Patient And Ward Correlates Of Outdoor Therapeutic Experience: Implications For Enhancing Patient Resilience In Psychiatric Hospitals

Abstract

Psychosocial resilience is often overlooked as dimension of sustainable healthcare, yet it is crucial in healthcare settings where the built environment can either buffer or amplify distress. Guided by the Attention Restoration Theory, Stress Reduction Theory, Supportive Design theory and Biophilic Design theory, the study investigated how patient and ward-level correlates shape in-patients’ Outdoor Therapeutic Experience (OTE) in psychiatric hospitals in Southeast Nigeria. A cross-sectional survey of 123 adult in-patients across four tertiary psychiatric facilities captured patient demographics (IDASQ), six socio-spatial ward attributes (SS-WAC) and seven OTE indicators (PIWA-OTES; α = 0.82). Theil-Sen median and 0.5-quantile regression modelled predictors of the composite OTE score. The mean PIWA-OTES score was 3.9 ± 0.5, indicating moderately high perceived restorativeness. Quantile regression explained 39 % of the variance, outputting the following as independently predicting higher OTE: open-ward layouts preserving privacy; high-occupancy wards promoting interaction; centrally located open nursing stations enhancing both safety and freedom with nurses; direct door access to outdoor spaces enhancing autonomy; pleasing natural views; and dignified communal visitor areas (β = 0.147–0.175; all p < 0.001). Patient characteristics showed no significant predictive value. While some findings challenge conventional assumptions, they reflect locally embedded social norms and adaptive spatial experiences. These results suggest that design strategies for mental healthcare environments must be sensitive to cultural expectations and resource constraints if they are to snowball into broader psychosocial resilience. Architectural recommendations include supporting voluntary interaction in high-occupancy spaces, ensuring spatial privacy through layout rather than enclosure, enhancing view quality, and enabling meaningful social interaction zones. This evidence supports context-specific design approaches to improve perceived outdoor environmental restorativeness in psychiatric care settings within the region.