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Journal ArticleDOI

An ecological study investigating the association between access to urban green space and mental health

01 Nov 2013-Public Health (Elsevier)-Vol. 127, Iss: 11, pp 1005-1011
TL;DR: In this article, a cross-sectional examination of the relationship between access to urban green spaces and counts of anxiety/mood disorder treatments among residents (aged 15 years and over) in Auckland City, New Zealand was conducted.
About: This article is published in Public Health.The article was published on 2013-11-01. It has received 374 citations till now. The article focuses on the topics: Mood & Anxiety.
Citations
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Journal ArticleDOI
TL;DR: It is shown how ecosystem service assessments can be expanded to include mental health, and a heuristic, conceptual model for doing so is provided.
Abstract: A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

736 citations

Journal ArticleDOI
TL;DR: It is found limited evidence for a causal relationship between surrounding greenness and mental health in adults, whereas the evidence was inadequate in children, and recommendations are provided in order to provide consistent and evidence-based recommendations for policy makers.
Abstract: Many studies conducted during the last decade suggest the mental health benefits of green and blue spaces. We aimed to systematically review the available literature on the long-term mental health benefits of residential green and blue spaces by including studies that used standardized tools or objective measures of both the exposures and the outcomes of interest. We followed the PRISMA statement guidelines for reporting systematic reviews and meta-analysis. In total 28 studies were included in the systematic review. We found limited evidence for a causal relationship between surrounding greenness and mental health in adults, whereas the evidence was inadequate in children. The evidence was also inadequate for the other exposures evaluated (access to green spaces, quality of green spaces, and blue spaces) in both adults and children. The main limitation was the limited number of studies, together with the heterogeneity regarding exposure assessment. Given the increase in mental health problems and the current rapid urbanization worldwide, results of the present systematic review should be taken into account in future urban planning. However, further research is needed to provide more consistent evidence and more detailed information on the mechanisms and the characteristics of the green and blue spaces that promote better mental health. We provide recommendations for future studies in order to provide consistent and evidence-based recommendations for policy makers.

705 citations


Cites background or result from "An ecological study investigating t..."

  • ...2013, New Zealand [23] Ecological >15 y 319521 Health ministry database Anxiety/mood disorder treatment counts Distance to total and useable GS Increasing distance to usable GS ↑ risk of treatment...

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  • ...Author (Year, Country) Study Design Age of the Study Population (Stratifications/Interactions) N Tools to Measure Mental Health Mental Health Item Greenness Data Source Surrounding Greenness Indicator Risk of Mental Health Problems Adults (or population irrespective of age) Triguero-Mas et al. 2015, Spain [14] Cross- sectional 34–64 y (physical activity, gender, degree of urbanization, socioeconomic status and social support) 8793 GHQ-12 SF-36 Perceived mental health NDVI 100 m, 300 m, 500 m and 1 km buffers Increasing greenness ↓ risk of poor mental health (for both tests and all buffers assessed) Van den Berg et al. 2010, The Netherlands [39] Cross- sectional >18 y (stressful life events) 4529 GHQ-12 Perceived mental health Land-cover map % GS in 1 km & 3 km buffers - Weich et al. 2002, The UK [40] Cross- sectional Adults >16 y 1896 CES-D20 Depression BESSC (audit) Number of trees and amount of houses with private garden in the housing area - White et al. 2013, The UK [20] Longitudinal Adults 12818 GHQ-12 Mental health and well-being Land-cover map % GS at CAU Increasing greenness ↓ risk of poor mental health ADHD/DMS-IV: ADHD symptom Criteria of Diagnostic and Statistical Manual of Mental Disorder, 4th Edition; CAU level: Census area unit level; CES-D20: Centre for Epidemiologic Studies Depression scale (20 items); CIS-R: Revised Clinical Interview Schedule; DASS: Depression Anxiety and Stress Scales; GHQ-(12/30): General Health Questionnaire-(number of items included); GS: green space; ICD-10: International Classification of Disease; K(6/10): Kessler Psychological Distress Scale (number of items included); NDVI: Normalized Difference Vegetation Index; PSS: Perceived Stress Scale; SDQ: Strengths and Difficulties Questionnaire; SF-36: Short form health survey (36 items), WEMWBS: Warwick-Edinburgh Mental Well-being Scale; a SDQ measures hyperactivity, emotional symptoms, conduct problems, peer problems, prosocial behaviour and ADHD/DMS-IV measures inattention and hyperactivity-impulsivity symptoms; b A factor was created to define surrounding greenness....

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  • ...Eight cross-sectional studies [14,26–30,41,42] and one ecological study [23] evaluated the mental health benefits of access to green spaces....

