Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review

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Aim To explore the existing literature related to leisure-based interventions for adults with schizophrenia. Method A systematic search was conducted using Arksey and O’Malley’s framework with studies published on leisure-based intervention from January 1990 to December 2023. Results The review included 11 articles in the study. The quantitative research found that many types of leisure activities, such as cooking groups, discussions, board games, arts and crafts, painting, beading, sewing, clay work, paper crafts, and so on, were utilized as interventions. Qualitative studies found that individuals with schizophrenia spent less time in social and leisure activities and more time relaxing and doing nothing. Conclusion The study highlights the need to conduct further research on leisure-based interventions using various study designs like randomized controlled trials and mixed methods to understand its effectiveness among individuals with schizophrenia. 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F1000Research 2026, 13 :698 ( https://doi.org/10.12688/f1000research.151869.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Systematic Review Revised Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] Amar Nishad https://orcid.org/0000-0002-5761-1721 1 , Anil Kumar Mysore Nagaraj https://orcid.org/0000-0002-4436-9761 2 , Chythra R Rao https://orcid.org/0000-0002-4016-2683 3 , Keshavaram P https://orcid.org/0009-0007-6095-2432 1 , Priyanka Rajpaul https://orcid.org/0009-0008-0143-005X 4 Amar Nishad https://orcid.org/0000-0002-5761-1721 1 , Anil Kumar Mysore Nagaraj https://orcid.org/0000-0002-4436-9761 2 , [...] Chythra R Rao https://orcid.org/0000-0002-4016-2683 3 , Keshavaram P https://orcid.org/0009-0007-6095-2432 1 , Priyanka Rajpaul https://orcid.org/0009-0008-0143-005X 4 PUBLISHED 23 Mar 2026 Author details Author details 1 Department of Occupational Therapy, Manipal College of Health Professions, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 4 Occupational Therapy, Sukoon Health, Gurugram, New Delhi, 110048, India Amar Nishad Roles: Conceptualization, Data Curation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Anil Kumar Mysore Nagaraj Roles: Conceptualization, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Chythra R Rao Roles: Conceptualization, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Keshavaram P Roles: Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Priyanka Rajpaul Roles: Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. Abstract Background Schizophrenia is a severe mental illness characterized by psychosis, apathy, social withdrawal, and cognitive impairment, which results in impaired functioning in work, school, parenting, self-care, independent living, interpersonal relationships, and leisure time. Aim To explore the existing literature related to leisure-based interventions for adults with schizophrenia. Method A systematic search was conducted using Arksey and O’Malley’s framework with studies published on leisure-based intervention from January 1990 to December 2023. Results The review included 11 articles in the study. The quantitative research found that many types of leisure activities, such as cooking groups, discussions, board games, arts and crafts, painting, beading, sewing, clay work, paper crafts, and so on, were utilized as interventions. Qualitative studies found that individuals with schizophrenia spent less time in social and leisure activities and more time relaxing and doing nothing. Conclusion The study highlights the need to conduct further research on leisure-based interventions using various study designs like randomized controlled trials and mixed methods to understand its effectiveness among individuals with schizophrenia. READ ALL READ LESS Keywords Leisure-based interventions, schizophrenia, Adults, Recreation, Scoping review Corresponding Author(s) Anil Kumar Mysore Nagaraj ( [email protected] ) Close Corresponding author: Anil Kumar Mysore Nagaraj Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Nishad A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Nishad A, Mysore Nagaraj AK, R Rao C et al. Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 13 :698 ( https://doi.org/10.12688/f1000research.151869.3 ) First published: 27 Jun 2024, 13 :698 ( https://doi.org/10.12688/f1000research.151869.1 ) Latest published: 23 Mar 2026, 13 :698 ( https://doi.org/10.12688/f1000research.151869.3 ) Revised Amendments from Version 2 In response to the first comment, we meant that we have retained “leisure” as the primary term, as it is used predominantly across the article, and removed references to “recreation” from the introductory section, as it seemed not necessary. This revision ensures alignment between the definition provided and the terminology used throughout the review as it was suggested by the reviewer. Location of revision: Introduction, second paragraph. In response to the second comment, we have revised the presentation of the results by summarizing study design characteristics and quality-of-life outcomes within the data charting table. Rather than uploading this as a separate file, the revised table has now been updated in the same extended data link already cited in the manuscript, located at the end of the article. This ensures consistency and ease of access for readers and reviewers. In response to the first comment, we meant that we have retained “leisure” as the primary term, as it is used predominantly across the article, and removed references to “recreation” from the introductory section, as it seemed not necessary. This revision ensures alignment between the definition provided and the terminology used throughout the review as it was suggested by the reviewer. Location of revision: Introduction, second paragraph. In response to the second comment, we have revised the presentation of the results by summarizing study design characteristics and quality-of-life outcomes within the data charting table. Rather than uploading this as a separate file, the revised table has now been updated in the same extended data link already cited in the manuscript, located at the end of the article. This ensures consistency and ease of access for readers and reviewers. See the authors' detailed response to the review by Luigi Giuliani See the authors' detailed response to the review by Jason Page READ REVIEWER RESPONSES Introduction Schizophrenia is a severe mental disorder characterized by psychosis, apathy, social withdrawal, and cognitive impairment, which results in impaired functioning in work, school, parenting, self-care, independent living, interpersonal relationships, and leisure time ( Geller, 1992 ). Approximately 24 million individuals worldwide, or 1 in 300, are affected by schizophrenia ( World Health Organization, 2022 ). In adulthood, the corresponding rate is 1 in 222 ( World Health Organization, 2022 ). The most common times for onset are in late teens and the twenties, and in men it happens earlier than in women ( World Health Organization, 2022 ). Schizophrenia is one of the main mental health disorders contributing to the global disease burden, affecting different functioning domains, including social functioning ( World Health Organization, 2012 ). People with schizophrenia have both internal and environmental obstacles to engaging in leisure activities, such as side effects from medicine, cultural stigma, family dynamics, and cultural norms ( Rezaie et al., 2017 ). Leisure is defined as a “non-obligatory activity that is Intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations such as work, self-care, or sleep” ( American Occupational Therapy Association, 2014 ). Leisure plays a crucial role in a meaningful life for those with mental illness, offering benefits such as a strengthened sense of identity, self-belonging, active involvement, reduced boredom, and an effective method for managing stress ( Iwasaki et al., 2014 ). However, leisure activities pose certain challenges. These involve finding, planning, and carrying out suitable and captivating leisure pursuits ( Hein et al., 2020 ; Giacco et al., 2012 ). Depending on personal perceptions, leisure can be defined as either casual, serious, or project-based. It can take many different forms, such as instantaneous, brief, and intrinsically fulfilling activities without the need for special skills (i.e., casual leisure); systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself (serious leisure); or occasionally short-term tasks completed as part of work obligations (project based leisure) ( Stebbins, 2008 ). Giacco et al. (2012) mention that “negative symptoms of psychosis may make it difficult for a person to participate in leisure activities”. Negative symptoms, such as apathy, anhedonia, and social withdrawal, can significantly hinder motivation and the ability to engage in enjoyable activities ( Fervaha et al., 2014 ). These symptoms can create barriers to participation in leisure, which is essential for mental health recovery. Moreover, cognitive deficits, commonly associated with psychosis, further exacerbate these challenges. Impairments in memory, attention, and executive functioning can make it difficult for individuals with schizophrenia to plan, initiate, and sustain leisure activities. The combination of negative symptoms and cognitive deficits often leads to a reduction in leisure participation, depriving individuals of the therapeutic benefits of these activities, such as stress relief, social connection, and improved quality of life ( Lepage et al., 2014 ; Fervaha et al., 2014 ). A study by Fervaha et al. (2014) found that cognitive impairment was a significant predictor of reduced engagement in leisure activities among individuals with schizophrenia. Another study highlighted how anhedonia and cognitive dysfunction jointly reduce the likelihood of pursuing pleasurable activities ( Der-Avakian & Markou, 2012 ; Pisoni et al., 2021 ; Liang et al., 2022 ), which are critical components of leisure. Addressing these issues through targeted interventions may enhance their engagement in leisure activities, contributing positively to their overall well-being. Preliminary research shows that active leisure as an intervention has been beneficial in schizophrenia ( Lipskaya-Velikovsky et al., 2020 ; Snethen et al., 2012 ; Dean et al., 2014 ; Voruganti et al., 2006 ; Caddy et al., 2011 ). However, one study has been precise in inferring that people with schizophrenia participated in active leisure only when it was part of an intervention ( Yanos & Robilotta, 2011 ). The above preliminary findings indicate that leisure-focused therapies could be crucial to achieving recovery oriented results ( Iwasaki et al., 2014 ). Thus, our study aimed to explore the existing literature related to leisure-based interventions for adults with schizophrenia by identifying the findings of the existing studies and the impact and utilization of these interventions. Methods The framework proposed by scoping reviews by Arksey & O’Malley (2005) was used in the current scoping review. Research question What are the available studies on leisure-based interventions or programs provided for adults with schizophrenia? Search strategy Having specific criteria for searching the relevant articles is a requirement to answer the question framed for any scoping review ( Arksey & O’Malley, 2005 ). The databases Scopus, PubMed, and Embase were accessed. The grey literature searches through Google scholar were carried out. Search keywords “Schizophrenia” OR “Psychosis” AND “leisure” OR “leisure activity” OR “leisure activities” OR “recreation” OR “activity” OR “activity group” OR “activity groups” OR “creative activity” OR “recreational therapy” OR “leisure-based intervention” AND “Adults” OR “Adult”. The Boolean search strategy was applied to connect using AND, and OR. The following criteria were decided on for the scoping review by all the reviewers: Inclusion criteria • Studies using leisure-based interventions, qualitative studies, single-case studies, cross-sectional and longitudinal studies with or without a comparison control group from January1990 to December 2023 were included. • Full-text articles in only English language were included. Exclusion criteria • Letter to editors, correspondence articles, viewpoints, ideas, opinions, short communications, and conference proceedings were excluded. Study selection The search was carried out in the selected databases by two independent reviewers adhering to the established inclusion and exclusion criteria. Following title and abstract screening, the articles included for full-text screening were exported to an Excel sheet for blinding of the selection process. Any disagreement during the selection process was resolved with the help of other reviewers. The included articles were reviewed in full text and data extraction covered the following: title, author(s), year of publication, country, setting, methodology, and results. The extracted data were entered into the Excel sheet, and all the authors reviewed the information. The study details are charted in Table 1(extended data). Three