Association between indoor-outdoor green features and psychological health during the COVID-19 lockdown in Italy: A cross-sectional nationwide study

Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysis

Prior reviews have highlighted that nature exposure was a valuable coping strategy enhancing mental health during the COVID-19 pandemic. However, no existing reviews have determined the quality of evidence and risk of bias of the empirical studies supporting this claim. To address this gap, we employed a Navigation Guide systematic review and meta-analysis approach to investigate associations between nature exposure and mental health during the pandemic. Searches in PubMed, Web of Science, Scopus, CINAHL, and PsycInfo retrieved relevant articles published between January 1, 2020, and March 4, 2024. We used the Navigation Guide methodology to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessments to evaluate the overall quality of evidence. Our search retrieved 113 studies that met the inclusion criteria and reported diverse types of exposure, including nature availability, nature visit frequency, green space accessibility, and green space type, alongside associations with 12 mental health outcomes. Meta-analyses found access to gardens was associated with lower odds of depression [(Pooled odds ratio [OR] = 0.71, 95%CI = 0.61, 0.82), I2 = 0%, n = 3] and anxiety [(Pooled OR = 0.73, 95%CI = 0.63, 0.84), I2 = 0%, n = 3]. Increased time in green spaces was associated with lower level of stress [(Pooled Corr = -0.11, 95%CI = -0.17, -0.05), I2 = 0%, n = 2]. Higher frequency of visits to nature was associated with improved mental well-being [(Pooled standardized beta = 0.10, 95%CI = 0.07, 0.14), I2 = 0%, n = 2] and general mental health [(Pooled standardized beta = 0.11, 95%CI = 0.03-0.38), I2 = 82%, n = 2]. However, the number of pooled studies was small and the overall quality of evidence was "very low" for all outcomes, and high levels of bias were observed (26% of studies had high, 71% probably high). Nonetheless, given the trends in the results, nature-based solutions emphasizing exposure to gardens and green spaces near the home may have promoted psychological resilience during this public health crisis.

A systematic review of the relationship between natural environments and physiological and mental health during different stages of the COVID-19 pandemic

COVID-19 has altered how individuals interact with natural environments. Numerous studies have investigated the effects of such environments on health. However, how natural environments influenced individuals' physiological and mental health during various stages of the COVID-19 pandemic remains unclear. Therefore, we conducted this study to investigate the effects of natural environments on individuals' physiological and mental health during different stages of the pandemic; we also identified factors that mediated these effects. Overall, we evaluated the importance of natural environments during challenging times. This study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The pandemic period was divided into three stages on the basis of severity: pandemic (March 2020 - February 2022), easing (February 2022-September 2022), and post-acute COVID pandemic (September 2022 - present). An initial pool of 3018 studies was narrowed down to a final sample of 73 studies. During the pandemic stage, individuals frequenting public green spaces exhibited improved well-being, reduced stress levels, and a sense of nature deprivation. Private green spaces played crucial roles in maintaining health during the pandemic stage. Highquality window views were associated with improved well-being and reduced depression. During the easing stage, the environmental quality of public green spaces influenced individuals' perceived safety and sense of belonging. And coastal areas were the preferred natural destinations in this stage. During the post-acute COVID pandemic stage, individuals acknowledged the importance of natural environments in maintaining physiological and mental health as they gradually returned to prepandemic normalcy. In conclusion, the COVID-19 pandemic highlighted humanity's reliance on nature. Therefore, sufficient urban spaces should be dedicated to preservation of natural environments to mitigate negative emotions arising from prolonged indoor stays.

Exposure to urban green spaces and mental health during the COVID-19 pandemic: evidence from two low and lower-middle-income countries

Introduction

The COVID-19 pandemic has had a significant impact on mental health globally, with limited access to mental health care affecting low- and middle-income countries (LMICs) the most. In response, alternative strategies to support mental health have been necessary, with access to green spaces being a potential solution. While studies have highlighted the role of green spaces in promoting mental health during pandemic lockdowns, few studies have focused on the role of green spaces in mental health recovery after lockdowns. This study investigated changes in green space access and associations with mental health recovery in Bangladesh and Egypt across the pandemic.

Methods

An online survey was conducted between January and April 2021 after the first lockdown was lifted in Bangladesh (n = 556) and Egypt (n = 660). We evaluated indoor and outdoor greenery, including the number of household plants, window views, and duration of outdoor visits. The quantity of greenness was estimated using the normalized difference vegetation index (NDVI). This index was estimated using satellite images with a resolution of 10x10m during the survey period (January-April 2021) with Sentinel-2 satellite in the Google Earth Engine platform. We calculated averages within 250m, 300m, 500m and 1000m buffers of the survey check-in locations using ArcGIS 10.3. Multiple linear regression models were used to evaluate relationships between changes in natural exposure and changes in mental health.