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  • ...Author (Year, Country) Study Design Age of the Study Population (Stratifications/Interactions) N Tools to Measure Mental Health Mental Health Item Greenness Data Source Surrounding Greenness Indicator Risk of Mental Health Problems Adults (or population irrespective of age) Francis et al. 2012, Australia [24] Cross- sectional Adults (20–79 y) 911 K6 Psychological distress Land-cover map Size and n° of public open space in a 1600 m buffer - Maas et al. 2009, The Netherlands [35] Cross- sectional 12 to >65 y 4842- 10089 GHQ-12 Propensity to psychiatric morbidity Land-cover map % GS in 1 km & 3 km buffers Increasing greenness in 1 km ↓ propensity to psychiatric morbidity Maas et al. 2009, The Netherlands [25] Cross- sectional All ages (age, socioeconomic status, urbanity degree) 345143 Primary care medical records Mental health morbidity (depression and anxiety) Land-cover map % GS in 1 km & 3 km buffers Increasing greenness in 1 km ↓ depression & anxiety In 3 km ↓ anxiety (stronger associations with depression in children for both buffers) Nutsford et al. 2013, New Zealand [23] Ecological >15 y 319521 Health ministry database Anxiety/mood disorder treatment counts Land-cover map % of total and useable GS of >500 m2 (300 m & 3 km buffers) Increasing total and usable GS in 3 km ↓ risk of treatment Richardson et al. 2013, New Zealand [36] Cross- sectional >15 y (physical activity) 8157 SF-36 Mental health Land-cover map % GS of ≥0.02 ha at CAU Increasing greenness ↓ poor mental health Roe et al. 2013, The UK [37] Cross- sectional 33–55 y of socio-economically deprived areas ~100 PSS WEMWBS (short version) Stress Well-being Land-cover map % GS at CAU Increasing greenness ↓ stressc Sarkar et al. 2013, The UK [38] Cross- sectional 65–84 y 687 GHQ-30 Psychological distress NDVI 500 m buffer - Table 1....

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  • ...Additionally, quite a few studies were at risk of obtaining significant results due to multiple testing, although some of them did not even obtain significant associations after multiple analyses [17,20,21,23,24,26,27,30,34,37,40]....

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Journal ArticleDOI
TL;DR: A research agenda on nature contact and health is proposed, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions.
Abstract: Background: At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantia...

653 citations

Journal ArticleDOI
TL;DR: There is consistent evidence that greenness exposure during pregnancy is positively associated with birth weight, though findings for other birth outcomes are less conclusive.
Abstract: Researchers are increasingly exploring how neighborhood greenness, or vegetation, may affect health behaviors and outcomes. Greenness may influence health by promoting physical activity and social contact; decreasing stress; and mitigating air pollution, noise, and heat exposure. Greenness is generally measured using satellite-based vegetation indices or land-use databases linked to participants' addresses. In this review, we found fairly strong evidence for a positive association between greenness and physical activity, and a less consistent negative association between greenness and body weight. Research suggests greenness is protective against adverse mental health outcomes, cardiovascular disease, and mortality, though most studies were limited by cross-sectional or ecological design. There is consistent evidence that greenness exposure during pregnancy is positively associated with birth weight, though findings for other birth outcomes are less conclusive. Future research should follow subjects prospectively, differentiate between greenness quantity and quality, and identify mediators and effect modifiers of greenness-health associations.

648 citations

Journal ArticleDOI
TL;DR: Higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety and stress, after controlling for a wide range of confounding factors.
Abstract: Green space is now widely viewed as a health-promoting characteristic of residential environments, and has been linked to mental health benefits such as recovery from mental fatigue and reduced stress, particularly through experimental work in environmental psychology. Few population level studies have examined the relationships between green space and mental health. Further, few studies have considered the role of green space in non-urban settings. This study contributes a population-level perspective from the United States to examine the relationship between environmental green space and mental health outcomes in a study area that includes a spectrum of urban to rural environments. Multivariate survey regression analyses examine the association between green space and mental health using the unique, population-based Survey of the Health of Wisconsin database. Analyses were adjusted for length of residence in the neighborhood to reduce the impact of neighborhood selection bias. Higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety and stress, after controlling for a wide range of confounding factors. Results suggest that “greening” could be a potential population mental health improvement strategy in the United States.

514 citations

References
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Journal ArticleDOI
TL;DR: In this paper, a conceptual framework of associations between urban green space and ecosystem and human health is proposed, which highlights many dynamic factors, and their complex interactions, affecting ecosystem health and human Health in urban areas.

2,151 citations


"An ecological study investigating t..." refers background in this paper

  • ...Three primary theoretical pathways have been identified through which green space may influence mental health.(13,15) First, recreational physical activity, common in green space, promotes positive moods and reduces stress levels....