independent authors participated in selecting the studies, and all authors reached a consensus on the studies to be included after discussion. Figure 1 shows the selection of studies in this review. Figure 1. PRISMA chart. Results The study yielded 30,194 articles out of which 20,733 articles were screened for title and abstract screening after duplicate removal. After title and abstract screening, 194 articles were eligible for the full text screening, 183 articles were excluded as they did not meet the inclusion criteria, and finally 11 articles were included in the review. In total two studies were pilot interventional study, one randomized controlled study, one case-control, one retrospective study, three were cross sectional, one was cross sectional longitudinal study and two were qualitative in nature. Out of 11 studies, four were conducted in England ( Dean et al., 2014 ; Ngamaba et al., 2021 ; Shimitras et al., 2003 ; Cella et al., 2016 ), three in USA ( Iwasaki et al., 2014 ; Snethen et al. 2012 ; McCormick et al., 2012 ), two in Australia ( Caddy et al., 2011 ; Hayes & Halford, 1996 ), one in France ( Voruganti et al., 2006 ), and one in Israel ( Lipskaya-Velikovsky et al., 2020 ). Further, these studies can be broadly classified into exploratory/observational and interventional studies, many of them being exploratory/observational. The results of these studies are explained below. Observational studies on impact of leisure in schizophrenia The first ever study in this area by Hayes and Halford (1996) aimed to understand time use among employed and unemployed single men with schizophrenia as well the impact of employment status on leisure activities. The researchers found that employed individuals with schizophrenia engaged in a more diverse range of activities, including leisure pursuits, compared to unemployed individuals. This suggests that employment not only provides structure but also facilitates greater engagement in leisure activities. The involvement in leisure activities is important as it can contribute to overall well-being and quality of life. Subsequently, Shimitras et al.(2003) examined the time use of 229 adults diagnosed with schizophrenia using an epidemiological survey in London, England. Twenty-four-hour time budgets were collected, and time use was calculated for 10 major categories of occupations. The study found that individuals with schizophrenia spent a significant portion of their time on passive activities, such as watching television, and less time on productive or social activities. The study concluded that individuals with schizophrenia have limited engagement in varied and meaningful activities, suggesting the need for interventions that promote more active and structured daily routines to enhance quality of life. Later, a retrospective study by Caddy et al. (2011) examined the mental health outcomes of 403 inpatients with mental illness including schizophrenia participating in art- and craft-based creative therapies at a private psychiatric hospital over 5 years. The data of those who attended at least six sessions of the art and craft based creative activity group was analyzed. The patients showed statistically significant improvements across various psychometric measures like the Depression and Anxiety Stress Scale (DASS-21), The Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES), the Medical Outcomes Short Form Questionnaire, and the Health of the Nation Outcome Scale (HONOS) from admission to discharge, thus showing that participation in creative activity has potential benefits. McCormick et al. (2012) investigated the association between the type of activities (active/sedentary, leisure/non-leisure) and the emotional experiences of patients with schizophrenia spectrum disorders (SSD). The researchers employed the experience sampling method to collect data on the activities and emotional experiences of 45 persons with SSD. The results showed that most of the participants’ leisure activities were sedentary. The study discovered that physically active leisure activities were linked to fewer negative emotional experiences. The authors concluded that studying the emotional experiences linked with various activities can assist in informing interventions and therapy approaches for enhancing subjective well-being in persons with SSD. Iwasaki et al. (2014) examined the role of leisure in the recovery and health of culturally diverse individuals with mental illness including schizophrenia, bipolar disorder, and major depression. The study results found that engaging in leisure activities can provide meaningful experiences, promote a sense of connection and autonomy, reduce feelings of boredom, and enhance overall health. perceived active engagement in leisure is a strong predictor of recovery and lower psychiatric symptoms. It highlighted the importance of cultural diversity in leisure experiences and suggested that mental health services should incorporate leisure-based interventions to support recovery effectively. Another study Cella et al. (2016) aimed to understand the differences in time use patterns between people with schizophrenia and the general population. Utilizing the Time Use Survey, the results showed that people with schizophrenia spent less time in functional, social, and leisure activities compared to the general population, and more time resting and “doing nothing.” The severity of negative symptoms was associated with more time spent in passive activities and less time in social and leisure activities. The study suggests that time-use mapping can be a useful tool to assess progress toward recovery in people with schizophrenia. More recently, Ngamaba et al. (2021) investigated the relationship between participation in leisure activities and the quality of life for people with psychosis in England, using a cross-sectional survey design. The measures used were the Time Use Survey (TUS) and the Manchester Short Assessment of Quality of Life (MANSA). Descriptive statistics and multiple regression analyses were conducted. The findings suggested a positive correlation between active participation in leisure activities and improved quality of life among the participants. The study highlighted the importance of leisure activities as a potential therapeutic tool to enhance the well-being of people with psychosis. Leisure based interventional studies in schizophrenia In the year 2006, a study aimed to assess the feasibility of a novel adventure- and recreation-based group intervention in the rehabilitation of individuals with schizophrenia. The intervention had a summer module and a winter module, each consisting of 8 weekly sessions. The summer module (camping, canoeing, kayaking, rock climbing, etc) and the winter module (skating, skiing, snowboarding, etc) activities usually lasted a full day, and camping trips occurred over 3 days. Patients in the study group showed marginal improvement in perceived cognitive abilities and on domain-specific functioning measures but experienced a significant improvement in their self-esteem and global functioning. The findings suggest that adventure and recreation activities can be effective in promoting physical health and psychological well-being among individuals with schizophrenia ( Voruganti et al., 2006 ). Around the same time, a study Snethen et al. (2012) sought to assess Independence through Community Access and Navigation (I-CAN) intervention, which aimed to enhance community participation in adults with schizophrenia spectrum disorders (SSD). The I-CAN intervention is a recreational therapy (RT) intervention modeled after the individualized placement and support (IPS) model. Recreation therapy is a therapeutic approach that uses structured leisure and recreational activities to improve functional abilities, community participation, and overall well-being in individuals with mental illness. RT interventions emphasize individualized goal setting, skill development, and engagement in meaningful community-based leisure. At the end of the intervention, seven out of the 10 study participants with schizophrenia revealed that the intervention led to increased community involvement, improved planning skills, and better coping skills, largely due to the therapeutic relationship. The study offers preliminary support for I-CAN as an effective participant-centered approach for individuals with SSD. Dean et al. (2014) examined the effect of an activity group intervention on mental health and global functioning in people with schizophrenia, compared to standard care alone using a randomized controlled trial study design. The activity groups were run weekly for up to 90 minutes over 12 months, offering a range of activities like discussions, board games, and outings. Primary outcomes were global functioning, assessed using the Global Assessment of Functioning (GAF) and mental health symptoms measured using the Positive and Negative Syndrome Scale (PANSS). The results showed that while there were improvements in mental health symptoms among those in the activity group, there were no significant differences between the two groups in global functioning or other secondary outcomes at the 12-month follow-up. The authors suggest that further research is needed to understand how to better engage people with schizophrenia in social activities and evaluate the outcomes of such interventions. A study by Lipskaya-Velikovsky et al., (2020) aimed to evaluate the effectiveness of the “Occupational Connections” (OC) intervention, a manualized, short-term, group-based program designed to enhance participation in meaningful daily activities among individuals with serious mental illness, particularly schizophrenia. Participants were divided into two groups: the OC intervention group (16 participants) and a control group (17 participants) that received treatment as usual, including an open leisure activity group. The intervention was delivered over 10 sessions, with outcomes measured before and after the intervention. The findings suggest that OC intervention was effective in improving participants’ intention to engage in daily activities, diversity of participation, functional capacity, cognitive abilities, and symptoms of schizophrenia. The results indicate that OC may contribute positively to recovery-oriented services in inpatient settings and support community reintegration post-hospitalization. Discussion The available literature shows that individuals with schizophrenia spend relatively little time engaging in leisure activities and that those activities are predominantly passive, reflecting a broader issue of reduced social participation and activity engagement within this population. People with schizophrenia often gravitate towards passive leisure activities, such as watching TV, relaxing, or sleeping, rather than engaging in more active or socially engaging pursuits ( Hayes & Halford, 1996 ; Shimitras et al., 2003 ; Cella et al., 2016 ). This could be due to several factors intrinsic to the disorder, including negative symptoms like anhedonia, avolition, and social withdrawal, which reduce motivation and pleasure in daily activities ( Harris & Horan, 2021 ). Further, there is a significant difference in time use between individuals with schizophrenia and the general population, with the former group spending considerably less time in active leisure activities ( Cella et al., 2016 ). This difference emphasizes the impact of schizophrenia on social engagement and the potential isolation that comes from reduced participation in meaningful activities. The underutilization of active leisure activities highlights the need for targeted interventions that address the barriers to engagement faced by individuals with schizophrenia. Also, the studies reveal that engaging in leisure activities offers significant benefits for patients with schizophrenia across multiple dimensions, including cognitive, clinical, functional, and quality of life aspects. Cognitive benefits: Leisure activities have been shown to positively impact cognitive functions, which are often impaired in individuals with schizophrenia.. Studies such as those by Lipskaya-Velikovsky et al. (2020) and Snethen et al. (2012) found that participation in structured leisure activities led to improvements in various cognitive domains such as executive functioning, language understanding, and visual memory. Clinical benefits: Leisure activities have been associated with reductions in both positive and negative symptoms of schizophrenia. Studies reported that engagement in leisure activities can reduce psychiatric symptoms such as anxiety, depression, and negative affect ( Iwasaki et al., 2014 ; McCormick et al., 2012 ). Functional benefits: Engagement in leisure activities provides a structured way for patients to interact with their environment, develop coping strategies, and enhance their ability to manage daily tasks. Studies by Dean et al. (2014) and Snethen et al. (2012) demonstrated that leisure-based interventions could lead to increased community involvement, better planning abilities, and improved coping skills. Quality of life benefits: Leisure activities provide meaningful engagement that can enhance the sense of identity, autonomy, and