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

## TL;DR

This study creates a diagnostic assessment sheet to help design personalized forest therapy programs for depression patients, using expert input through the Delphi technique.

## Contribution

The novel contribution is the development of a structured diagnostic assessment sheet for personalized forest therapy programs using interdisciplinary expert consensus.

## Key findings

- 26 therapeutic activities were identified and grouped into six categories through expert consensus.
- Nine key precaution items were determined to ensure safety and appropriateness in program design.
- A framework was developed to guide clinicians and forest therapy instructors in creating individualized programs.

## Abstract

Background/Objectives: Depression is a serious mental illness worldwide, with a continuously increasing prevalence. As evidence supporting forest therapy as a non-pharmacological 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.