Results

The results showed that mental health improved in both countries after the lockdown period. People in both countries increased their time spent outdoors in green spaces after the lockdown period, and these increases in time outdoors were associated with improved mental health. Unexpectedly, changes in the number of indoor plants after the lockdown period were associated with contrasting mental health outcomes; more plants translated to increased anxiety and decreased depression. Refocusing lives after the pandemic on areas other than maintaining indoor plants may assist with worrying and feeling panicked. Still, indoor plants may assist with depressive symptoms for people remaining isolated.

Conclusion

These findings have important implications for policymakers and urban planners in LMICs, highlighting the need to increase access to natural environments in urban areas to improve mental health and well-being in public health emergencies.

Biophilic Design and Its Effectiveness in Creating Emotional Well-Being, Green Satisfaction, and Workplace Attachment Among Healthcare Professionals: The Hospice Context

OBJECTIVE

The present study aimed to explore the biophilic design attributes within a hospice care center from the healthcare professionals' perspective by utilizing a qualitative research and investigated the effect of hospice professionals' attitudes toward the uncovered green features on the prediction of their workplace attachment through a quantitative research.

BACKGROUND

In hospice establishments, studies showed that applying biophilic design principles significantly reduces stress and improves emotional well-being. Yet, despite its importance, attitude toward biophilic design, and its significant influence on well-being, satisfaction and attachment to the workplace of hospice healthcare professionals have not yet been researched.

METHODS

The qualitative research used semi-structured in-depth interviews among hospice professionals to reveal biophilic design features that exert an influence on their activity, while the quantitative research employed a confirmatory factor analysis and the structural equation modeling to analyze the data.

RESULTS AND CONCLUSIONS

The qualitative research generated five biophilic design features, such as open spaces with natural light, natural decorative elements, landscape provided by nature through windows, wooden furniture, and colors that create a warm atmosphere within the hospice care center. The quantitative approach indicated that attitude toward the uncovered biophilic design features in the context of the COVID-19 pandemic significantly improved the healthcare providers' emotional well-being. This dimension, in turn, contributed to their satisfaction with green features/natural decor and attachment to the workplace. Results of this study provide practitioners and researchers valuable strategies to incorporate biophilic design features in the working environments of hospice settings.

Understanding the pathways between the use of urban green spaces and self-rated health: A case study in Mexico City

In recent decades, extensive research has demonstrated the positive impact of urban green spaces (UGS) on public health through several pathways. However, in the context of Latin America, particularly Mexico City, there remains a notable scarcity of evidence linking UGS use to health outcomes and an insufficient understanding of the pathways or factors underlying these associations. Therefore, this study employs Structural Equation Modeling (SEM) to investigate the intricate pathways between UGS use and residents' perceived health in Mexico City, a densely populated urban center. The SEM integrates three key mediators: sentiments towards UGS, UGS quality, and time spent within these spaces. Survey data was collected through an online survey distributed via social media in May 2020 (n = 1,707). The findings indicate a minor yet significant direct link between UGS use and self-reported health (0.0427, p < 0.1). Conversely, the indirect pathways through sentiments towards UGS, UGS quality, and time spent in UGS were highly significant (0.1950, p < 0.01), underscoring their substantial role as mediators in the UGS use-health association. While a comprehensive understanding of the mechanisms linking perceived health to UGS use in Mexico City requires further research, this study proposes that fostering positive sentiments towards UGS, enhancing UGS quality, and encouraging extended visits to green areas could potentially amplify the perceived health benefits associated with UGS use among residents. These insights offer valuable inputs for policymaking, emphasizing the importance of integrating public perspectives to optimize nature-based solutions and broaden their positive impact within Mexico City.

The health perception of urban green spaces and its emotional impact on young adults: an empirical study from three cities in China

Introduction

Exposure to green space can bring many benefits to physical and mental health, but in China, the attractiveness of green space to youth groups seems to be not significant. The question of how to encourage young people to go out of the house to better perceive green space, enjoy nature, and promote physical and mental health is on our minds.

Methods

This study combines young people's green space perception, green space use, and purpose of visit to explore its impact on the emotional health of youth groups, combined with the PANAS psychological data scale, an online questionnaire survey of 426 residents (18-35  years old) in three Chinese cities, and was used to construct a multiple regression model and AMOS structural equations.