belonging, all of which are essential for improving quality of life. Ngamaba et al. (2021) highlighted that individuals who engaged more frequently in leisure activities reported higher quality of life scores, particularly in domains related to social relationships, physical health, and psychological well-being. Caddy et al. (2011) and Lipskaya-Velikovsky et al. (2020) both used a pre-post group intervention design. The former had a larger sample size (n=403 patients) compared to the latter (n=33 patients). ( Caddy et al. 2011 ) focused on art- and craft-based creative therapies, whereas Lipskaya-Velikovsky et al. (2020) focused on the “Occupational Connections” intervention, which emphasized meaningful daily activities. Both studies reported improvements in mental health outcomes, but Caddy et al. (2011) demonstrated statistically significant improvements across various psychometric measures, while Lipskaya-Velikovsky et al. (2020) noted significant improvements in participation diversity and cognitive functioning. The larger sample size in Caddy et al. (2011) study may offer more robust statistical power, leading to a broader generalization of results. Lipskaya-Velikovsky et al. (2020) focus on personal meaningful activities aligns with recovery-oriented care, suggesting that interventions tailored to personal relevance may enhance recovery outcomes ( Jacob, 2015 ). Dean et al. (2014) employed a randomized controlled trial, Voruganti et al. (2006) used a case-control pre-post design and Snethen et al. (2012) employed a pilot intervention study. Dean et al. (2014) utilized an RCT, providing a high level of evidence but might have been limited by the nature of the intervention. Voruganti et al. (2006) employed a case-control design with a focus on physical and adventurous activities, which was likely more effective in promoting changes in self-esteem and global functioning, similar findings were noted in a study by ( Mahindru et al., 2023 ). Snethen et al. (2012) study, although small, highlighted the importance of personalized interventions. Dean et al. (2014) had the largest sample, which typically increases the robustness of findings. Voruganti et al. (2006) and Snethen et al. (2012) had smaller samples, but the nature of their interventions might have led to more impactful outcomes despite this limitation. The type of intervention appears to be a critical factor in the outcomes. In Voruganti et al. (2006) physically demanding and immersive activities seemed to create more substantial changes compared to the more passive activities in ( Dean et al., 2014 ) and the community-focused intervention in Snethen et al. (2012) . The differences in outcomes can be attributed to the intensity, physicality, and immersive nature of the interventions. Voruganti et al. (2006) achieved significant improvements in global functioning and self-esteem, likely due to the challenging nature of the activities. Snethen et al. (2012) showed improvements in community involvement, highlighting the value of individualized and participant-centered approaches. Dean et al. (2014) lack of significant differences might suggest that the intervention’s intensity or the types of activities were insufficient to produce substantial changes in global functioning. Recreation therapy represents an important but underrepresented pathway for facilitating access to leisure among individuals with schizophrenia. As demonstrated by Snethen et al. (2012) , RT-based interventions focus on reducing environmental and personal barriers to leisure participation through structured, goal-oriented, and community-based activities. Despite its relevance, recreation therapy remains insufficiently discussed in leisure-focused schizophrenia research, highlighting the need for greater integration and explicit reporting of RT approaches in future intervention studies. The types of leisure activities varied across studies, reflecting differences in cultural factors, feasibility, acceptability, and affordability. This variability suggests that leisure-based interventions should be tailored to individual preferences and contexts. The duration of leisure-based intervention sessions ranged from 45 minutes to 1 hour. The variability in session length may be attributed to the client-centered nature of these interventions. Hayes & Halford (1996) and Shimitras et al. (2003) employed observational designs, making them suitable for examining time use patterns among individuals with schizophrenia. However, while Hayes and Halford (1996) focused specifically on the impact of employment status, Shimitras et al. (2003) provided a broader overview of daily activities within a larger population. Shimitras et al. (2003) had a significantly larger sample size (n=229 participants) compared to ( Hayes & Halford, 1996 ) (n=48). Though Shimitras et al. (2003) study has a larger sample size, ( Hayes & Halford, 1996 ) study may offer deeper insights into the specific subgroup of employed versus unemployed individuals with schizophrenia. The outcomes of the two studies are complementary. Hayes and Halford (1996) found that employment supports greater diversity in activities, including leisure, which contributes to overall well-being. On the other hand, Shimitras et al. (2003) identified a general lack of engagement in meaningful activities among individuals with schizophrenia, particularly those who may not be employed. Together, these findings suggest that promoting employment and creating opportunities for structured, active engagement could be key strategies for improving the quality of life for individuals with schizophrenia. Iwasaki et al. (2014) used in-depth interviews, which allowed for a comprehensive understanding of leisure’s role in recovery but may have limited generalizability due to subjective reporting. McCormick et al. (2012) used the experience sampling method, providing real-time data on activities and emotions, which may offer more objective insights but with a smaller sample size. Iwasaki et al. (2014) had a larger sample (n=101), allowing for a broader understanding of leisure’s impact across not only schizophrenia, but other major mental disorders. It also highlighted the broad benefits of leisure activities, including improved recovery outcomes and cultural considerations, reflecting the importance of integrating leisure into treatment plans. McCormick et al. (2012) specifically linked physically active leisure activities to fewer negative emotional experiences, providing more targeted recommendations for improving subjective well-being in SSD patients. Both studies emphasize the importance of activity in mental health but with different approaches, and with varying depths of analysis. Cella et al. (2016) is the only study that we came across, that compared people with schizophrenia to the general population, revealing that those with schizophrenia spent less time in meaningful activities, similar findings were also observed in ( Minato & Zemke, 2004 ; Ohi et al., 2019 ; Strassnig et al., 2019 ). This highlights the impact of schizophrenia on daily life and suggests the need for targeted interventions to increase engagement in meaningful activities. Thus, overall the results of the existing exploratory as well as interventional studies infer that leisure-based interventions have a beneficial role in patients with schizophrenia. Strength and limitations To the best of our knowledge, this is the first scoping review on leisure-based interventions in individuals with schizophrenia. The limitation of our study is that only published literature in English was searched in the current review, which may have resulted in missing relevant non-English studies. Our literature search provided a limited number of interventional studies that have used leisure as a therapeutic intervention as most studies are exploratory. The current review may help future researchers conduct relevant research related to the gaps identified in this article. Nevertheless, most of the studies identified in this scoping review have found that there is a positive effect of leisure-based interventions in the treatment of schizophrenia, though there can be a risk of bias that invites us to be cautious when interpreting these results. Gaps identified and future implications There are limited studies on leisure-based interventions among individuals with schizophrenia. Future studies may focus on evaluating the effectiveness of leisure-based interventions specifically on various deeds such as activities of daily living (ADL), instrumental activities of daily living, social participation, and other associated factors such as self-confidence, motivation, emotional expressions, and communication skills. Also, we need studies to develop guidelines for the duration and the type of leisure modalities that could be used among persons with schizophrenia. Such studies are all the more essential in low middle income and middle-income countries. The existing research also highlights the need to conduct randomized controlled trials and mixed-method studies, to further understand the effectiveness of leisure-based interventions. Conclusion The purpose of this scoping review was to gather and describe the available research on the use of leisure as an intervention among individuals with schizophrenia have proven beneficial for individuals with schizophrenia, positively impacting clinical, cognitive, functional, and quality of life domains. These interventions improve symptoms, cognitive functions, daily functioning, and overall well-being. The evidence supports incorporating leisure-based activities into therapeutic programs, highlighting their value as a key component of comprehensive care. Sustained employment is a facilitator for active leisure. Flexible, client-centered, and culturally appropriate interventions can help overcome the challenges of passive lifestyles and encourage more active participation in meaningful leisure activities. Future research, especially the interventional studies, should continue to validate leisure based interventions, to optimize treatment strategies for schizophrenia. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 27 Jun 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Occupational Therapy, Manipal College of Health Professions, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 3 Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 4 Occupational Therapy, Sukoon Health, Gurugram, New Delhi, 110048, India Amar Nishad Roles: Conceptualization, Data Curation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Anil Kumar Mysore Nagaraj Roles: Conceptualization, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Chythra R Rao Roles: Conceptualization, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Keshavaram P Roles: Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Priyanka Rajpaul Roles: Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 23 Mar 2026, 13:698 https://doi.org/10.12688/f1000research.151869.3 version 2 Revised Published: 16 Sep 2024, 13:698 https://doi.org/10.12688/f1000research.151869.2 version 1 Published: 27 Jun 2024, 13:698 https://doi.org/10.12688/f1000research.151869.1 Copyright © 2026 Nishad A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Nishad A, Mysore Nagaraj AK, R Rao C et al. Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 13 :698 ( https://doi.org/10.12688/f1000research.151869.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 16 Sep 2024 Revised Views 0 Cite How to cite this report: Page J. Reviewer Report For: Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 13 :698 ( https://doi.org/10.5256/f1000research.171414.r332633 ) The direct URL for this report is: https://f1000research.com/articles/13-698/v2#referee-response-332633 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Nov 2024 Jason Page , SUNY Cortland, Cortland, New York, USA Approved VIEWS 0 https://doi.org/10.5256/f1000research.171414.r332633 Overall of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. In the Second paragraph of the introduction mentions "leisure/recreational activities" leisure is defined but recreation is not nor is ... Continue reading READ ALL Overall of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. In the Second paragraph of the introduction mentions "leisure/recreational activities" leisure is defined but recreation is not nor is the relationship between the two. Either define recreation or remove it as for the rest of the article the authors use leisure almost exclusively. Quality of life and study design sections could be put into a table and summarized for easy review. No mention is made of recreation therapy as a potential avenue for increasing access to leisure for people with schizophrenia and despite being mentioned in relation to Snethen et al (2012) no explanation of what RT is is provided. I would suggest the article below as a means of offering Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable References 1. Ray L, Hopper T, McHugh T: Therapeutic recreation as a pathway to support mental health in Northern Canada: practitioners perspectives. Leisure/Loisir . 