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  • ...aesthetic place for social and recreational opportunities, which encourages physical activity, enhances social ties and promotes mental and physical recuperation.(13,15) The majority of green space studies evaluate its influence on physical health or general health as the health outcome....

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Journal ArticleDOI
TL;DR: This research shows that the percentage of green space in people’s living environment has a positive association with the perceived general health of residents, and green space seems to be more than just a luxury and consequently the development of greenspace should be allocated a more central position in spatial planning policy.
Abstract: Study objectives: To investigate the strength of the relation between the amount of green space in people's living environment and their perceived general health. This relation is analysed for different age and socioeconomic groups. Furthermore, it is analysed separately for urban and more rural areas, because the strength of the relation was expected to vary with urbanity. Design: The study includes 250 782 people registered with 104 general practices who filled in a self administered form on sociodemographic background and perceived general health. The percentage of green space (urban green space, agricultural space, natural green space) within a one kilometre and three kilometre radius around the postal code coordinates was calculated for each household. Methods: Multilevel logistic regression analyses were performed at three levels—that is, individual level, family level, and practice level—controlled for sociodemographic characteristics. Main results: The percentage of green space inside a one kilometre and a three kilometre radius had a significant relation to perceived general health. The relation was generally present at all degrees of urbanity. The overall relation is somewhat stronger for lower socioeconomic groups. Elderly, youth, and secondary educated people in large cities seem to benefit more from presence of green areas in their living environment than other groups in large cities. Conclusions: This research shows that the percentage of green space in people's living environment has a positive association with the perceived general health of residents. Green space seems to be more than just a luxury and consequently the development of green space should be allocated a more central position in spatial planning policy.

1,611 citations

Journal ArticleDOI
TL;DR: In this article, an observational study examined the influence of attractiveness on the use of POS by observing users of three pairs of high- and low-quality (based on attractiveness) POS matched for size and location.

1,413 citations

Journal ArticleDOI
TL;DR: Most studies reported findings that generally supported the view that green space have a beneficial health effect, and Simplistic urban interventions may therefore fail to address the underlying determinants of urban health that are not remediable by landscape redesign.
Abstract: Background Urban development projects can be costly and have health impacts. An evidence-based approach to urban planning is therefore essential. However, the evidence for physical and non-physical health benefits of urban green space is unclear. Methods A literature search of academic and grey literature was conducted for studies and reviews of the health effects of green space. Articles found were appraised for their relevance, critically reviewed and graded accordingly. Their findings were then thematically categorized. Results There is weak evidence for the links between physical, mental health and well-being, and urban green space. Environmental factors such as the quality and accessibility of green space affects its use for physical activity. User determinants, such as age, gender, ethnicity and the perception of safety, are also important. However, many studies were limited by poor study design, failure to exclude confounding, bias or reverse causality and weak statistical associations. Conclusion Most studies reported findings that generally supported the view that green space have a beneficial health effect. Establishing a causal relationship is difficult, as the relationship is complex. Simplistic urban interventions may therefore fail to address the underlying determinants of urban health that are not remediable by landscape redesign.

1,147 citations


"An ecological study investigating t..." refers background in this paper

  • ...A review of health associations with urban green space concluded that many claims are supported by weak evidence and studies were limited by poor design and failure to exclude confounding factors and bias.(1) Much less established is the investigation of the effects of access to and visualization of green space on mental health....

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  • ...General consensus in existing literature finds green space to be negatively associated with poor mental health,(5,11) however it is met with some contention and the causal pathways remain relatively unexplored.(1,2) Mental health is important as it is often a precursor for other chronic conditions and physical health outcomes....

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Journal ArticleDOI
TL;DR: In this paper, a multilevel analysis was conducted by combining Dutch data on the self-reported health of over 10, 000 people with land-use data, on the amount of greenspace in their living environment.
Abstract: Are people living in greener areas healthier than people living in less green areas? This hypothesis was empirically tested by combining Dutch data on the self-reported health of over 10 000 people with land-use data on the amount of greenspace in their living environment. In the multilevel analysis we controlled for socioeconomic and demographic characteristics, as well as urbanity. Living in a green environment was positively related to all three available health indicators, even stronger than urbanity at the municipal level. Analyses on subgroups showed that the relationship between greenspace and one of the health indicators was somewhat stronger for housewives and the elderly, two groups that are assumed to be more dependent on, and therefore exposed to, the local environment. Furthermore, for all three health indicators the relationship with greenspace was somewhat stronger for lower educated people. Implications for policymaking and spatial planning are discussed briefly.

1,115 citations