Impact of Gardening on Mental Health

This research proposal explores the positive impact of gardening on the mental health of older people in South Australia. It discusses the connection between physical and mental health, reviews relevant literature, and highlights the benefits of gardening in reducing mental health issues. The research aims to investigate the specific mental issues that can be reduced through gardening and compare the effectiveness of gardening with other therapeutic activities and medication.

Running head: IMPACT OF GARDENING ON MENTAL HEALTH
IMPACT OF GARDENING ON MENTAL HEALTH
Name of the Student:
Name of the University:
Author Note:

1IMPACT OF GARDENING ON MENTAL HEALTH
Title of the Research Proposal: Positive Impact of gardening on the mental health of
older people in South Australia.

2IMPACT OF GARDENING ON MENTAL HEALTH
Introduction
Time and again, researches have revealed that gardening has the potential to
impose a positive impact on the mental health of individuals. Especially, when it comes
to elderly members of the society, gardening can reduce a good number of mental
health issues like depression, social isolation, anxiety and other that are of harder to
treat with the help of medicines or therapy. In this research proposal, the researcher
rationale is for exploring the positive impact of gardening on the mental health of older
people in South Australia. In the following paragraphs, first of all, a review of scholarly
literature that is relevant to the research topic has been conducted. The fact that
physical and mental health of a human being remains connected and improvement of
one eventually leads to the development of another cannot be avoided. In the following
section, a narrative literature review has been conducted. While conducting the
literature review the methods employed by previous researchers, similarity and
dissimilarities between the already conducted research papers, strengths and
weaknesses of the current knowledge as well as the gaps in the existing literature will
be discussed in the following paragraphs. The literature review section will be followed
by a brief discussion of the aims and objectives of the research. This will be followed by
the research design that will include the epistemology, theoretical perspective, research
methodology, ethical consideration, data analysis method and dissemination that will be
followed while conducting the research.
Literature Review
According to Hofmann et al., (2017), regular gardening has the potential to reduce the
loss of hair due to chronic stress, lack of physical activity and idleness in elderly

3IMPACT OF GARDENING ON MENTAL HEALTH
individuals. Contact with nature, as well as physical activity mitigation, has the potential
to mitigate stress while intensifies stress outcomes. However, the research found that if
the level of stress is high, spending a prolonged period of time in contact with nature
head to the enhancement of stress. Moreover, gardening lacks the capability to
enhance social interaction and hence does not possess the potential to deal with mental
health issues like social isolation. The method chosen for conducting the research
includes quasi-experimental procedure one of the major weaknesses of this research
paper includes for quasi experiential researches, a random selection of participants is
required. However, for this research paper allotment was not totally random and
systematically related to relevant factors of the research model. The major strength of
the paper includes is that the research involves a good number of participants.
Peeters et al., (2014) stated that curvilinear association results in the betterment of
physical and mental wellbeing of middle-aged a well as older women. According to the
researcher, older aged women who conduct gardening are more active physically. Not
only has this gardening also helped older women to reduce depression. Older women
with higher amount of house and garden work posses a higher level of mental as well
as physical wellbeing. Two major strengths of the research paper involves its large
sample size and the statistical analyzing used that is generalized additive modeling.
Studies have revealed that contact with nature on a daily basis can have a long-
lasting impact on the health and it includes the anxiety symptoms, depression,
longevity, heart disease, circulatory disease, obesity, diabetes, birth weight, Thus, it can
be highlighted that contact with nature on a daily basis can act as a form of preventive
medicine. Gardening is considered as one of the most active and potential ways of

4IMPACT OF GARDENING ON MENTAL HEALTH
interacting with nature and it is even considered as a great way of passing time in
several countries. In the USA it is seen that about 117 people participate in active
gardening and it is one in every three people; In the UK around 40 percent of the
population indulges in gardening which is 27 million people; Similarly, one in every 4
people (27 million people) in Japan participate in gardening and it is even considered as
a hobby(Soga, Gaston, & Yamaura, 2017).It has been highlighted by Nicklett, Anderson
& Yen (2016), gardening is seen to be potentially impacting the health benefits of the
older people. It is important to mention that the older people indulge into gardening for
various reasons like leisure time physical activity, personal enrichment, psychological
enrichment, social enrichment(Nicklett, Anderson, & Yen, 2016).Gardening is actually
one of the favorite pastimes for older people. It is important to mention that that main
theme of gardening is considered as a linkage between the plants and the humans and
it involves the psychological activities. The main logic behind gardening is to promote
living things and due to this gardening has the potential to enable creativity, social
interaction as well as reciprocal exchange communication with other individuals.
Gardening can effectively help in the creation of the new meaning of life and new
memories for the older adults. The various gardening activities include the taste, smell
and touch. Furthermore, there is a visible minimization by seeing different natural
environments. Other studies also have highlighted that the gardening also leads to a
reduction of the blood pressure by reducing the blood pressure and the improvement in
the mood by spending time in the natural environment(Hassan, Qibing, & Tao, 2017).A
study has indicated and highlighted both the psychological and physiological effect of
transplanting activities without and with plants on older adults. It was found that the