Results and discussion

The results of the study showed that, firstly, environmental attractiveness, environmental odor, and number of facilities were the key factors influencing adolescents' landscape perception evaluation, while activity space, environmental odor, and environmental attractiveness had a greater impact on adolescents' emotional well-being. Second, among adolescents' visit purposes, socializing and fitness were more likely to help them generate positive emotions while resting and viewing activities were effective in helping them alleviate negative emotions. In addition, in terms of usage, residents who took public transportation as well as those who arrived on foot were the most emotionally healthy. The findings of this paper provide insights for public policymakers, urban planners, and landscape architects to better encourage youth participation in green spaces when they are installed.

Characteristics of Home and Neighborhood Built Environments During COVID-19 for Older Adults in the United States and Italy

The home and neighborhood environments impact the social and mental health of older adults, yet little research has addressed the various contexts that can affect these relationships, such as community culture, built and natural elements, and demographics. This survey-based study examined community-dwelling older adults' access and use of transitional outdoor/indoor space (i.e., porches, gardens, windows, etc.), and how that use was related to health variables and changed with the pandemic in two available samples of older adults in the United States and Italy. Use of both outdoor and indoor space was found to be more individualistic in Boston, in the United States, than in Chieti, Italy, where use of these areas with others was more common. Results suggest that window viewing from within the home may be an activity that individuals in Italy engage in when feeling lonely. Changes in the use of home and community space after COVID-19 were minimal; only in the United States did individuals report greater time indoors since the onset of the pandemic. Use of the built environment in and around the home by older adults was found to have multidimensional characteristics between the United States and Italy, with the potential to foster connections and improve well-being.

The relationship between perceived restorativeness and place attachment for hikers at Jeju Gotjawal Provincial Park in South Korea: the moderating effect of environmental sensitivity

Objectives

Jeju Gotjawal Provincial Park provides visitors with opportunities for outdoor recreation and informs visitors of the environmental significance of the park's ecosystem. This study attempted to examine how the perceived restorativeness of park visitors influenced their place attachment. In addition, the moderating effect of environmental sensitivity on the hypothesized relationship was explored.

Methods

Using the purposive sampling method, 408 surveys were collected at Jeju Gotjawal Provincial Park. The hypotheses were tested by confirmatory factor analysis, path analysis, and invariance tests using Lisrel 8.70.

Results

The results indicated that perceived restorativeness had a positive influence on place attachment (place identity and place dependence). Further, the hypothesized relationship was stronger for the visitors with higher environmental sensitivity, compared to those with weaker environmental sensitivity.

Conclusion

Park managers should consider ways to increase the perceived restorativeness of visitors as they experience the natural environment at the park. Also, since environmental sensitivity played an important role in shaping the perceived restorativeness-place attachment relationship, there is a need for educational programs that can inform visitors of the significance of the natural environment to increase their affection for nature.

Impacts of rising COVID-19 incidence and changed working conditions on forest visits in early 2020 of the pandemic: Evidence from Switzerland

The COVID-19 pandemic forced many nations to implement a certain degree of lockdown measures to contain the spread of the virus. It has been reported that recreational visits to forests and green spaces increased in response to the lockdown. In this study, we investigated the effect of the policy-induced changes in working conditions during the lockdown period, as well as the effect of COVID-19 infection rates, on forest visits throughout Switzerland early in the COVID-19 pandemic. We analyzed data from an online panel survey first conducted one week before the government imposed the lockdown in Switzerland and repeated two weeks after the lockdown began. We use a modeling approach to assess the impact of the home-office and short-time working situation on forest visitation frequency, as well as their effects on the length of visits to the forest. For those who visited the forest both before and during the lockdown, the frequency of forest visits increased during the early lockdown phase considered here, while the duration of visits decreased. According to our model, the opportunity to work from home was a significant driver of the increased frequency of forest visits by this visitor group, while COVID-19 infection rates had no effect on their forest visits.

Green space and the health of the older adult during pandemics: a narrative review on the experience of COVID-19

Introduction

Aging is an inevitable process that leads to changes in various dimensions of older adult life, including physical, psychological, and social aspects. Unfortunately, older adults are more susceptible to health problems caused by adverse experiences such as the Corona outbreak.

Aim

The current study examines the lived experience of older adults in facing the conditions of the Corona epidemic to see how green spaces at various scales can influence the physical and mental health of this group.