2024; 48 (4): 629-654 Publisher Full Text 2. Frail. Jackie, Quattrini.Jessica,Thompson.Rebecca,Berzaitis.Smith,Oretan, Lindsey: Personal Benefits of Therapeutic Recreation for Persons with Mental Illness: Advocating for Service Delivery to Key Decision Makers. Competing Interests: No competing interests were disclosed. Reviewer Expertise: MY research background is in recreational therapy with an emphasis on behavioral health. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Page J. Reviewer Report For: Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 13 :698 ( https://doi.org/10.5256/f1000research.171414.r332633 ) The direct URL for this report is: https://f1000research.com/articles/13-698/v2#referee-response-332633 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Feb 2026 Anil Kumar Mysore Nagaraj , Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India 09 Feb 2026 Author Response Overall, of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. Response: We thank the reviewer for their ... Continue reading Overall, of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. Response: We thank the reviewer for their positive and encouraging comments and for acknowledging the value of the scoping review despite the limited available literature. 2) In the Second paragraph of the introduction mentions "leisure/recreational activities" leisure is defined but recreation is not nor is the relationship between the two. Either define recreation or remove it as for the rest of the article the authors use leisure almost exclusively. Response: We thank the reviewer for highlighting this important conceptual issue. We agree that clarity is required regarding the use of the terms leisure and recreation . In response, we have revised the introduction to ensure conceptual consistency throughout the manuscript. Specifically, we have retained “leisure” as the primary term, as it is used predominantly across the article, and removed unnecessary references to “recreation” in the introductory section. This revision ensures alignment between the definition provided and the terminology used across the review. 3) Quality of life and study design sections could be put into a table and summarized for easy review. Response: We appreciate this helpful suggestion. In response, we have revised the presentation of results by summarizing study design characteristics and quality-of-life outcomes in tabular form within the data charting table. This restructuring enhances clarity, allows for easier comparison across studies, and improves the overall readability of the review. 4) No mention is made of recreation therapy as a potential avenue for increasing access to leisure for people with schizophrenia and despite being mentioned in relation to Snethen et al (2012) no explanation of what RT is is provided. Response: We thank the reviewer for this valuable observation. We agree that recreation therapy (RT) warrants clearer explanation in the context of this review. Accordingly, we have added a brief description of recreation therapy when discussing the study by Snethen et al. (2012), clarifying its role as a therapeutic approach that facilitates engagement in meaningful leisure and community participation. We have also acknowledged recreation therapy as a potential avenue for enhancing access to leisure among individuals with schizophrenia within the discussion section, while maintaining the primary focus of the review on leisure-based interventions. Overall, of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. Response: We thank the reviewer for their positive and encouraging comments and for acknowledging the value of the scoping review despite the limited available literature. 2) In the Second paragraph of the introduction mentions "leisure/recreational activities" leisure is defined but recreation is not nor is the relationship between the two. Either define recreation or remove it as for the rest of the article the authors use leisure almost exclusively. Response: We thank the reviewer for highlighting this important conceptual issue. We agree that clarity is required regarding the use of the terms leisure and recreation . In response, we have revised the introduction to ensure conceptual consistency throughout the manuscript. Specifically, we have retained “leisure” as the primary term, as it is used predominantly across the article, and removed unnecessary references to “recreation” in the introductory section. This revision ensures alignment between the definition provided and the terminology used across the review. 3) Quality of life and study design sections could be put into a table and summarized for easy review. Response: We appreciate this helpful suggestion. In response, we have revised the presentation of results by summarizing study design characteristics and quality-of-life outcomes in tabular form within the data charting table. This restructuring enhances clarity, allows for easier comparison across studies, and improves the overall readability of the review. 4) No mention is made of recreation therapy as a potential avenue for increasing access to leisure for people with schizophrenia and despite being mentioned in relation to Snethen et al (2012) no explanation of what RT is is provided. Response: We thank the reviewer for this valuable observation. We agree that recreation therapy (RT) warrants clearer explanation in the context of this review. Accordingly, we have added a brief description of recreation therapy when discussing the study by Snethen et al. (2012), clarifying its role as a therapeutic approach that facilitates engagement in meaningful leisure and community participation. We have also acknowledged recreation therapy as a potential avenue for enhancing access to leisure among individuals with schizophrenia within the discussion section, while maintaining the primary focus of the review on leisure-based interventions. Competing Interests: No competing interests Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Feb 2026 Anil Kumar Mysore Nagaraj , Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India 09 Feb 2026 Author Response Overall, of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. Response: We thank the reviewer for their ... Continue reading Overall, of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. Response: We thank the reviewer for their positive and encouraging comments and for acknowledging the value of the scoping review despite the limited available literature. 2) In the Second paragraph of the introduction mentions "leisure/recreational activities" leisure is defined but recreation is not nor is the relationship between the two. Either define recreation or remove it as for the rest of the article the authors use leisure almost exclusively. Response: We thank the reviewer for highlighting this important conceptual issue. We agree that clarity is required regarding the use of the terms leisure and recreation . In response, we have revised the introduction to ensure conceptual consistency throughout the manuscript. Specifically, we have retained “leisure” as the primary term, as it is used predominantly across the article, and removed unnecessary references to “recreation” in the introductory section. This revision ensures alignment between the definition provided and the terminology used across the review. 3) Quality of life and study design sections could be put into a table and summarized for easy review. Response: We appreciate this helpful suggestion. In response, we have revised the presentation of results by summarizing study design characteristics and quality-of-life outcomes in tabular form within the data charting table. This restructuring enhances clarity, allows for easier comparison across studies, and improves the overall readability of the review. 4) No mention is made of recreation therapy as a potential avenue for increasing access to leisure for people with schizophrenia and despite being mentioned in relation to Snethen et al (2012) no explanation of what RT is is provided. Response: We thank the reviewer for this valuable observation. We agree that recreation therapy (RT) warrants clearer explanation in the context of this review. Accordingly, we have added a brief description of recreation therapy when discussing the study by Snethen et al. (2012), clarifying its role as a therapeutic approach that facilitates engagement in meaningful leisure and community participation. We have also acknowledged recreation therapy as a potential avenue for enhancing access to leisure among individuals with schizophrenia within the discussion section, while maintaining the primary focus of the review on leisure-based interventions. Overall, of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. Response: We thank the reviewer for their positive and encouraging comments and for acknowledging the value of the scoping review despite the limited available literature. 2) In the Second paragraph of the introduction mentions "leisure/recreational activities" leisure is defined but recreation is not nor is the relationship between the two. Either define recreation or remove it as for the rest of the article the authors use leisure almost exclusively. Response: We thank the reviewer for highlighting this important conceptual issue. We agree that clarity is required regarding the use of the terms leisure and recreation . In response, we have revised the introduction to ensure conceptual consistency throughout the manuscript. Specifically, we have retained “leisure” as the primary term, as it is used predominantly across the article, and removed unnecessary references to “recreation” in the introductory section. This revision ensures alignment between the definition provided and the terminology used across the review. 3) Quality of life and study design sections could be put into a table and summarized for easy review. Response: We appreciate this helpful suggestion. In response, we have revised the presentation of results by summarizing study design characteristics and quality-of-life outcomes in tabular form within the data charting table. This restructuring enhances clarity, allows for easier comparison across studies, and improves the overall readability of the review. 4) No mention is made of recreation therapy as a potential avenue for increasing access to leisure for people with schizophrenia and despite being mentioned in relation to Snethen et al (2012) no explanation of what RT is is provided. Response: We thank the reviewer for this valuable observation. We agree that recreation therapy (RT) warrants clearer explanation in the context of this review. Accordingly, we have added a brief description of recreation therapy when discussing the study by Snethen et al. (2012), clarifying its role as a therapeutic approach that facilitates engagement in meaningful leisure and community participation. We have also acknowledged recreation therapy as a potential avenue for enhancing access to leisure among individuals with schizophrenia within the discussion section, while maintaining the primary focus of the review on leisure-based interventions. Competing Interests: No competing interests Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 27 Jun 2024 Views 0 Cite How to cite this report: Giuliani L. Reviewer Report For: Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 13 :698 ( https://doi.org/10.5256/f1000research.166558.r301277 ) The direct URL for this report is: https://f1000research.com/articles/13-698/v1#referee-response-301277 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 06 Aug 2024 Luigi Giuliani , University of Campania Luigi Vanvitelli, Naples, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.166558.r301277 The study by Nishad et al. aims to explore the existing literature related to the leisure-based interventions for adults with schizophrenia by identifying the range of study designs. The results of the present study highlight the need to conduct further ... Continue reading READ ALL The study by Nishad et al. aims to explore the existing literature related to the leisure-based interventions for adults with schizophrenia by identifying the range of study designs. The results of the present study highlight the need to conduct further research on leisure-based interventions using rigorous study designs like randomized controlled trials and mixed methods to understand its effectiveness among individuals with schizophrenia. The study topic is timely and interesting. However, according to the comments provided below, some important issues should be addressed. Abstract The aims of the study are missing. In the results section, listing the methodology of all the studies included in the review might be removed. In the results section, are reported only the findings of qualitative studies. Please report also the quantitative results. Introduction Citations after the sentences “Approximately 24 million individuals worldwide, or 1 in 300, are affected by schizophrenia” and “In adulthood, the corresponding rate is 1 in 222” are missing. Please add them. The sentence “One of the main mental health disorders contributing to the global disease burden is schizophrenia, that also affects social functioning” does not appear fluid within the paragraph and it could be changed with “Schizophrenia is one of the main mental health