5IMPACT OF GARDENING ON MENTAL HEALTH
mean diastolic and systolic blood pressure were highly lower after plant task. Therefore,
it can be said that the reduction in the diastolic and systolic blood pressure leads to the
lowering of stress and it facilitates a state of relaxation. The study has also highlighted
that the relaxation level increases only when the participants have completed the
gardening task and not just completing the control task. The psychological benefits of
gardening include several benefits like the improved mental condition and the improved
mood state that reduces the levels of anxiety. Therefore, it can be said that the
beneficial effects of gardening are cost-effective, simple and accessible and it increases
the activity of brainwave in the older adults(Hassan et al., 2017).
The horticulture activities are shown to alleviate the severity of depression and
also reduce rumination in clinically depressed patients. Horticulture also reduces the
negative mood like confusion, anger, fatigue, depression and tension. On the other
hand, it increases the positive dimension like energy and vigour. A study carried out
also highlighted that a 7-week horticulture activity improved the psychological wellbeing
in comparison to the waitlist control group. Hence, the horticultural activities are found to
be promising and it improved the mental health. It is important to mention that
Horticultural Therapy is conducted professionally and it can be considered as a client
centred treatment that utilizes the horticultural activities and meets the rehabilitative and
therapeutic goals of the participants. The study highlighted that effectiveness of the
horticulture technique and it improved the physical health, cognitive health, and mental
health of the older adults. Studies have demonstrated that contact with nature is linked
with improved sleep quality and positive mood. Therefore, engagement with nature is
seen to improve mood state and mitigate stress. Study has indicated that the

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horticulture technique imparts an enjoyable and playful experience by providing
increasing compliance and intrinsic motivation. Furthermore, it can be seen that the
change in lifestyle motivates as well as enhances the physical activity levels and it
increases the ability and health as well as face the challenges in daily life. The
community-based horticulture technique actually facilitates the older individuals with the
ability to socialize as well as improve mental health. It is generally seen that after the
retirement the older adults are more likely to lead a sedentary life. The elderly adults
that live alone evidence loneliness due to the lack of social interaction and this could
increase the chances of mental health problems. Therefore, participation in the
community-based horticulture technique leads to the building up of the social
connectedness among the older individuals. When the community-based interventions
are supported by cost-effective horticulture technique then the older adults will have a
much healthier lifestyle(Chan et al., 2017).
It has been highlighted by Han, Park & Ahn (2018), that horticultural therapy
group showed the lowering in the levels of cortisol as it can be said that higher levels of
cortisol are related with the higher levels of stress. Thus, it can be said that the
participants that participated into the horticultural theory program can lead to reduction
in stress and it will lead to the reduction of stress compared to the ones that did not
participate into the program (Lêng & Wang, 2016). Furthermore, previous studies have
highlighted that the ones that participated into the 8 sessions horticultural therapy
program highly exhibited the lowering of subjective stress and levels of cortisol. It is
important to mention that the 20 sessions horticultural program therapy also lead to the
reduction of anxiety, depression, and reduced levels of cortisol. However, it is also seen