Method

Relevant articles published, from 2019 to February 17, 2023, were searched using in the Scopus and Web of Science databases. Eligible studies published in English and all studies passed a quality evaluation.

Result

In the final search, 40 articles were selected and analyzed. The majority of studies conducted during the pandemic categorized the impact of green spaces on the health of older adults into three main categories: Place-based attribute, Process, and Function.

Conclusion

The findings of this study demonstrated that people were using private green spaces (gardens, balconies, etc.), small local green public spaces, sitting and gathering spaces in the neighborhood, nearby open spaces, and urban green-blue spaces throughout the epidemic era. They visited green spaces outside the city and urban areas, including urban gardens, agricultural areas, forestlands, and pastures. In this research, we investigated the characteristics of these spaces and classified them into four physical categories: urban landscape, land use, activity, movement, and accessibility. The results showed that exposure to nature or green space improved physical and mental health and increased attention and decision-making quality in older people. We have proposed design implications recommendations for crises to improve safety, security, and social capital by increasing the safe access of older adults to diverse and high-quality green spaces on different scales, which will ultimately enhance the physical and mental health of people in different age groups.

Effects of COVID-19 Stress on Healing Behavior in Residential Spaces

This study aims to analyze the effects of COVID-19 stress on healing behavior in residential spaces. Based on the results, the study further examines the residential space as a healing environment according to space use behavior in the post-COVID era. A survey including 2101 Korean people was conducted. The COVID Stress Scale for Korean People (CSSK) was used to identify COVID-19 stress. In addition, using a literature review on healing environment factors and behavioral changes after the pandemic, survey questions were developed to assess changes in healing behavior. A frequency analysis was conducted for sociodemographic factors, and the relationship between COVID stress factors and healing behavior factors in residential spaces was examined using factor and correlation analyses. Multiple regression analysis was conducted to verify the effects of COVID stress factors on changes in healing behavior. The results revealed that COVID stress affected healing behavior in residential spaces; however, there were differences in healing behavior depending on the COVID stress factors. Fear of being infected positively affected infection prevention behavior in homes. Anger towards others negatively affected the establishment of elements that support various activities in the residential spaces and furniture arrangement. Stress from social distancing difficulties affected healing behavior in residential spaces but was not related to infection prevention behavior. Residential spaces can serve as healing spaces when people are provided with various spatial factors that support diverse types of behavior during a pandemic crisis.

Natural environments, psychosocial health, and health behaviors in a crisis - A scoping review of the literature in the COVID-19 context

The COVID-19 outbreak led to major restrictions globally, affecting people's psychosocial health and their health behaviors. Thus, the purpose of this scoping review was to summarize the available research regarding nature and health in the COVID-19 context. Keywords relating to natural environments and COVID-19 were combined to conduct a systematic online search in six major databases. Eligibility criteria were a) published since 2020 with data collected in the COVID-19 context b) peer-reviewed, c) original empirical data collected on human participants, d) investigated the association between natural environments and psychosocial health or health behaviors, and e) English, German, or Scandinavian languages. Out of 9126 articles being screened, we identified 188 relevant articles, representing 187 distinct studies. Most research focused on adults in the general population and was predominantly conducted in the USA, Europe, and China. Overall, the findings indicate that nature may mitigate the impact of COVID-19 on psychological health and physical activity. Through a systematic thematic analysis of the extracted data, three primary themes were identified: 1) type of nature assessed, 2) psychosocial health and health behaviors investigated, and 3) heterogeneity in the nature-health relationship. Research gaps in the COVID-19 context were identified regarding I) nature characteristics that promote psychosocial health and health behaviors, II) investigations of digital and virtual nature, III) psychological constructs relating to mental health promotion, IV) health-promoting behaviors other than physical activity, V) underlying mechanisms regarding heterogeneity in the nature-health relationship based on human, nature, and geographic characteristics, and VI) research focusing on vulnerable groups. Overall, natural environments demonstrate considerable potential in buffering the impact of stressful events on a population level on mental health. However, future research is warranted to fill the mentioned research gaps and to examine the long-term effects of nature exposure during COVID-19.

