Landscape design integrating intangible cultural heritage elements with psychological healing functions on emotional recovery in patients with depression

Abstract Background Depression is a leading cause of global disability. While effective, conventional treatments face challenges like low adherence and stigma. Recent studies in environmental psychology increasingly emphasize the positive role of natural environments in emotional recovery. Intangible Cultural Heritage (ICH) elements, which embody profound cultural memory and emotional resonance, can be integrated into landscape design to enhance spiritual belonging and emotional regulation. However, existing designs often remain aesthetic-focused, lacking systematic validation for their efficacy in depressed populations. This study explored the effect of ICH-integrated landscape design on the emotional state of depressed patients, to provide empirical evidence for culturally therapeutic environmental design. Methods A total of 120 patients meeting the ICD-10 criteria for a depressive episode were recruited and randomly assigned to Group A (n = 60) or Group B (n = 60). Group A engaged in sitting and walking activities for 30 minutes, three times per week, within a landscape environment incorporating ICH elements (e.g., traditional patterns, local plants, folk motifs). Group B performed the same activities for an identical duration in an ordinary urban park. The intervention period lasted 8 weeks. The Hamilton Depression Rating Scale (HAMD), the Positive and Negative Affect Schedule (PANAS), and the high-frequency power of Heart Rate Variability (HRV) were used as assessment tools at baseline and week 8. Analysis of Covariance (ANCOVA) was employed to control for baseline scores and compare the post-intervention effects between the two groups. Results ANCOVA results revealed significant between-group differences after the 8-week intervention in HAMD scores (F(1, 117) = 35.42, p.001), PANAS positive affect scores (F(1, 117) = 28.15, p.001), and HRV high-frequency power (F(1, 117) = 22.73, p.001). As shown in Table 1, the improvement in all indicators was significantly greater in Group A compared to Group B. Discussion Landscape design integrating intangible cultural heritage (ICH) elements is more effective than standard urban parks in alleviating depressive symptoms, enhancing positive emotions, and regulating autonomic function. Drawing on environmental psychology and cultural identity theories, its mechanism likely involves the familiar cultural symbols and collective memory of ICH, which can evoke cultural belonging and foster positive emotional connections, thereby reducing psychological alienation and negative rumination. These results indicate that such design functions as a culturally informed therapeutic medium, offering a novel non-pharmacological intervention pathway for depression. Funding No. 2022KY1711; No. 2022JGB503.