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that the 8 session horticulture therapy program improved alpha-amylase levels, salivary
cortisol and even in participants that have the post-traumatic stress disorder. In
comparison to viewing the plants that lack foliage, viewing the foliage plants is found to
be inducing the psychological relaxation and physiological relaxation. This lowers the
prefrontal cortex activity and it improves the emotional state and increases the
parasympathetic nervous activity and emotional state. Viewing the forest scenery is
found to be increasing the parasympathetic activity, reduced heart rate, lowered blood
pressure and suppressed the sympathetic nervous activity. It is important to highlight
that transferring the foliage plants into the pots promoted the psychological relaxation
and physiological relaxation as it decreases oxy-haemoglobin concentration, and
sympathetic nerve activity in the prefrontal cortex. These results were shown against
the transferring foliage plants in comparison to the non-foliage ones. When working with
the plants that are real, psychological condition in of the adults were found to improve in
comparison to working with the artificial ones. It is important to highlight that the
touching soil leads to the secretion of serotonin and it produces the feelings of
happiness(Han, Park, & Ahn, 2018). Psychologists have emphasized that the domestic
gardens are linked to the sense of ownership, belonging, autonomy and self. Studies
have concluded that the physical spaces like the gardening can actually provide new
insights of immigration of health psychology(Wen Li, Hodgetts, & Ho, 2010).
Similarities and dissimilarities
When it comes to similarities and dissimilarities of the previous research , paper,
one of the chief similarities that has been identified while conducting the literature
review is that almost all the articles agreed with the fact that gardening has the potential

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to reduce mental issues in elderly people. Another similarity includes the majority of the
research have implemented primary data collection methods in order to gain
appropriate result. However, when it comes to the dissimilarities, it has been found that
different researchers have conducted the research on different parts of the world and
different aspects of the mental issues that can be reduced through gardening.
Literature gap
One of the major gaps that have been found in the research paper involves lack of
academic literatures which are conducted on the impact of horticulture on the elderly
adults of South Australia. Another major gap of this research may include limited
number of research paper on the relationship between mental health of elderly people
and gardening. Majority of the academic studies that the researcher has come across
have been written on the relation between horticulture and mental health of people.
While searching for literature, a very limited number of relevant articles where
researchers have been conducted specifically based on the elderly residents of the
society have been found. Therefore, this research has been conducted in order to
enhance the knowledge of future researchers on the impact of gardening on elderly
people of South Australia. Not only this, but this researcher will be also helpful for
psychiatrists who are looking for an effective way to reduce mental problems like stress,
anxiety and depression of the elderly adults.

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Aims and objectives
The aim of the research is to investigate the Positive Impact of gardening on the mental
health of older people in South Australia.
The objectives of the research are as followed:
1. To find out what chief mental issues can be reduced or eliminated by gardening
2. To find out how gardening imposes a positive impact on the mental health of
older individuals in South Australia.
3. To compare the result obtained from other therapeutic activities and medication
and gardening, when it comes to ensuring the mental wellbeing of the elderly.
Research design
 epistemology and theoretical perspective
The term epistemology refers to a branch of research philosophy that deals with the
source of knowledge. More specifically, research epistemology is associated with
nature, possibilities sources as well as limitations of knowledge in the study field. A
good number of sources of knowledge are used in research philosophy (Sankey, 2016).
Authoritarian knowledge includes information obtained from books and research paper.
Logical knowledge is comprised of creation of new knowledge with the help of applying
logical reasoning. This research will follow rationalism research epistemology. While
rationalism relies on empirical findings that are through valid measures as a source of
knowledge, empiricism accepts personal experiences associated with observation,

10IMPACT OF GARDENING ON MENTAL HEALTH
feelings and senses as a valid source of knowledge (Gan& Grunow, 2016). Considering
the fact that this research will solely deal with scientific information and the result
obtained in this research will be free from any assumption, the rationalism epistemology
will be followed by the researcher to conduct this research. The mentioned
epistemology will help the researchers to identify authentic and assumption-free impacts
of gardening on the mental health of elderly adults of South Australia.
The research philosophy of this research is positivism. The positivism research
philosophy depends on the quantifiable observation that eventually leads to statistical
analysis. Considering the fact that the result of this result will be based on statistical
analysis of the collected data, for this research paper positivist research philosophy has
been selected. According to the epistemology of positivist research philosophy only
observable phenomenon possesses the potential to provide credible data as well as
facts (Ponelis, 2015). Hence, this research is focused on causality as well as a law like
generalisations that will result in reducing phenomenon to the simplest elements.
When it comes to theoretical perspective of this research, it is completely based on
scientific evidence like experiments a statistics for revealing the nature of the operation
methods of the research question. The study will be conducted based on the
functionalism sociological perspective. According to the mentioned theoretical
perspective, each of the aspects of the society is independent and possess the potential
to contribute the functioning of the society as a whole. The research question that is the
impact of gardening on the mental wellbeing of elderly residents of South Australia will
need a macro level of analysis. In order to answer the question, the researcher will have
to chiefly focus on the relationship between the parts of the society. The positivist