Perceived Social Support Mediates the Relationship between Use of Greenspace and Geriatric Depression: A Cross-Sectional Study in a Sample of South-Italian Older Adults

A growing body of evidence is suggestive for the beneficial role of contact with greenspace (e.g., use of greenspace, visual access to greenspace, etc.) on mental health (e.g., depression, anxiety, etc.). In addition, several studies have pointed out the benefits of social support and social interaction on psychological wellbeing. Even if evidence on the association between contact with greenspace and perceived social support were mixed, it was supposed that the use of greenspace could enhance social interactions and perceived social support, especially among older adults. The present study aims to explore the effect of use of greenspace on geriatric depression in a sample of South-Italian older adults and the mediating role of perceived social support in this association. A structural equation model was tested in a sample of 454 older adults (60-90 years old) residing in the Metropolitan Area of Bari, Apulia. The fit indices revealed the goodness of fit of the model (CFI = 0.934; TLI = 0.900; IFI = 0.911; NFI = 0.935; RMSEA = 0.074; SRMR = 0.056). Results showed that the use of greenspace was inversely associated with geriatric depression through perceived social support. These findings underlined the relevance of perceived social support on the pathway linking use of greenspace and geriatric depressive symptoms. This evidence may be useful to policymakers to plan interventions for promoting physical access to greenspace and social participation in an age-friendly city framework.

Exploring the effects of the Covid-19 pandemic on people's relationships with gardens

Gardens are places where science and art combine to create environments that often offer restorative and therapeutic experience to those who encounter them. During the Covid-19 pandemic, in the UK and elsewhere there has been a surge of interest in gardening. Public appreciation of gardens and other green spaces has grown and inequality of access to gardens and outdoor spaces has been extensively documented. Gardens are prevalent and of cultural significance in the UK, where their salutary properties have been documented for centuries. Yet people's relationships with gardens during the pandemic have been relatively underexplored in academia and were already under-researched prior to the pandemic's inception. This qualitative study investigates the relationships between people and gardens during the Covid-19 pandemic. Specifically, through thematic analysis based on in-depth interviews with 12 participants, it explores the effects that the pandemic had on people's relationships with gardens during an approximately 9-month period after the first national lockdown began in the UK. It places emphasis on health and wellbeing and garden design, using the concepts of agency and affordances as lenses through which to explore people's relationships with gardens. The results of this paper support others which have found people to be more supportive of nature-friendly garden design and to feel more connected with nature since the pandemic began.

Pandemic urban development is leading us away from nature

Recovery plans in Europe in the COVID-19 pandemic era have stimulated construction-led development, which has eclipsed nature-based agendas in terms of scale, size, and policy. One estimate is that only 0.3% of spending on urban infrastructure globally is directed towards various nature-based solutions and other ecosystem efforts supporting human well-being. In the future we will urgently need to employ nature-based approaches in crisis management for the power and potential of nature to be fully employed in pursuit of urban recovery. We strongly recommend that nature-based approaches be an explicit requirement to secure funding for future recovery plans.

Is indoor and outdoor greenery associated with fewer depressive symptoms during COVID-19 lockdowns? A mechanistic study in Shanghai, China

Increasing numbers of studies have observed that indoor and outdoor greenery are associated with fewer depressive symptoms during COVID-19 lockdowns. However, most of these studies examined direct associations without sufficient attention to underlying pathways. Furthermore, few studies have combined different types of indoor and outdoor greenery to examine their effects on the alleviation of depressive symptoms. The present study hypothesized that indoor and outdoor exposure to greenery increased the perceived restorativeness of home environments, which, in turn, reduced loneliness, COVID-related fears, and, ultimately, depressive symptoms. To test our hypotheses, we conducted an online survey with 386 respondents in Shanghai, China, from April to May 2022, which corresponded to strict citywide lockdowns that resulted from the outbreak of the Omicron variant. Indoor greenery measures included the number of house plants, gardening activities, and digital nature exposure as well as semantic image segmentation applied to photographs from the most viewed windows to quantify indoor exposure to outdoor trees and grass. Outdoor greenery measures included total vegetative cover (normalized difference vegetation index [NDVI]) within a 300 m radius from the home and perceived quality of the community's greenery. Associations between greenery and depressive symptoms/clinical levels of depression, as measured by the Patient Health Questionnaire-9 (PHQ-9), were examined using generalized linear and logistic regression models. Structural equation modeling (SEM) was used to test pathways between greenery exposure, restorativeness, loneliness, fear of COVID-19, and depressive symptoms. The results showed that: 1) indoor and outdoor greenery were associated with fewer depressive symptoms; 2) greenery could increase the restorativeness of the home environment, which, in turn, was associated with fewer COVID-related mental stressors (i.e., loneliness and fear of COVID-19), and ultimately depressive symptoms; and 3) gender, education, and income did not modify associations between greenery and depressive symptoms. These findings are among the first to combine objective and subjective measures of greenery within and outside of the home and document their effects on mental health during lockdowns. Comprehensive enhancements of greenery in living environments could be nature-based solutions for mitigating COVID-19 related mental stressors.