disorders contributing to the global disease burden, affecting different functioning domains, among which social functioning”. Does “systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself” and “occasionally short-term tasks completed as part of work obligations” correspond respectively to serious- and project-based leisure activities? Please specify. The sentence “One aspect of a meaningful life that provides those with mental illness with many benefits is leisure, which includes identity, belonging to themselves, involvement, lowering boredom, and a method of managing their stress” does not appear fluid within the paragraph. Please change it, linking the sentence with the previous one. The authors states that “negative symptoms of psychosis may make it difficult for a person to participate in leisure activities”. The concept could be further discussed, more references are needed and also the impact of cognitive deficit on participating in leisure activity should be examined. The aim of the study should be modified. Instead of prioritizing the identification of the range of study designs, the focus should be placed on the findings of the included studies, highlighting the impact and utilization of leisure-based interventions in adults with schizophrenia. Methods (Major concern) I have some concerns regarding the search string. By using "schizophrenia AND psychosis," there is a risk, albeit minimal, of excluding studies on patients with schizophrenia that do not include the term psychosis. Additionally, parentheses were not used, which might have resulted in missing some works that could have been included. Results I recommend reorganizing the presentation of the results because the current format might be unclear. For instance, it is not evident why the sections "Leisure activities and association with various factors in individuals with schizophrenia", "Time use and schizophrenia", and "Clinical and functional outcome" are separated, as they appear to summarize similar results. When listing the locations where the studies were conducted, the authors sometimes use the city and other times the country. This leads to inconsistencies, such as separating the study conducted in the USA from the one conducted in Philadelphia. In my opinion, it would be better to choose a single classification criterion to ensure consistency. Discussion: The discussion section needs to be completely rewritten. The authors merely restate the results of individual studies instead of organizing the discussion around the following suggested points: Discuss the finding that patients with schizophrenia spend little time engaging in leisure activities and that the activities they do engage in are usually passive. Discuss the fact that the included studies in the review show that engaging in leisure activities benefits patients with schizophrenia. Specifically, address how these activities impact cognitive, clinical, functional, and quality of life dimensions. Discuss the studies that utilized leisure-based interventions for patients with schizophrenia. Summarize the findings of these studies, and examine any differences in outcomes based on sample size, study design, and type of intervention as reported in the included studies. The conclusions should include a consideration of how promising and important leisure-based interventions can be, if the authors believe they are. This addition would highlight the potential value and significance of these interventions in the treatment and support of patients with schizophrenia. Other The manuscript would benefit from a review by a native English speaker due to the presence of small but frequent grammatical and spelling errors. Improving the language quality would enhance the clarity and readability of the paper. Are the rationale for, and objectives of, the Systematic Review clearly stated? Partly Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Not applicable Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Mental disorders. Schizophrenia and other psychotic disorders. Psychotherapy, psychosocial interventions and and cognitive remediation. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Giuliani L. Reviewer Report For: Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 13 :698 ( https://doi.org/10.5256/f1000research.166558.r301277 ) The direct URL for this report is: https://f1000research.com/articles/13-698/v1#referee-response-301277 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 16 Sep 2024 Anil Kumar Mysore Nagaraj , Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India 16 Sep 2024 Author Response Abstract The aims of the study are missing. Reply: - Thank you for identifying this error. We have incorporated it in the manuscript. In ... Continue reading Abstract The aims of the study are missing. Reply: - Thank you for identifying this error. We have incorporated it in the manuscript. In the results section, listing the methodology of all the studies included in the review might be removed. Reply: - Thank you. We have removed it in the revised manuscript In the results section, are reported only the findings of qualitative studies. Please report also the quantitative results. Reply: - Thank you for the suggestion. We have reported the quantitative studies as well in the revised in the manuscript Introduction Citations after the sentences “Approximately 24 million individuals worldwide, or 1 in 300, are affected by schizophrenia” and “In adulthood, the corresponding rate is 1 in 222” are missing. Please add them. Reply:- We have inserted the citation- (World Health Organization, 2022) after the above sentences in the revised manuscript, in paragraph 1, lines 5 and 6. Thank you. The sentence “One of the main mental health disorders contributing to the global disease burden is schizophrenia, that also affects social functioning” does not appear fluid within the paragraph and it could be changed with “Schizophrenia is one of the main mental health disorders contributing to the global disease burden, affecting different functioning domains, among which social functioning”. Reply: - Thank you for the suggestion. We have changed it as above in the revised manuscript Does “systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself” and “occasionally short-term tasks completed as part of work obligations” correspond respectively to serious- and project-based leisure activities? Please specify. Reply:- Yes, the phrases "systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself" and "occasionally short-term tasks completed as part of work obligations" correspond to serious- and project-based leisure activities, respectively. This has been clarified in the second paragraph of the introduction in the manuscript now. Thanks. The sentence “One aspect of a meaningful life that provides those with mental illness with many benefits is leisure, which includes identity, belonging to themselves, involvement, lowering boredom, and a method of managing their stress” does not appear fluid within the paragraph. Please change it, linking the sentence with the previous one. Reply:- Thank you for the suggestion. We have revised and reworded the sentences in the 2 nd paragraph of the introduction in the manuscript. The authors state that “negative symptoms of psychosis may make it difficult for a person to participate in leisure activities”. The concept could be further discussed, more references are needed and also the impact of cognitive deficit on participating in leisure activity should be examined. Reply:- Thank you for the suggestion. We have revised this in the manuscript, cited more references for the impact of negative symptoms, and added existing studies that mention the impact of cognitive deficit on participating in leisure activity. The entire paragraph three of the introduction has been added to include the above. The aim of the study should be modified. Instead of prioritizing the identification of the range of study designs, the focus should be placed on the findings of the included studies, highlighting the impact and utilization of leisure-based interventions in adults with schizophrenia. Reply:- Thank you for identifying this. We have modified the last paragraph of the introduction as suggested above. Method (Major concern) I have some concerns regarding the search string. By using "schizophrenia AND psychosis," there is a risk, albeit minimal, of excluding studies on patients with schizophrenia that do not include the term psychosis. Additionally, parentheses were not used, which might have resulted in missing some works that could have been included. Reply:- The authors used the ‘OR’ Boolean operator for schizophrenia OR psychosis. By oversight, while mentioning this in the manuscript it was typed as AND. The parentheses were utilized during the search depending on the databases that we used. Thus, it is unlikely that we have missed any studies. We are sorry for the error in the manuscript (AND instead of OR). We have now changed it to OR in the manuscript. Results: - I recommend reorganizing the presentation of the results because the current format might be unclear. For instance, it is not evident why the sections "Leisure activities and association with various factors in individuals with schizophrenia", "Time use and schizophrenia", and "Clinical and functional outcome" are separated, as they appear to summarize similar results. Reply: - Thank you for this observation. We initially thought that some studies have a specific objective that they can be classified into groups, however, there are overlaps and so we have now merged all the following studies under one group of “leisure as a therapeutic intervention” – (Lipskaya-Velikovsky et al., 2020; Snethen et al., 2012; Dean et al., 2014; Voruganti et al., 2006; Caddy et al., 2011; McCormick et al., 2012; Iwasaki et al., 2014, Hayes & Halford 1996; Shimitras et al., 2003; Cella et al., 2016; Ngamaba et al. (2021). When listing the locations where the studies were conducted, the authors sometimes use the city and other times the country. This leads to inconsistencies, such as separating the study conducted in the USA from the one conducted in Philadelphia. In my opinion, it would be better to choose a single classification criterion to ensure consistency. Reply: - Thank you for the suggestion. We have opted to use the name of the country and have changed it accordingly in the first paragraph of the result. Discussion Discuss the finding that patients with schizophrenia spend little time engaging in leisure activities and that the activities they do engage in are usually passive. Reply:- Thank you for the suggestion. We have changed the entire discussion as suggested. Discuss the fact that the included studies in the review show that engaging in leisure activities benefits patients with schizophrenia. Specifically, address how these activities impact cognitive, clinical, functional, and quality of life dimensions. Reply: - Thank you for the suggestion. We have revised accordingly in the manuscript Discuss the studies that utilized leisure-based interventions for patients with schizophrenia. Summarize the findings of these studies, and examine any differences in outcomes based on sample size, study design, and type of intervention as reported in the included studies. Reply :- Thank you for the suggestion. We have discussed the above points in the modified discussion. The conclusions should include a consideration of how promising and important leisure-based interventions can be, if the authors believe they are. This addition would highlight the potential value and significance of these interventions in the treatment and support of patients with schizophrenia. Reply:- Conclusion modified in the manuscript. Thank you. OTHER CHANGES: We have now included 11 additional references (5 in introduction and 6 in discussion). These are cited in the text as well as listed under bibliography, highlighted in green. Some rewording done in strengths & limitations, gaps identified and future implications. Abstract The aims of the study are missing. Reply: - Thank you for identifying this error. We have incorporated it in the manuscript. In the results section, listing the methodology of all the studies included in the review might be removed. Reply: - Thank you. We have removed it in the revised manuscript In the results section, are reported only the findings of qualitative studies. Please report also the quantitative results. Reply: - Thank you for the suggestion. We have reported the quantitative studies as well in the revised in the manuscript Introduction Citations after the sentences “Approximately 24 million individuals worldwide, or 1 in 300, are affected by schizophrenia” and “In adulthood, the corresponding rate is 1 in 222” are missing. Please add them. Reply:- We have inserted the citation- (World Health Organization, 2022) after the above sentences in the revised manuscript, in paragraph 1, lines 5 and 6. Thank you. The sentence “One of the main mental health disorders contributing to the global disease burden is schizophrenia, that also affects social functioning” does not appear fluid within the paragraph and it could be changed with “Schizophrenia is one of the main mental