Using virtual reality urban greenness with peer support to reduce stress and enhance social connection in older adults with mild depression: A pilot randomized controlled trial

Abstract Background and Objectives Virtual reality (VR) urban greenspace (UGS) presents an innovative strategy to enhance the mental well-being of older individuals in urban environments. However, knowledge regarding the design of VR UGS interventions to effectively reduce stress among older adults while fostering social connections remains unclear. We conducted a three-arm cluster-randomized controlled trial to evaluate the effectiveness of a social prescribing model in reducing stress and enhancing social connection among older people with mild depressive symptoms. Research Design and Methods The three-arm cluster-randomized controlled trial (25 participants per arm) consisted of: VRUGS without peer support (VRUGS), VRUGS with peer support (VRUGS-PS), and a control group (CG; non-biophilic VR intervention without peer supporters). The study captured subjective (e.g., self-reported stress) and objective measurements (e.g., heart rate [HR]) of stress and social connection assessments pre- and post-intervention. Results Mixed linear modeling revealed that compared to the CG, VRUGS group experienced significant reductions in self-reported anxiety (β = -2.72, p = 0.009) and negative emotions (β = -1.16, p = 0.039). The VRUGS-PS group showed a significant increase in social connection (β = 0.76, p = 0.017). Compared to CG, the VRUGS group showed a significant HR decrease during the intervention (β = -1.93, p < 0.001), while the VRUGS-PS group exhibited a significant HR reduction post-intervention (β = -0.60, p = 0.035), experiencing stress relief. Discussion and Implications This study provides preliminary evidence that virtual nature-based social prescribing model's effectiveness in reducing stress and enhancing social connections among older adults.