A systematic environmental intervention, nidotherapy, given to whole communities: protocol for a randomised stepped-wedge trial
Author(s)
Type
Journal Article
Abstract
Background
Environmental changes can be positive in mental illness. Systematic, planned and guided environmental change in all its aspects is called nidotherapy. It has shown some benefit but has not been extended to whole communities.
Aims
A cluster-randomised step-wedge trial is planned in six village communities in Nottinghamshire, England, covering an adult population of 400.
Method
Adults in six villages will be offered a full personal environmental assessment followed by agreed change in different 3-month periods over the course of 1 year. All six villages have populations between 51 and 100 residents and are similar demographically. Assessments of mental health, personality status, social function, quality of life and environment satisfaction will be made. After the initial baseline period of 3 months, two villages will be randomised to nidotherapy for 3 months, a further two at 6 months and the last two at 9 months.
Results
The primary outcome will be change in social function; secondary outcomes include health-related quality of life, anxiety and depressive symptoms, personality status, costs of nidotherapy and life satisfaction. Adverse events will also be recorded. The analysis will be carried out using a multimodal statistical approach examining (a) the change in scores of the primary outcome (social function); (b) change in scores of all secondary outcomes, including costs; and (c) changes in environmental satisfaction.
Conclusions
The findings of this study should help to determine whether nidotherapy has a place in the early detection and treatment of mental pathology.
Environmental changes can be positive in mental illness. Systematic, planned and guided environmental change in all its aspects is called nidotherapy. It has shown some benefit but has not been extended to whole communities.
Aims
A cluster-randomised step-wedge trial is planned in six village communities in Nottinghamshire, England, covering an adult population of 400.
Method
Adults in six villages will be offered a full personal environmental assessment followed by agreed change in different 3-month periods over the course of 1 year. All six villages have populations between 51 and 100 residents and are similar demographically. Assessments of mental health, personality status, social function, quality of life and environment satisfaction will be made. After the initial baseline period of 3 months, two villages will be randomised to nidotherapy for 3 months, a further two at 6 months and the last two at 9 months.
Results
The primary outcome will be change in social function; secondary outcomes include health-related quality of life, anxiety and depressive symptoms, personality status, costs of nidotherapy and life satisfaction. Adverse events will also be recorded. The analysis will be carried out using a multimodal statistical approach examining (a) the change in scores of the primary outcome (social function); (b) change in scores of all secondary outcomes, including costs; and (c) changes in environmental satisfaction.
Conclusions
The findings of this study should help to determine whether nidotherapy has a place in the early detection and treatment of mental pathology.
Date Issued
2025-05-01
Date Acceptance
2024-12-11
Citation
BJPsych Open, 2025, 11 (3)
ISSN
2056-4724
Publisher
Cambridge University Press
Journal / Book Title
BJPsych Open
Volume
11
Issue
3
Copyright Statement
© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
License URL
Publication Status
Published
Article Number
e84
Date Publish Online
2025-04-11