Effects of Forest Therapy on Depressive Symptoms: A Systematic Review and Meta-Analysis.

Objective: To systematically evaluate the efficacy of various forest therapy interventions for alleviating depressive symptoms using network meta-analysis, identify the optimal intervention pattern, and provide evidence-based guidance for clinical application. Eligibility Criteria: Randomized controlled trials (RCTs) evaluating forest therapy for depressive symptoms were included. Studies were limited to English publications with extractable outcome data; non-forest interventions, simulated nature exposure, and studies with severe comorbidities or incomplete data were excluded. Information Sources: PubMed, Medline, Embase, Cochrane Library, and CINAHL were searched from inception to May 2026. Study Appraisal and Synthesis Methods: Study quality was assessed using the Cochrane ROB 2.0 tool. Network meta-analysis was performed with a random-effects model; heterogeneity was quantified using Results: Eighteen RCTs with 2169 participants were included. Random-effects meta-analysis showed forest therapy significantly reduced depressive symptoms: SMD = -1.009, 95% CI (-1.411, -0.608), Conclusion: Forest therapy is an effective non-pharmacological intervention for depressive symptoms. While forest therapy seems to offer benefits, the certainty of the evidence is constrained by significant heterogeneity, potential publication bias, a scarcity of direct comparisons among intervention models, and a lack of long-term follow-up studies. Future research should standardize protocols, conduct large-scale RCTs, incorporate long-term follow-up, and develop regionally adapted interventions. Registration: PROSPERO CRD420261402570.