How physical home workspace characteristics affect mental health: A systematic scoping review

BACKGROUND

During the 1990s, voluntary teleworking became more grounded, because of expected advantages as increased productivity and comfort. However, COVID-19 obliged employees to work from home (WFH), even in unsuitable houses, which might have reduced their mental health. A holistic overview of methods and measures of the physical home-workspace characteristics and mental health is currently lacking. Insights in the potential influence of the physical home-workspace on mental health are also not yet holistically examined.

OBJECTIVE

The aim of this study is to provide insights in previously studied relationships between the physical home-workspace and mental health and to identify measures for both using a systematic scoping review.

METHODS

This study used the PRISMA method to systematically review existing literature.

RESULTS

Most studies focussed on noise, acoustics, and privacy, in relation to productivity, concentration, and sleep quality. Only a few studies used objective measures for physical home-workspace characteristics.

CONCLUSION

The list of relevant measures can be used by academics to examine relationships between the home-workspace and mental health further. Workplace managers can use it to help employees in optimizing their home-workspace.

When green enters a room: A scoping review of epidemiological studies on indoor plants and mental health

BACKGROUND

Increasing numbers of epidemiological studies are investigating the association between outdoor greenery and various health outcomes. However, in the case of indoor plants, although experimental studies seem relatively abundant, epidemiological studies remain scarce, and research considering the mental health effects is even more limited. Thus, we aim to identify and summarise the relevant epidemiological studies on indoor plant exposure and mental health via this scoping review, thereby presenting the current state of knowledge and research niches.

METHODS

PubMed and PsycINFO were systematically searched for epidemiological studies on indoor plant exposure and mental health, including mental and behavioural disorders, quality of life, and cognitive function. The publication period was from the inception of these two databases to 22nd June 2022. We extracted information on exposure to indoor plants and mental health-related outcomes from the relevant studies.

RESULTS

The systematic search yielded 1186 unique results. Six studies met the inclusion criteria and were finally included in this scoping review. All included studies were Europe-based cross-sectional studies on mental and behavioural disorders. One study was conducted in 2015 and investigated the office environment, whereas the other five were conducted during the COVID-19 pandemic and focused on the home environment. Despite considerable heterogeneity in outcome assessments and indoor plant exposure metrics, all six studies generally reported beneficial associations between having indoor plants and mental health, such as reducing stress, depressive symptoms, and negative emotions.

CONCLUSIONS

Epidemiological evidence on exposure to indoor plants and mental health is currently limited. In general, favourable effects of indoor plants are supported, although most relevant studies were conducted in the context of COVID-19. Before conducting more studies to explore the associations, data collection methods must be refined with more elaborate designs that allow for the measurement of more comprehensive metrics of indoor plants.

REGISTRATION

Open Science Framework, osf.io/5xr6b.

Alleviating mental health disorders through doses of green spaces: an updated review in times of the COVID-19 pandemic

The COVID-19 pandemic has highlighted issues due to mental health disorders, in particular the serious consequences derived from lockdown measures. This paper aims to analyse the literature on the potential direct impact of the natural environment on mental health disorders. We have systematically reviewed the studies analysing green spaces and mental health included in this review using PubMed, Web of Science, Scopus and Cochrane Library. A retrospective time-frame is considered, covering the COVID-19 pandemic. We have found that exposure to, use and proximity to green spaces have a beneficial impact on mental health among elderly, students and patients with underlying pathologies. However, it has negative effects on the mental health of women and young adults. Exposure to and interaction with the natural environment can improve certain mental health disorders and should be taken into account for strategies and policies related to future threats to public health.

Bringing nature into private urban housing: Environmental, social and food connections for urban resilience

Ongoing confinement for millions of urban citizens due to the Covid-19 pandemic has raised ecological consciousness, changed food habits and questioned the relationship urban dwellers have with nature. There is more interest in bringing plants into urban homes and in sustainable food sources, but no research have studied the relationships between food behaviours and plant-care activities. To address this gap and explore urban citizens' nature relatedness through the greening of private areas, we conducted a national survey of French, young urban citizens (n = 1000), who are more committed to 'edible' cities than older generations but have the lowest rate of plant purchasers. A quantitative approach reveals the prevalence of aesthetic/hedonistic expectations for plants in private housing but also demonstrates contrasting perceptions of tasks for plant maintaining and unequal valuation of social issues around plants. We discuss continuities between environmental awareness, commitment to sustainable food and natural/social uses of plants and argue that urban planning processes should address potential synergies for more integrative resilience. Community building around green areas, urban agriculture or collective gardens, in cities, can have ripple effects towards the greening of private housing. Lastly, the multi-disciplinary approach bridging psychosociology and urban studies can inspire multi-scalar urban planning.

