Virtual Reality-Based Relaxation Training and Symptom Improvement Among Inpatients With Depressive Disorders: Retrospective Nonrandomized Comparative Study.

Background: Virtual reality (VR) is increasingly used for adjunctive relaxation training in psychiatric care. However, evidence remains limited among hospitalized patients with depressive disorders, particularly in routine inpatient settings in China, and little is known about whether improvement varies by session frequency. Objective: This retrospective study examined whether adjunctive VR-based relaxation training was associated with changes in depressive and anxiety symptoms among inpatients with depressive disorders and whether improvement differed by session frequency. Methods: We conducted a retrospective, nonrandomized natural-group comparison using complete anonymized medical records from patients hospitalized in Lishui Second People's Hospital between January 1 and December 31, 2022. Patients met International Classification of Diseases, Tenth Revision (ICD-10) diagnostic criteria for depressive episodes or recurrent depressive disorders and were screened using predefined criteria. The analytic sample included 133 inpatients: 63 (47.4%) received adjunctive VR-based relaxation training plus usual care and 70 (52.6%) received usual care only. Usual care included pharmacotherapy and physiotherapy. The VR intervention consisted of 25-minute immersive relaxation sessions delivered approximately 3 times per week. Symptoms were assessed at admission and discharge using the 17-item Hamilton Depression Scale and Hamilton Anxiety Rating Scale. Response was defined as a reduction of 50% or more from baseline, and remission was defined as a total score of 7 or less. Baseline characteristics, outcome scores, response and remission rates, and exploratory session-frequency subgroups were compared. All analyzed variables were checked against complete medical records; no missing values were identified, and no imputation was performed. Results: The VR and control groups did not differ significantly in baseline depressive or anxiety scores. At discharge, adjunctive VR-based relaxation training was associated with lower depressive and anxiety symptom scores than usual care alone. The VR group also showed higher response rates for both depressive and anxiety symptoms and a higher anxiety remission rate, whereas depression remission was similar. Exploratory session-frequency analyses suggested that anxiety improvement may be more consistently associated with VR exposure than depression remission; however, the pattern was not strictly linear and should be interpreted cautiously because treatment frequency was linked to hospitalization duration and routine care factors. Conclusions: This study is innovative in evaluating structured VR-based relaxation training as an adjunct to routine inpatient depression care and in providing preliminary observations on session-frequency patterns in a real-world Chinese psychiatric setting. Unlike many previous VR studies conducted in noninpatient, nonclinical, or short-term experimental contexts, this study reflects everyday clinical practice among hospitalized patients with depressive disorders. The findings contribute practical evidence for integrating immersive relaxation into comprehensive inpatient care, particularly when additional anxiety relief is desired. Because the study was retrospective and nonrandomized, the findings indicate associations rather than causal effects and should be confirmed in prospective randomized controlled trials.