average treatment effect on the treated, ATT）均在1%水平上显著，且数值差异较小、方向一致，表明结果稳健。
2.6　中介效应
本研究通过PROCESS 中的Model 4构建“园艺疗法→心理韧性→抑郁症状”的时序路径来检验中介效应。具体而言，以2023年是否参与园艺疗法为自变量，2024年心理韧性得分为中介变量，2024年抑郁症状得分为因变量，在控制混杂变量的基础上，检验园艺疗法对心理韧性的滞后预测效应，以及心理韧性对抑郁症状的预测作用。
结果如表6所示，园艺疗法正向预测心理韧性（β=1.023，P<0.001），而心理韧性能够负向预测机构老年人抑郁症状（β=-0.490，P<0.001）。Bootstrap法（5 000次抽样）检验结果显示，总效应（β=-1.582,95%CI:-2.271～-0.894）、直接效应（β=-1.081,95%CI:-1.743～-0.419）和中介效应（β=-0.501,95% CI:-0.772～-0.287）都显著，中介效应占总效应的31.7%。
在中介效应的基础上，为验证中介效应的前半段路径是否受睡眠质量的调节，采用PROCESS中的Model7进行检验。结果如表7所示，睡眠质量与心理韧性呈正相关（β=0.133，P<0.001），园艺疗法与睡眠质量的交互项对心理韧性（β=0.077，P<0.05）的正向预测作用显著。这表明，睡眠质量调节了中介效应的前半段路径，因此有调节的中介模型成立。
简单斜率分析表明，当睡眠质量较低时，园艺疗法对心理韧性不具有预测作用（β=0.317，P>0.05）；当睡眠质量较高时，园艺疗法对心理韧性具有正向预测作用（β=1.269，P<0.001），见图1。这表明，随着睡眠质量的提高，园艺疗法对心理韧性的正向预测作用越显著。
3　讨论
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3.1　园艺疗法与机构老年人抑郁症状呈负相关
研究发现，参与园艺疗法与机构老年人抑郁症状呈显著负相关，表明其可能与降低抑郁症状风险有关，这与以往的研究结果一致[11]。园艺疗法通过组织老年人参与植物栽培与深度自然互动，促进其多感官的综合刺激，有助于提升老年人对自然环境的感知度与整体认知功能[12]。此外，园艺活动中的体力劳动，是一种无意识运动，能够引导身体产生渐进式放松反应[13]，使得肌肉在不产生疲劳感的情况下逐渐放松，降低人体的皮质醇水平，从而减少焦虑感和抑郁症状。
3.2　心理韧性的中介作用
深入探究其潜在机制，研究发现心理韧性在园艺疗法与机构老年人抑郁症状之间起到部分中介作用。心理韧性反映的是个体面对压力时恢复心理健康的能力，具有较强心理韧性的人能够更好地识别和管理自己的情绪，避免负面情绪的过度积累和持续，从而预防抑郁的发生[14]。园艺疗法通过让老年人亲身体验植物生长的过程，增强其参与感、成就感及满足感，从而缓解因自我价值缺失而引发的抑郁症状。同时，园艺疗法项目后期的维护和照料活动多以组队合作形式进行，能够有效帮助老年人在园艺互动中建立社会联系，增强归属感，从而缓解社交退缩心理，提升心理韧性，并通过减轻孤独感间接影响抑郁症状。
3.3　睡眠质量的调节作用
本研究还证实了睡眠质量在园艺疗法对机构老年人心理韧性的预测关系中起到调节作用。在睡眠质量较好的机构老年人中，园艺疗法对其心理韧性的正向预测作用被放大；而在睡眠质量较差的机构老年人中，园艺疗法对其心理韧性的正向预测作用不再显著。这可能是由于睡眠质量差容易引起神经内分泌失调[15]，导致老年人在活动时出现专注力下降和疲劳感增强等问题，难以全神贯注地体验园艺疗法，甚至将园艺活动视为负担而产生挫败感，从而削弱其从中获得的自我效能感。相反，睡眠质量好的老年人通常表现出更高的参与主动性和任务坚持性，能够更充分地体验园艺活动带来的益处，并从劳动成果中获得满足感，这种持续的正向反馈有助于有效提升其心理韧性。
本研究首次采用多期追踪数据和倾向得分匹配法来研究园艺疗法对国内机构老年人抑郁症状的影响机制，并证实了园艺疗法对机构老年人抑郁症状是一种有效的补充医疗手段。因此，相关部门应支持养老机构及社区照护体系将园艺疗法纳入老年人日常服务，构建结合园艺疗法、心理韧性提升与睡眠健康管理的综合干预模式，并通过定期评估与监测，切实提升老年人生活质量与心理健康水平，从而为积极应对人口老龄化提供有效支撑。
本研究仍存在一定局限性。首先，作为回顾性研究，尽管通过倾向得分匹配控制了可观测混杂变量，但无法完全排除由自我选择导致的偏倚；其次，受数据所限，对园艺疗法的测量仅采用是否参与的二分变量，未能涵盖其参与频率、时长及完成质量等具体信息；最后，虽使用三期数据构建了时序路径，但中介模型尚不足以充分刻画变量间的动态交互。未来研究可从以下方面展开：一是采用前瞻性队列研究以确立更清晰的因果时序；二是通过日志记录与客观监测收集详细过程数据；三是增加测量时点并运用交叉滞后面板模型动态检验交互机制。
基金
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  • 国家社会科学基金项目(21BRK006)
文献
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参考文献 引证文献
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2026年第53卷第11期
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doi: 10.20043/j.cnki.MPM.202509342
  • 接收时间：2025-09-20
  • 首发时间：2026-11-02
  • 出版时间：2026-06-10
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  • 收稿日期：2025-09-20
基金
国家社会科学基金项目(21BRK006)
作者信息
    上海工程技术大学管理学院，上海 201620

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Number of
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Number of
species		 占总种数比例
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total species (%)		 属
Genus		 种数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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