health disorders contributing to the global disease burden, affecting different functioning domains, among which social functioning”. Reply: - Thank you for the suggestion. We have changed it as above in the revised manuscript Does “systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself” and “occasionally short-term tasks completed as part of work obligations” correspond respectively to serious- and project-based leisure activities? Please specify. Reply:- Yes, the phrases "systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself" and "occasionally short-term tasks completed as part of work obligations" correspond to serious- and project-based leisure activities, respectively. This has been clarified in the second paragraph of the introduction in the manuscript now. Thanks. The sentence “One aspect of a meaningful life that provides those with mental illness with many benefits is leisure, which includes identity, belonging to themselves, involvement, lowering boredom, and a method of managing their stress” does not appear fluid within the paragraph. Please change it, linking the sentence with the previous one. Reply:- Thank you for the suggestion. We have revised and reworded the sentences in the 2 nd paragraph of the introduction in the manuscript. The authors state that “negative symptoms of psychosis may make it difficult for a person to participate in leisure activities”. The concept could be further discussed, more references are needed and also the impact of cognitive deficit on participating in leisure activity should be examined. Reply:- Thank you for the suggestion. We have revised this in the manuscript, cited more references for the impact of negative symptoms, and added existing studies that mention the impact of cognitive deficit on participating in leisure activity. The entire paragraph three of the introduction has been added to include the above. The aim of the study should be modified. Instead of prioritizing the identification of the range of study designs, the focus should be placed on the findings of the included studies, highlighting the impact and utilization of leisure-based interventions in adults with schizophrenia. Reply:- Thank you for identifying this. We have modified the last paragraph of the introduction as suggested above. Method (Major concern) I have some concerns regarding the search string. By using "schizophrenia AND psychosis," there is a risk, albeit minimal, of excluding studies on patients with schizophrenia that do not include the term psychosis. Additionally, parentheses were not used, which might have resulted in missing some works that could have been included. Reply:- The authors used the ‘OR’ Boolean operator for schizophrenia OR psychosis. By oversight, while mentioning this in the manuscript it was typed as AND. The parentheses were utilized during the search depending on the databases that we used. Thus, it is unlikely that we have missed any studies. We are sorry for the error in the manuscript (AND instead of OR). We have now changed it to OR in the manuscript. Results: - I recommend reorganizing the presentation of the results because the current format might be unclear. For instance, it is not evident why the sections "Leisure activities and association with various factors in individuals with schizophrenia", "Time use and schizophrenia", and "Clinical and functional outcome" are separated, as they appear to summarize similar results. Reply: - Thank you for this observation. We initially thought that some studies have a specific objective that they can be classified into groups, however, there are overlaps and so we have now merged all the following studies under one group of “leisure as a therapeutic intervention” – (Lipskaya-Velikovsky et al., 2020; Snethen et al., 2012; Dean et al., 2014; Voruganti et al., 2006; Caddy et al., 2011; McCormick et al., 2012; Iwasaki et al., 2014, Hayes & Halford 1996; Shimitras et al., 2003; Cella et al., 2016; Ngamaba et al. (2021). When listing the locations where the studies were conducted, the authors sometimes use the city and other times the country. This leads to inconsistencies, such as separating the study conducted in the USA from the one conducted in Philadelphia. In my opinion, it would be better to choose a single classification criterion to ensure consistency. Reply: - Thank you for the suggestion. We have opted to use the name of the country and have changed it accordingly in the first paragraph of the result. Discussion Discuss the finding that patients with schizophrenia spend little time engaging in leisure activities and that the activities they do engage in are usually passive. Reply:- Thank you for the suggestion. We have changed the entire discussion as suggested. Discuss the fact that the included studies in the review show that engaging in leisure activities benefits patients with schizophrenia. Specifically, address how these activities impact cognitive, clinical, functional, and quality of life dimensions. Reply: - Thank you for the suggestion. We have revised accordingly in the manuscript Discuss the studies that utilized leisure-based interventions for patients with schizophrenia. Summarize the findings of these studies, and examine any differences in outcomes based on sample size, study design, and type of intervention as reported in the included studies. Reply :- Thank you for the suggestion. We have discussed the above points in the modified discussion. The conclusions should include a consideration of how promising and important leisure-based interventions can be, if the authors believe they are. This addition would highlight the potential value and significance of these interventions in the treatment and support of patients with schizophrenia. Reply:- Conclusion modified in the manuscript. Thank you. OTHER CHANGES: We have now included 11 additional references (5 in introduction and 6 in discussion). These are cited in the text as well as listed under bibliography, highlighted in green. Some rewording done in strengths & limitations, gaps identified and future implications. Competing Interests: We declare no competing interests. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 16 Sep 2024 Anil Kumar Mysore Nagaraj , Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India 16 Sep 2024 Author Response Abstract The aims of the study are missing. Reply: - Thank you for identifying this error. We have incorporated it in the manuscript. In ... Continue reading Abstract The aims of the study are missing. Reply: - Thank you for identifying this error. We have incorporated it in the manuscript. In the results section, listing the methodology of all the studies included in the review might be removed. Reply: - Thank you. We have removed it in the revised manuscript In the results section, are reported only the findings of qualitative studies. Please report also the quantitative results. Reply: - Thank you for the suggestion. We have reported the quantitative studies as well in the revised in the manuscript Introduction Citations after the sentences “Approximately 24 million individuals worldwide, or 1 in 300, are affected by schizophrenia” and “In adulthood, the corresponding rate is 1 in 222” are missing. Please add them. Reply:- We have inserted the citation- (World Health Organization, 2022) after the above sentences in the revised manuscript, in paragraph 1, lines 5 and 6. Thank you. The sentence “One of the main mental health disorders contributing to the global disease burden is schizophrenia, that also affects social functioning” does not appear fluid within the paragraph and it could be changed with “Schizophrenia is one of the main mental health disorders contributing to the global disease burden, affecting different functioning domains, among which social functioning”. Reply: - Thank you for the suggestion. We have changed it as above in the revised manuscript Does “systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself” and “occasionally short-term tasks completed as part of work obligations” correspond respectively to serious- and project-based leisure activities? Please specify. Reply:- Yes, the phrases "systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself" and "occasionally short-term tasks completed as part of work obligations" correspond to serious- and project-based leisure activities, respectively. This has been clarified in the second paragraph of the introduction in the manuscript now. Thanks. The sentence “One aspect of a meaningful life that provides those with mental illness with many benefits is leisure, which includes identity, belonging to themselves, involvement, lowering boredom, and a method of managing their stress” does not appear fluid within the paragraph. Please change it, linking the sentence with the previous one. Reply:- Thank you for the suggestion. We have revised and reworded the sentences in the 2 nd paragraph of the introduction in the manuscript. The authors state that “negative symptoms of psychosis may make it difficult for a person to participate in leisure activities”. The concept could be further discussed, more references are needed and also the impact of cognitive deficit on participating in leisure activity should be examined. Reply:- Thank you for the suggestion. We have revised this in the manuscript, cited more references for the impact of negative symptoms, and added existing studies that mention the impact of cognitive deficit on participating in leisure activity. The entire paragraph three of the introduction has been added to include the above. The aim of the study should be modified. Instead of prioritizing the identification of the range of study designs, the focus should be placed on the findings of the included studies, highlighting the impact and utilization of leisure-based interventions in adults with schizophrenia. Reply:- Thank you for identifying this. We have modified the last paragraph of the introduction as suggested above. Method (Major concern) I have some concerns regarding the search string. By using "schizophrenia AND psychosis," there is a risk, albeit minimal, of excluding studies on patients with schizophrenia that do not include the term psychosis. Additionally, parentheses were not used, which might have resulted in missing some works that could have been included. Reply:- The authors used the ‘OR’ Boolean operator for schizophrenia OR psychosis. By oversight, while mentioning this in the manuscript it was typed as AND. The parentheses were utilized during the search depending on the databases that we used. Thus, it is unlikely that we have missed any studies. We are sorry for the error in the manuscript (AND instead of OR). We have now changed it to OR in the manuscript. Results: - I recommend reorganizing the presentation of the results because the current format might be unclear. For instance, it is not evident why the sections "Leisure activities and association with various factors in individuals with schizophrenia", "Time use and schizophrenia", and "Clinical and functional outcome" are separated, as they appear to summarize similar results. Reply: - Thank you for this observation. We initially thought that some studies have a specific objective that they can be classified into groups, however, there are overlaps and so we have now merged all the following studies under one group of “leisure as a therapeutic intervention” – (Lipskaya-Velikovsky et al., 2020; Snethen et al., 2012; Dean et al., 2014; Voruganti et al., 2006; Caddy et al., 2011; McCormick et al., 2012; Iwasaki et al., 2014, Hayes & Halford 1996; Shimitras et al., 2003; Cella et al., 2016; Ngamaba et al. (2021). When listing the locations where the studies were conducted, the authors sometimes use the city and other times the country. This leads to inconsistencies, such as separating the study conducted in the USA from the one conducted in Philadelphia. In my opinion, it would be better to choose a single classification criterion to ensure consistency. Reply: - Thank you for the suggestion. We have opted to use the name of the country and have changed it accordingly in the first paragraph of the result. Discussion Discuss the finding that patients with schizophrenia spend little time engaging in leisure activities and that the activities they do engage in are usually passive. Reply:- Thank you for the suggestion. We have changed the entire discussion as suggested. Discuss the fact that the included studies in the review show that engaging in leisure activities benefits patients with schizophrenia. Specifically, address how these activities impact cognitive, clinical, functional, and quality of life dimensions. Reply: - Thank you for the suggestion. We have revised accordingly in the manuscript Discuss the studies that utilized leisure-based interventions for patients with schizophrenia. Summarize the findings of these studies, and examine any differences in outcomes based on sample size, study design, and type of intervention as reported in the included studies. Reply :- Thank you for the suggestion. We have discussed the above points in the modified discussion. The conclusions should include a consideration of how promising and important leisure-based interventions can be, if the authors