The evaluation of the 3-30-300 green space rule and mental health

BACKGROUND AND AIMS

Urban green space has many health benefits, but it is still unclear how much actually is needed for better health. Recently a new 3-30-300 rule of thumb for urban forestry and urban greening has been proposed, but this rule has not been evaluated for benefits on health. The rule requires that every citizen should be able to see at least three trees from their home, have 30 percent tree canopy cover in their neighbourhood and not live more than 300 m away from the nearest park or green space. The aim of this study was to evaluate the relationship between the 3-30-300 green space rule and its components in relation to mental health.

METHODS

We conducted a cross-sectional study based on a population-based sample of 3145 individuals aged 15-97 years from in Barcelona, Spain who participated in the Barcelona Health Survey (2016-2017). We created 3-30-300 green space indicators using questionnaire data, GIS, remote sensing and land cover maps. Mental health status was assessed with the 12-item General Health Questionnaire (GHQ-12) and also the use of tranquilizer/sedatives or antidepressants and psychiatrist or psychologist visits. Analyses were conducted using mixed effects logistic regression models with districts as the random effect, adjusted for relevant covariates.

RESULTS

We found that people in Barcelona had relatively little exposure to green space, whether through window view, living in an area with sufficient greenness, or access to a major green space, and only 4.7% met a surrogate 3-30-300 green space rule. Residential surrounding greenness, but not tree window view or access to major green space, was significantly associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits. Meeting the full surrogate 3-30-300 green space rule was associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits, but only for the latter combined the association was statistically significant (Odds ratio = 0.31, 95% CI: 0.11, 0.91).

CONCLUSION

Few people achieved the 3-30-300 green space in Barcelona and we used a surrogate measure. We observed health benefits when the full surrogate rule was met.

Exploring public values through Twitter data associated with urban parks pre- and post- COVID-19

Since school and business closures due to the evolving COVID-19 outbreak, urban parks have been a popular destination, offering spaces for daily fitness activities and an escape from the home environment. There is a need for evidence for parks and recreation departments and agencies to base decisions when adapting policies in response to the rapid change in demand and preferences during the pandemic. The application of social media data analytic techniques permits a qualitative and quantitative big-data approach to gain unobtrusive and prompt insights on how parks are valued. This study investigates how public values associated with NYC parks has shifted between pre- COVID (i.e., from March 2019 to February 2020) and post- COVID (i.e., from March 2020 to February 2021) through a social media microblogging platform -Twitter. A topic modeling technique for short text identified common traits of the changes in Twitter topics regarding impressions and values associated with the parks over two years. While the NYC lockdown resulted in much fewer social activities in parks, some parks continued to be valued for physical activity and nature contact during the pandemic. Concerns about people not keeping physical distance arose in parks where frequent human interactions and crowding seemed to cause a higher probability of the coronavirus transmission. This study demonstrates social media data could be used to capture park values and be specific per park. Results could inform park management during disruptions when use is altered and the needs of the public may be changing.

Citizens' use of public urban green spaces at the time of the COVID-19 pandemic in Italy

Since early 2020, Coronavirus Disease 2019 (COVID-19) has spread rapidly, quickly becoming a global pandemic. To counter the COVID-19 outbreak, national governments have issued different measures and restrictions, forcing citizens to adapt to a whole new lifestyle. These restrictions have impacted on the use of green spaces by citizens owing to many factors: more available free time, increased flexibility in the work environment, and a need to relax in Nature to relieve anxiety and stress. Urban green spaces provide many benefits for the physical and psychological well-being of citizens (e.g., habitat conservation, pollution control, recreational and leisure opportunities). To understand if citizens' habits have changed due to the COVID-19 restrictions, this study provides insights from a web-based survey monitoring the use of such spaces before and during the COVID-19 lockdowns in Italy. A web-based questionnaire was conducted via "Facebook Messenger" and "WhatsApp" at the end of the second wave of COVID-19 (May-June 2021). Data collection having been concluded, 1075 completed questionnaires were collected and processed. The results show that while many reduced their weekly frequentation of green areas (-16.5%), the number of people frequenting green areas near their home every day increased (+7.7%). Two main groups of people were identified: the first, those who intensified their visits to green areas being those who desired to spend time in contact with Nature; the second, those who were reluctant to visit green areas for fear of being infected. The results also show most of the respondents felt urban green areas were either very important (82.1%) or important (14.4%). Overall, the results reveal that COVID-19 induced a positive perception of the benefits provided by urban green areas, with a consequent greater use of them, which seems destined to last even once the public health emergency has passed.

