A systematic literature review and meta-analysis of virtual reality nature effects on higher education students' mental health and wellbeing.

Virtual Reality nature (VRn) may deliver mental health and wellbeing without being outside in real nature. The main objective of this systematic review and meta-analysis was to report effects of VRn on mental health and wellbeing of students in higher education. To be eligible, participants were higher education students, the intervention was VRn, the outcome variable was a mental health parameter, and the study design was experimental. Information sources were: OVID (Embase, MEDLINE, PsycINFO), SCOPUS, CINAHL, Cochrane Library, PubMed and GreenFILE. Searches were conducted May 2023 and re-run November 2024. The modified Downs and Black checklist for randomised and non-randomised studies was used to assess risk of bias. To synthesise results, data were first extracted into a Microsoft Excel spreadsheet and summarised in narrative, statistical and tabular formats. Twenty-four articles were included. Two studies were 'good' quality, 18 'fair', and four 'poor'. Total sample size was 1,419. Two studies compared VRn versus real nature, six VRn versus no intervention, seven VRn versus flat-screen. Twelve studies included forests as the only natural environment. Thirteen of 17, seven of eight, four of five, and four of seven studies reported pre-post intervention beneficial effects on self-reported mood, anxiety, stress and cognition, respectively. Nine of 13, six of 10 and all five studies that measured cardiovascular, skin conductivity and brain activity respectively, reported pre-post intervention beneficial effects. All five studies that measured anxiety, all three studies that measured mood, and all four studies that measured stress, found no significant differences between VRn and flat-screen images of nature. Caution is required drawing conclusions due to studies' quality and sample sizes. That said, the review suggests that nature replicated in VR shows promise for benefits to mental health and wellbeing in higher education students.