believe they are. This addition would highlight the potential value and significance of these interventions in the treatment and support of patients with schizophrenia. Reply:- Conclusion modified in the manuscript. Thank you. OTHER CHANGES: We have now included 11 additional references (5 in introduction and 6 in discussion). These are cited in the text as well as listed under bibliography, highlighted in green. Some rewording done in strengths & limitations, gaps identified and future implications. Abstract The aims of the study are missing. Reply: - Thank you for identifying this error. We have incorporated it in the manuscript. In the results section, listing the methodology of all the studies included in the review might be removed. Reply: - Thank you. We have removed it in the revised manuscript In the results section, are reported only the findings of qualitative studies. Please report also the quantitative results. Reply: - Thank you for the suggestion. We have reported the quantitative studies as well in the revised in the manuscript Introduction Citations after the sentences “Approximately 24 million individuals worldwide, or 1 in 300, are affected by schizophrenia” and “In adulthood, the corresponding rate is 1 in 222” are missing. Please add them. Reply:- We have inserted the citation- (World Health Organization, 2022) after the above sentences in the revised manuscript, in paragraph 1, lines 5 and 6. Thank you. The sentence “One of the main mental health disorders contributing to the global disease burden is schizophrenia, that also affects social functioning” does not appear fluid within the paragraph and it could be changed with “Schizophrenia is one of the main mental health disorders contributing to the global disease burden, affecting different functioning domains, among which social functioning”. Reply: - Thank you for the suggestion. We have changed it as above in the revised manuscript Does “systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself” and “occasionally short-term tasks completed as part of work obligations” correspond respectively to serious- and project-based leisure activities? Please specify. Reply:- Yes, the phrases "systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself" and "occasionally short-term tasks completed as part of work obligations" correspond to serious- and project-based leisure activities, respectively. This has been clarified in the second paragraph of the introduction in the manuscript now. Thanks. The sentence “One aspect of a meaningful life that provides those with mental illness with many benefits is leisure, which includes identity, belonging to themselves, involvement, lowering boredom, and a method of managing their stress” does not appear fluid within the paragraph. Please change it, linking the sentence with the previous one. Reply:- Thank you for the suggestion. We have revised and reworded the sentences in the 2 nd paragraph of the introduction in the manuscript. The authors state that “negative symptoms of psychosis may make it difficult for a person to participate in leisure activities”. The concept could be further discussed, more references are needed and also the impact of cognitive deficit on participating in leisure activity should be examined. Reply:- Thank you for the suggestion. We have revised this in the manuscript, cited more references for the impact of negative symptoms, and added existing studies that mention the impact of cognitive deficit on participating in leisure activity. The entire paragraph three of the introduction has been added to include the above. The aim of the study should be modified. Instead of prioritizing the identification of the range of study designs, the focus should be placed on the findings of the included studies, highlighting the impact and utilization of leisure-based interventions in adults with schizophrenia. Reply:- Thank you for identifying this. We have modified the last paragraph of the introduction as suggested above. Method (Major concern) I have some concerns regarding the search string. By using "schizophrenia AND psychosis," there is a risk, albeit minimal, of excluding studies on patients with schizophrenia that do not include the term psychosis. Additionally, parentheses were not used, which might have resulted in missing some works that could have been included. Reply:- The authors used the ‘OR’ Boolean operator for schizophrenia OR psychosis. By oversight, while mentioning this in the manuscript it was typed as AND. The parentheses were utilized during the search depending on the databases that we used. Thus, it is unlikely that we have missed any studies. We are sorry for the error in the manuscript (AND instead of OR). We have now changed it to OR in the manuscript. Results: - I recommend reorganizing the presentation of the results because the current format might be unclear. For instance, it is not evident why the sections "Leisure activities and association with various factors in individuals with schizophrenia", "Time use and schizophrenia", and "Clinical and functional outcome" are separated, as they appear to summarize similar results. Reply: - Thank you for this observation. We initially thought that some studies have a specific objective that they can be classified into groups, however, there are overlaps and so we have now merged all the following studies under one group of “leisure as a therapeutic intervention” – (Lipskaya-Velikovsky et al., 2020; Snethen et al., 2012; Dean et al., 2014; Voruganti et al., 2006; Caddy et al., 2011; McCormick et al., 2012; Iwasaki et al., 2014, Hayes & Halford 1996; Shimitras et al., 2003; Cella et al., 2016; Ngamaba et al. (2021). When listing the locations where the studies were conducted, the authors sometimes use the city and other times the country. This leads to inconsistencies, such as separating the study conducted in the USA from the one conducted in Philadelphia. In my opinion, it would be better to choose a single classification criterion to ensure consistency. Reply: - Thank you for the suggestion. We have opted to use the name of the country and have changed it accordingly in the first paragraph of the result. Discussion Discuss the finding that patients with schizophrenia spend little time engaging in leisure activities and that the activities they do engage in are usually passive. Reply:- Thank you for the suggestion. We have changed the entire discussion as suggested. Discuss the fact that the included studies in the review show that engaging in leisure activities benefits patients with schizophrenia. Specifically, address how these activities impact cognitive, clinical, functional, and quality of life dimensions. Reply: - Thank you for the suggestion. We have revised accordingly in the manuscript Discuss the studies that utilized leisure-based interventions for patients with schizophrenia. Summarize the findings of these studies, and examine any differences in outcomes based on sample size, study design, and type of intervention as reported in the included studies. Reply :- Thank you for the suggestion. We have discussed the above points in the modified discussion. The conclusions should include a consideration of how promising and important leisure-based interventions can be, if the authors believe they are. This addition would highlight the potential value and significance of these interventions in the treatment and support of patients with schizophrenia. Reply:- Conclusion modified in the manuscript. Thank you. OTHER CHANGES: We have now included 11 additional references (5 in introduction and 6 in discussion). These are cited in the text as well as listed under bibliography, highlighted in green. Some rewording done in strengths & limitations, gaps identified and future implications. Competing Interests: We declare no competing interests. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 27 Jun 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 3 (revision) 23 Mar 26 Version 2 (revision) 16 Sep 24 read Version 1 27 Jun 24 read Luigi Giuliani , University of Campania Luigi Vanvitelli, Naples, Italy Jason Page , SUNY Cortland, Cortland, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Page J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Nov 2024 | for Version 2 Jason Page , SUNY Cortland, Cortland, New York, USA 0 Views copyright © 2024 Page J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. In the Second paragraph of the introduction mentions "leisure/recreational activities" leisure is defined but recreation is not nor is the relationship between the two. Either define recreation or remove it as for the rest of the article the authors use leisure almost exclusively. Quality of life and study design sections could be put into a table and summarized for easy review. No mention is made of recreation therapy as a potential avenue for increasing access to leisure for people with schizophrenia and despite being mentioned in relation to Snethen et al (2012) no explanation of what RT is is provided. I would suggest the article below as a means of offering Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable References 1. Ray L, Hopper T, McHugh T: Therapeutic recreation as a pathway to support mental health in Northern Canada: practitioners perspectives. Leisure/Loisir . 2024; 48 (4): 629-654 Publisher Full Text 2. Frail. Jackie, Quattrini.Jessica,Thompson.Rebecca,Berzaitis.Smith,Oretan, Lindsey: Personal Benefits of Therapeutic Recreation for Persons with Mental Illness: Advocating for Service Delivery to Key Decision Makers. Competing Interests No competing interests were disclosed. Reviewer Expertise MY research background is in recreational therapy with an emphasis on behavioral health. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 09 Feb 2026 Anil Kumar Mysore Nagaraj, Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India Overall, of good scoping review drawing on the limited research available to the authors based on their inclusion exclusion Criteria. Response: We thank the reviewer for their positive and encouraging comments and for acknowledging the value of the scoping review despite the limited available literature. 2) In the Second paragraph of the introduction mentions "leisure/recreational activities" leisure is defined but recreation is not nor is the relationship between the two. Either define recreation or remove it as for the rest of the article the authors use leisure almost exclusively. Response: We thank the reviewer for highlighting this important conceptual issue. We agree that clarity is required regarding the use of the terms leisure and recreation . In response, we have revised the introduction to ensure conceptual consistency throughout the manuscript. Specifically, we have retained “leisure” as the primary term, as it is used predominantly across the article, and removed unnecessary references to “recreation” in the introductory section. This revision ensures alignment between the definition provided and the terminology used across the review. 3) Quality of life and study design sections could be put into a table and summarized for easy review. Response: We appreciate this helpful suggestion. In response, we have revised the presentation of results by summarizing study design characteristics and quality-of-life outcomes in tabular form within the data charting table. This restructuring enhances clarity, allows for easier comparison across studies, and improves the overall readability of the review. 