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philosophy specifically relies on the following aspects. First of all, in a positivist study,
the researcher will apply the chosen methods mechanically in order to
operationalize the theory (Palinkas et al., 2015). The same thing will be done for this
research a well. Secondly, the research will be concluded based on the result and the
result will only be determined by data that can be measured.
 methodology /method/s
Research Design
The research design of this research will be exploratory research design. As the name
implies, exploratory research explores the research question whose purpose is not to
offer final as well as conclusive solutions to the existing issues (McCusker& Gunaydin,
2015). This type of research is performed for studying an issue that has not been
defined clearly yet. Considering the fact that the research topic of this research is to find
out the positive impact of gardening on the elderly citizens, the exploratory research
design has been chosen to have a better understanding of the research problem. Else-
Quest& Hyde, (2016)stated that the aim of exploratory research is not to provide the
audiences with final and conclusive answers but to explore the research topic with
varying level of depth. Generally, exploratory researches are conducted on research
topic on which very little amount of researches has been conducted previously (Quinlan
et al.,2019).
Research approach
The research approach that will be chosen for this research includes inductive research
approach. This research approach initiates with the observations as well as theories

12IMPACT OF GARDENING ON MENTAL HEALTH
that are proposed towards the end of the research process.In researchers that follow
inductive research approach, no theories or hypothesis apply at the beginning of the
research and the researcher is thus free to alter the direction for the study after thee
the commencement of the research process (Olivia& Christopher, 2015).
Research Data collection
Both primary as well as secondary data will be collected for this research. A primary
data source can be defined as an original data source where data are collected first
hand for specific research by the researcher. Primary data collection methods include a
good number of ways that include surveys, interviews, experiments and field
observation. In order to collect primary data for this research a quasi-experiment will be
performed. In a controlled experiment an independent variable is considered as the only
factor that is allowed to be attuned with the dependent variable. For this research the
independent variable is gardening and the dependent variable is the mental health of
the elderly individual of South Australia (Lindley& Coulton, 2016). The experiment will
involve two groups of participants of elderly citizens. Both the group will be involved in
regular physical activities. However, one of the groups will be provided with an
additional activity of gardening. The duration of the physical activity will be 1 hour.
Physical activity has been chosen for the mentioned experiment since it has the
potential to improve physiological wellbeing. Not only this, fitness and physical well-
being posses automatic impose positive impact on physiological health of an individual.
An additional 2 hours of gardening activity will be performed by the independent
variable group data. For this research, paired T-test will be conducted for analysing the
result. Initially the two participants groups will be tested with a phycology based

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examination through a set of questionnaire containing 10 questions to measure the
base of mental health. The experiment will be conducted 4 days a week. After 8 weeks,
the same set of questionnaire will be provided to each group to measure their change in
mental state. The T test will be conducted on the two pair of marks. The tool that will be
used for measuring the collected data is the paired T test.
Secondary data is the information which is collected by the researcher from already
existing research articles, reports, newspapers and others. Secondary data are
generally collected from organizational record, government departments, previously
conducted researches on topics that are relevant to the research topic are some of the
commonly used sources of secondary data. For this research secondary data will be
collected from books and academic journals that are relevant to the research topic that
is the Positive Impact of gardening on the mental health of older people in South
Australia. As secondary data collection method literature review of the relevant
academic article will be performed.
Population and sampling methods
In order to collect the primary data for quantitative analysis, probability sampling will be
conducted. 50 Australian elderly adults will mental health issues will be recruited from
two of the most popular mental health centres namely the Western community mental
health care home and Southern intermediate care centre healthcare home of South
Australia. All the samples chosen will be under mental health treatment. The age group
of the participant will be between 65 to 75 years and both male and female participants,
irrespective of their age will be selected. For this research, participants who possess
physical disability or are too vulnerable both physically and mentally will not be selected.

