Composition of Diagnostic Assessment Sheet Items for Developing a Personalized Forest Therapy Program for Patients with Depression: Application of the Delphi Technique

Sep 30, 2026

Uploaded by Hazel

Depression remains a serious mental illness worldwide, with rising prevalence and a pressing demand for practical tools usable in real clinical settings. Accumulating evidence supports forest therapy as a nonpharmacological intervention, yet clinician-oriented implementation resources are limited. This study derives components for a diagnostic assessment sheet to help clinicians design individualized forest therapy programs for depression, using systematic literature/case analysis and a two-round Delphi survey with expert input. Findings identify therapeutic activities, activity types, and safety-focused assessment items to support medical–forest therapy integration.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages30

Reading Time1 h 16 min

AccessFree to download

Abstract

Introduction

Depression burden and diagnostic needs

Treatment options and role of forest therapy

Methods

Literature and case material analysis

Delphi survey design and expert panel

Results

Therapeutic activity identification

Classification into activity types

Assessment items and precaution items

Discussion

Safety and suitability for program design

Conclusions

Diagnostic assessment sheet framework and future validation

Article Composition of Diagnostic Assessment Sheet Items for Developing a Personalized Forest Therapy Program for Patients with Depression: Application of the Delphi Technique Gayeon Kim 1, Sinae Kang 1, Kyungsook Paek 1, Youngeun Seo 1, Hyoju Choi 2, Seyeon Park 1 and Pyeongsik Yeon 2, * Academic Editors: Ines Aguinaga-Ontoso and Herbert Löllgen Received: 30 October 2025 Revised: 22 December 2025 Accepted: 30 December 2025 Published: 3 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Graduated Department of Forest Therapy, Chungbuk National University, Cheongju 28644, Republic of Korea; [rkdus6520@naver.com](rkdus6520@naver.com) (G.K.) 2 Department of Forest Sciences, Chungbuk National University, Cheongju 28644, Republic of Korea * [Correspondence: well@chungbuk.ac.kr](Correspondence: well@chungbuk.ac.kr); Tel.: +82-10-8703-1214 Abstract Background/Objectives: Depression is a serious mental illness worldwide, with a continuously increasing prevalence. As evidence supporting forest therapy as a nonpharmacological intervention has accumulated, the need for collaboration between the medical and forest therapy sectors has emerged; however, practical tools applicable in real-world clinical settings remain limited. This study aimed to derive components of a diagnostic assessment sheet to support clinicians in developing personalized forest therapy programs for patients with depression. Methods: Program-related literature and case materials from diverse disciplines were systematically analyzed to identify transferable program development elements and therapeutic activities. Based on these findings, a two-round Delphi survey was conducted with 17 experts in forest therapy and medicine. Results: Through the Delphi process, 26 therapeutic activities were identified and classified into six final activity types. Assessment items were developed to support clinicians in selecting appropriate activity types, and nine key precaution items were identified to enhance safety and appropriateness during program design and implementation. Conclusions: This study provides a structured framework to guide clinicians and forest therapy instructors in composing individualized forest therapy programs for patients with depression, supporting practical medical–forest therapy integration. Future research should validate the diagnostic assessment sheet through empirical field testing. Keywords: depression; forest therapy; personalized intervention; Delphi technique; diagnostic assessment; healthcare; forest therapy activities 1. Introduction Globally, the prevalence of depression, anxiety, and other mental disorders has been increasing, to the extent that these conditions are now perceived as common. Among mental disorders, depression constitutes a serious global public health concern, affecting about 3.8% of the world’s population—approximately 280 million people [1] . Depression is strongly associated with suicide; more than 700,000 people die by suicide each year, and South Korea has the highest suicide rate among OECD member countries [2] . If left untreated, mental disorders can lead to adverse outcomes; therefore, timely and accurate diagnosis and treatment are essential [3] . Without treatment, depression may persist for several months to over a year and lead to diverse difficulties in daily functioning [4] . Insomnia is among the most common symptoms, alongside gastrointestinal and respiratory symptoms and chronic fatigue [5] . Beyond the wide range of psychological and physical symptoms, approximately 85% of individuals with depression experience significant anxiety symptoms, and comorbid depression and anxiety are associated with longer treatment courses [6] . Feeling depressed at times is a natural part of life; however, if symptoms become sever

FAQs

What was the study’s main objective?

To derive diagnostic assessment sheet components that support clinicians in developing personalized forest therapy programs for patients with depression.

How were the therapeutic activities and assessment items developed?

The study analyzed program-related literature and case materials, then used a two-round Delphi survey with 17 experts to identify therapeutic activities, classify them, and create corresponding assessment and precaution items.

What key outputs were produced by the Delphi process?

The Delphi process identified 26 therapeutic activities, classified them into six final activity types, developed assessment items for selecting activity types, and produced nine key precaution items to improve safety and appropriateness.

Sep 30, 2026

Uploaded by Hazel