4) No mention is made of recreation therapy as a potential avenue for increasing access to leisure for people with schizophrenia and despite being mentioned in relation to Snethen et al (2012) no explanation of what RT is is provided. Response: We thank the reviewer for this valuable observation. We agree that recreation therapy (RT) warrants clearer explanation in the context of this review. Accordingly, we have added a brief description of recreation therapy when discussing the study by Snethen et al. (2012), clarifying its role as a therapeutic approach that facilitates engagement in meaningful leisure and community participation. We have also acknowledged recreation therapy as a potential avenue for enhancing access to leisure among individuals with schizophrenia within the discussion section, while maintaining the primary focus of the review on leisure-based interventions. View more View less Competing Interests No competing interests reply Respond Report a concern Page J. Peer Review Report For: Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 13 :698 ( https://doi.org/10.5256/f1000research.171414.r332633) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-698/v2#referee-response-332633 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Giuliani L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Aug 2024 | for Version 1 Luigi Giuliani , University of Campania Luigi Vanvitelli, Naples, Italy 0 Views copyright © 2024 Giuliani L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The study by Nishad et al. aims to explore the existing literature related to the leisure-based interventions for adults with schizophrenia by identifying the range of study designs. The results of the present study highlight the need to conduct further research on leisure-based interventions using rigorous study designs like randomized controlled trials and mixed methods to understand its effectiveness among individuals with schizophrenia. The study topic is timely and interesting. However, according to the comments provided below, some important issues should be addressed. Abstract The aims of the study are missing. In the results section, listing the methodology of all the studies included in the review might be removed. In the results section, are reported only the findings of qualitative studies. Please report also the quantitative results. Introduction Citations after the sentences “Approximately 24 million individuals worldwide, or 1 in 300, are affected by schizophrenia” and “In adulthood, the corresponding rate is 1 in 222” are missing. Please add them. The sentence “One of the main mental health disorders contributing to the global disease burden is schizophrenia, that also affects social functioning” does not appear fluid within the paragraph and it could be changed with “Schizophrenia is one of the main mental health disorders contributing to the global disease burden, affecting different functioning domains, among which social functioning”. Does “systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself” and “occasionally short-term tasks completed as part of work obligations” correspond respectively to serious- and project-based leisure activities? Please specify. The sentence “One aspect of a meaningful life that provides those with mental illness with many benefits is leisure, which includes identity, belonging to themselves, involvement, lowering boredom, and a method of managing their stress” does not appear fluid within the paragraph. Please change it, linking the sentence with the previous one. The authors states that “negative symptoms of psychosis may make it difficult for a person to participate in leisure activities”. The concept could be further discussed, more references are needed and also the impact of cognitive deficit on participating in leisure activity should be examined. The aim of the study should be modified. Instead of prioritizing the identification of the range of study designs, the focus should be placed on the findings of the included studies, highlighting the impact and utilization of leisure-based interventions in adults with schizophrenia. Methods (Major concern) I have some concerns regarding the search string. By using "schizophrenia AND psychosis," there is a risk, albeit minimal, of excluding studies on patients with schizophrenia that do not include the term psychosis. Additionally, parentheses were not used, which might have resulted in missing some works that could have been included. Results I recommend reorganizing the presentation of the results because the current format might be unclear. For instance, it is not evident why the sections "Leisure activities and association with various factors in individuals with schizophrenia", "Time use and schizophrenia", and "Clinical and functional outcome" are separated, as they appear to summarize similar results. When listing the locations where the studies were conducted, the authors sometimes use the city and other times the country. This leads to inconsistencies, such as separating the study conducted in the USA from the one conducted in Philadelphia. In my opinion, it would be better to choose a single classification criterion to ensure consistency. Discussion: The discussion section needs to be completely rewritten. The authors merely restate the results of individual studies instead of organizing the discussion around the following suggested points: Discuss the finding that patients with schizophrenia spend little time engaging in leisure activities and that the activities they do engage in are usually passive. Discuss the fact that the included studies in the review show that engaging in leisure activities benefits patients with schizophrenia. Specifically, address how these activities impact cognitive, clinical, functional, and quality of life dimensions. Discuss the studies that utilized leisure-based interventions for patients with schizophrenia. Summarize the findings of these studies, and examine any differences in outcomes based on sample size, study design, and type of intervention as reported in the included studies. The conclusions should include a consideration of how promising and important leisure-based interventions can be, if the authors believe they are. This addition would highlight the potential value and significance of these interventions in the treatment and support of patients with schizophrenia. Other The manuscript would benefit from a review by a native English speaker due to the presence of small but frequent grammatical and spelling errors. Improving the language quality would enhance the clarity and readability of the paper. Are the rationale for, and objectives of, the Systematic Review clearly stated? Partly Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Not applicable Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Mental disorders. Schizophrenia and other psychotic disorders. Psychotherapy, psychosocial interventions and and cognitive remediation. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 16 Sep 2024 Anil Kumar Mysore Nagaraj, Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India Abstract The aims of the study are missing. Reply: - Thank you for identifying this error. We have incorporated it in the manuscript. In the results section, listing the methodology of all the studies included in the review might be removed. Reply: - Thank you. We have removed it in the revised manuscript In the results section, are reported only the findings of qualitative studies. Please report also the quantitative results. Reply: - Thank you for the suggestion. We have reported the quantitative studies as well in the revised in the manuscript Introduction Citations after the sentences “Approximately 24 million individuals worldwide, or 1 in 300, are affected by schizophrenia” and “In adulthood, the corresponding rate is 1 in 222” are missing. Please add them. Reply:- We have inserted the citation- (World Health Organization, 2022) after the above sentences in the revised manuscript, in paragraph 1, lines 5 and 6. Thank you. The sentence “One of the main mental health disorders contributing to the global disease burden is schizophrenia, that also affects social functioning” does not appear fluid within the paragraph and it could be changed with “Schizophrenia is one of the main mental health disorders contributing to the global disease burden, affecting different functioning domains, among which social functioning”. Reply: - Thank you for the suggestion. We have changed it as above in the revised manuscript Does “systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself” and “occasionally short-term tasks completed as part of work obligations” correspond respectively to serious- and project-based leisure activities? Please specify. Reply:- Yes, the phrases "systematic activities carried out by beginners or hobbyists with skills and expertise that could lead to a career itself" and "occasionally short-term tasks completed as part of work obligations" correspond to serious- and project-based leisure activities, respectively. This has been clarified in the second paragraph of the introduction in the manuscript now. Thanks. The sentence “One aspect of a meaningful life that provides those with mental illness with many benefits is leisure, which includes identity, belonging to themselves, involvement, lowering boredom, and a method of managing their stress” does not appear fluid within the paragraph. Please change it, linking the sentence with the previous one. Reply:- Thank you for the suggestion. We have revised and reworded the sentences in the 2 nd paragraph of the introduction in the manuscript. The authors state that “negative symptoms of psychosis may make it difficult for a person to participate in leisure activities”. The concept could be further discussed, more references are needed and also the impact of cognitive deficit on participating in leisure activity should be examined. Reply:- Thank you for the suggestion. We have revised this in the manuscript, cited more references for the impact of negative symptoms, and added existing studies that mention the impact of cognitive deficit on participating in leisure activity. The entire paragraph three of the introduction has been added to include the above. The aim of the study should be modified. Instead of prioritizing the identification of the range of study designs, the focus should be placed on the findings of the included studies, highlighting the impact and utilization of leisure-based interventions in adults with schizophrenia. Reply:- Thank you for identifying this. We have modified the last paragraph of the introduction as suggested above. Method (Major concern) I have some concerns regarding the search string. By using "schizophrenia AND psychosis," there is a risk, albeit minimal, of excluding studies on patients with schizophrenia that do not include the term psychosis. Additionally, parentheses were not used, which might have resulted in missing some works that could have been included. Reply:- The authors used the ‘OR’ Boolean operator for schizophrenia OR psychosis. By oversight, while mentioning this in the manuscript it was typed as AND. The parentheses were utilized during the search depending on the databases that we used. Thus, it is unlikely that we have missed any studies. We are sorry for the error in the manuscript (AND instead of OR). We have now changed it to OR in the manuscript. Results: - I recommend reorganizing the presentation of the results because the current format might be unclear. For instance, it is not evident why the sections "Leisure activities and association with various factors in individuals with schizophrenia", "Time use and schizophrenia", and "Clinical and functional outcome" are separated, as they appear to summarize similar results. Reply: - Thank you for this observation. We initially thought that some studies have a specific objective that they can be classified into groups, however, there are overlaps and so we have now merged all the following studies under one group of “leisure as a therapeutic intervention” – (Lipskaya-Velikovsky et al., 2020; Snethen et al., 2012; Dean et al., 2014; Voruganti et al., 2006; Caddy et al., 2011; McCormick et al., 2012; Iwasaki et al., 2014, Hayes & Halford 1996; Shimitras et al., 2003; Cella et al., 2016; Ngamaba et al. (2021). When listing the locations where the studies were conducted, the authors sometimes use the city and other times the country. This leads to inconsistencies, such as separating the study conducted in the USA from the one conducted in Philadelphia. In my opinion, it would be better to choose a single classification criterion to ensure consistency. Reply: - Thank you for the suggestion. We have opted to use the name of the country and have changed it accordingly in the first paragraph of the result. Discussion Discuss the finding that patients with schizophrenia spend little time engaging in leisure activities and that the activities they do engage in are usually passive. Reply:- Thank you for the suggestion. We have changed the entire discussion as suggested. Discuss the fact that the included studies in the review show that engaging in leisure activities benefits patients with schizophrenia. Specifically, address how these activities impact cognitive, clinical, functional, and quality of life dimensions. Reply: - Thank you for the suggestion. We have revised accordingly in the manuscript Discuss the studies that utilized leisure-based interventions for patients with schizophrenia. Summarize the findings of these studies, and examine any differences in outcomes based on sample size, study design, and type of intervention as reported in the included studies. Reply :- Thank you for the suggestion. We have discussed the above points in the modified discussion. The conclusions should include a consideration of how promising and important leisure-based interventions can be, if the authors believe they are. This addition would highlight the potential value and significance of these interventions in the treatment and support of patients with schizophrenia. Reply:- Conclusion modified in the manuscript. Thank you. OTHER CHANGES: We have now included 11 additional references (5 in introduction and 6 in discussion). These are cited in the text as well as listed under bibliography, highlighted in green. Some rewording done in strengths & limitations, gaps identified and future implications. View more View less Competing Interests We declare no competing interests. reply Respond Report a concern Giuliani L. Peer Review Report For: Leisure-Based Interventions in Adults with Schizophrenia: A Scoping Review [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 13 :698 ( https://doi.org/10.5256/f1000research.166558.r301277) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-698/v1#referee-response-301277 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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