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In order to recruit the participant for the study the whole process will be explained to the
healthcare service users by a psychiatrist as well as a social worker affiliated within the
centres. After that the participant information form will be given to the interested
participants. The participants who will show their interest in participating in the
experiment will be provided with the consent form. The whole experiment will be
conducted in the two mentioned healthcare home. Special permission for conducting
the experiment will be taken by the researcher. The participants will be assigned to
either a controlled group to the gardening therapy group with the help of probability
sampling. Probability sampling is defined as the sampling technique where sample
forms a larger population and are selected using a method based on the probability
theory (Olivia& Christopher, 2015). In this type of sampling, samples are gathered in the
process that provides all individuals in a population equal chance to get selected.
When it comes to the sampling of the secondary data collection for qualitative analysis,
nonprobability sampling will be conducted. Non-probability sampling refers to a
sampling technique where the samples are gathered in a process that does not provide
all the subjects in a population equal chance of being selected. 10 Academic research
articles that are relevant to the research topic will be selected for secondary data
collection. The articles should be published within 5 years so that the relevancy with the
current condition of the society can be ensured. Apart from this, articles that are written
in the English languages will only be selected for the research purpose.
 ethics
Ethical consideration in research is considered to be a highly crucial part of the same.
For this research, the researcher will ensure that no harm to the participants will take

15IMPACT OF GARDENING ON MENTAL HEALTH
place (Guetterman, Fetters& Creswell, 2015). While selecting participants for the
research, a detailed participant information form will be provided to the participants in
order to ensure that none of them lacks the knowledge about why the research will be
conducted. Along with a participant information form consent for the participants will
also be provided in order to ensure that participants will be joining the research
procedure on their own will.All the participants will be free to leave the experiment
whenever they will feel the urge to. However, they will be entitled to provide the
researcher with a valid reason so that it can be used as feedback for future researches.
Ethical behaviour is highly crucial for collaborative work since it encourages an
environment of accountability, mutual respect as well as trust amongst the researcher
and the stakeholders. This is crucial when issues associated with data sharing, co-
authorship, copyright guidelines, confidentiality, and many other issues are
considered. In order to ensure that no breach of confidentially will take place, the name
of the participants or any other stakeholders will not be disclosed in the research paper.
 data analysis
For this research both qualitative as well as quantitative data analysis method will be
followed. In order to analyse the data obtained from the data collected from the
experiment, quantitative method of data analysis will be followed. Quantitative data
analysis refers to a systematic approach of investigating during which numerical data is
collected and the researcher transforms the collected data into numerical data. For this
research, paired T test will be conducted for analysing the result. Initially the two
participants groups will be tested with a phycology based examination through a set of
questionnaire containing 10 questions to measure the base of mental health. After that

16IMPACT OF GARDENING ON MENTAL HEALTH
the gardening activity will be introduced to the experimental group. A regular follow-up
will be maintained throughout the time span of the experiment. After 8 weeks, the same
set of questionnaire will be provided to each group to measure their change in mental
state. The T test will be conducted on the two pair of marks. The paired sample T test,
can be defined a statistical procedure that is used for determining if the mean difference
between the two sets of observation is zero or not In this type of data analysis, each of
the subjects or entity are measured for two times, that in turn results in pairs of
observation (Quinlan et al., 2019).
For analysing the data collected from literature review, qualitative data analysis will be
performed. For this research, phenomenological data analysis procedure will be
followed. The data obtained from the literature review will be distributed into 2 or three
themes that will provide the researcher with a clearer and more specific identification of
the research issue.
 Dissemination
The first step that will be conducted after the completion of the research proposal
includes submitting the ethics for by mentioning the research procedures and purpose
to the South Australian Public Sector. After obtaining the approval, the above-
mentioned ethics form will be further submitted to the Human Research ethics
committee of the Western community mental health care mental healthcare home and
Southern intermediate care centre. The purpose of the research and detailed methods
that will be followed to conduct the research will be stated to the two mentioned
stakeholder health care home. It should be clearly mentioned in the form that no harm
to any of the participants will take place while conducting the research. Considering the

17IMPACT OF GARDENING ON MENTAL HEALTH
fact that the research will require facilities from the two healthcare home, the
requirement will be informed to the participants (Gan& Grunow, 2016). They will be
stated that for research purpose a psychologist will be recruited from the healthcare
home in order to explain the research procedure to the participant and recruit them
randomly to the two groups. Along with this a participant information form will also be
submitted in order to inform all the participants about the purpose and procedure that
will be followed while conducting the research.
Participation information sheet
Study title: Positive Impact of gardening on the mental health of older people in South
Australia.
I would like to invite you for taking part in a research study. However, before making the
decision of whether to take part in the study or not it is crucial to understand why the
research has been conducted. Please take time while going through the following
information carefully. You are free to ask a question if any information is not clear to
you.
WHAT THE RESEARCH IS ABOUT
The research aim is to investigate the impact of gardening on the mental health of
elderly people in South Australia.
WHAT WILL TAKING PART INVOLVE?
We will need at least 30 participants for the research. The participant who will take part
in the research will be randomly segregated into two groups. Participants In both the

18IMPACT OF GARDENING ON MENTAL HEALTH
group will need to part in mental health improving activities like physical exercise.
However in one of the two groups an additional activity of gardening will be
incorporated. Participants will need to perform gardening activities. After 4 weeks the
mental wellbeing of both the group will be calculated.
WHY HAVE YOU BEEN INVITED TO TAKE PART?
The mental health issue has the potential to impose an adverse impact on the physical
health of an individual and thus can lower the life span of the same. In order to
eradicate mental health issues in a sustainable way, we have chosen the healthcare
service users of the WESTERN COMMUNITY MENTAL HEALTH CARE and
SOUTHERN INTERMEDIATE CARE CENTRE mental healthcare home.
DO YOU HAVE TO TAKE PART?
The participation is completely voluntary and you as a candidate possess the right to
refuel participation, any irrelevant question and withdraw from the research and time
without any consequences.
WHAT ARE THE POSSIBLE RISKS AND BENEFITS OF TAKING PART?
There prevails no risk of psychological harm while participating in the research.
However there is a risk of minor physical harm while gardening and any kinds of allergic
reactions. The chief benefit of the taking part will be that participants will able to enjoy
the act of gardening and evidence its positive impact on their health.
WILL TAKING PART BE CONFIDENTIAL?

19IMPACT OF GARDENING ON MENTAL HEALTH
Taking part will be completely confidential and the researcher will have to face high
penalty or even imprisonment in case any breach of the confidentiality policy will take
place.
HOW WILL INFORMATION YOU PROVIDE BE RECORDED, STORED AND
PROTECTED?
The interview of the participants pre and post-experiment will be recorded with the help
of a tape recorder. All the information will be stored in a secured digital database
system with appropriate authenticity encryption where only authorized individuals will be
provided with access.
WHO SHOULD YOU CONTACT FOR FURTHER INFORMATION?
For further information, feel free to contact
Contact number the Researcher: 1234567890
Email: [e-mail]
[THANK YOU]
Informed consent form
I have read as well as understand the provided information and have had the
opportunity to ask questions. I understand that my participation is voluntary and that I
am free to withdraw at any time, without giving a reason and without cost. I understand
that I will be given a copy of this consent form. I voluntarily agree to take part in this
study.

20IMPACT OF GARDENING ON MENTAL HEALTH
Participant's signature ______________________________ Date __________
Investigator's signature _____________________________ Date __________

21IMPACT OF GARDENING ON MENTAL HEALTH
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25IMPACT OF GARDENING ON MENTAL HEALTH
Appendix
Questionnaire for the participants
How often have they been bothered by the following over the past 2 weeks?
1. Little interest or pleasure in doing things?
Not at all
Several days
More than half the days
Nearly every day
2. Feeling down, depressed, or hopeless?
Not at all
Several days
More than half the day
Nearly every day
3. Trouble falling or staying asleep, or sleeping too much?
Not at all
Several day
More than half the day

26IMPACT OF GARDENING ON MENTAL HEALTH
Nearly every day
4. Feeling tired or having little energy?
Not at all
Several days
More than half the days
Nearly every day
5. Feeling bad about yourself — or that you are a failure or have let
yourself or your family down?
Not at all
Several days
More than half the days
Nearly every day
6. Trouble concentrating on things, such as reading the newspaper or
watching television?
Not at all
Several days
More than half the days
Nearly every day

27IMPACT OF GARDENING ON MENTAL HEALTH
7. Moving or speaking so slowly that other people could have
noticed? Or so fidgety or restless that you have been moving a lot
more than usual?
Not at all
Several days
More than half the days
Nearly every day
8. Thoughts that you would be better off dead, or thoughts of hurting
yourself in some way?
Not at all
Several days
More than half the days
Nearly every day
9. Ask the patient: how difficult have these problems made it do work,
take care of things at home, or get along with other people?
Not at all
Several days
More than half the days
Nearly every day
10. Poor appetite or overeating?

28IMPACT OF GARDENING ON MENTAL HEALTH
Not at all
Several days
More than half the days
Nearly every day