Urban greenspace helps ameliorate people's negative sentiments during the COVID-19 pandemic: The case of Beijing

The COVID-19 pandemic has had negative effects on people's mental health worldwide, especially for those who live in large cities. Studies have reported that urban greenspace may help lessen these adverse effects, but more research that explicitly considers urban landscape pattern is needed to understand the underlying processes. Thus, this study was designed to examine whether the resident sentiments in Beijing, China changed before and during the pandemic, and to investigate what urban landscape attributes - particularly greenspace - might contribute to the sentiment changes. We conducted sentiment analysis based on 25,357 geo-tagged microblogs posted by residents in 51 neighborhoods. We then compared the resident sentiments in 2019 (before the COVID-19) with those in 2020 (during the COVID-19) using independent sample t-tests, and examined the relationship between resident sentiments and urban greenspace during the COVID-19 pandemic phases using stepwise regression. We found that residents' sentiments deteriorated significantly from 2019 to 2020 in general, and that urban sentiments during the pandemic peak times showed an urban-suburban trend that was determined either by building density or available greenspace. Although our analysis included several other environmental and socioeconomic factors, none of them showed up as a significant factor. Our study suggests the effects of urban greenspace and building density on residents' sentiments increased during the COVID-19 pandemic and that not all green spaces are equal. Increasing greenspace, especially within and near neighborhoods, seems critically important to helping urban residents to cope with public health emergencies such as global pandemics.

Nature's contributions in coping with a pandemic in the 21st century: A narrative review of evidence during COVID-19

While COVID-19 lockdowns have slowed coronavirus transmission, such structural measures also have unintended consequences on mental and physical health. Growing evidence shows that exposure to the natural environment (e.g., blue-green spaces) can improve human health and wellbeing. In this narrative review, we synthesized the evidence about nature's contributions to health and wellbeing during the first two years of the COVID-19 pandemic. We found that during the pandemic, people experienced multiple types of nature, including both outdoors and indoors. Frequency of visits to outdoor natural areas (i.e., public parks) depended on lockdown severity and socio-cultural contexts. Other forms of nature exposure, such as spending time in private gardens and viewing outdoor greenery from windows, may have increased. The majority of the evidence suggests nature exposure during COVID-19 pandemic was associated with less depression, anxiety, stress, and more happiness and life satisfaction. Additionally, nature exposure was correlated with less physical inactivity and fewer sleep disturbances. Evidence was mixed regarding associations between nature exposure and COVID-related health outcomes, while nature visits might be associated with greater rates of COVID-19 transmission and mortality when proper social distancing measures were not maintained. Findings on whether nature exposure during lockdowns helped ameliorate health inequities by impacting the health of lower-socioeconomic populations more than their higher-socioeconomic counterparts for example were mixed. Based on these findings, we argue that nature exposure may have buffered the negative mental and behavioral impacts of lockdowns during the COVID-19 pandemic. Recovery and resilience during the current crises and future public health crises might be improved with nature-based infrastructure, interventions, designs, and governance.

Nature's contributions in coping with a pandemic in the 21st century: A narrative review of evidence during COVID-19

While COVID-19 lockdowns have slowed coronavirus transmission, such structural measures also have unintended consequences on mental and physical health. Growing evidence shows that exposure to the natural environment (e.g., blue-green spaces) can improve human health and wellbeing. In this narrative review, we synthesized the evidence about nature's contributions to health and wellbeing during the first two years of the COVID-19 pandemic. We found that during the pandemic, people experienced multiple types of nature, including both outdoors and indoors. Frequency of visits to outdoor natural areas (i.e., public parks) depended on lockdown severity and socio-cultural contexts. Other forms of nature exposure, such as spending time in private gardens and viewing outdoor greenery from windows, may have increased. The majority of the evidence suggests nature exposure during COVID-19 pandemic was associated with less depression, anxiety, stress, and more happiness and life satisfaction. Additionally, nature exposure was correlated with less physical inactivity and fewer sleep disturbances. Evidence was mixed regarding associations between nature exposure and COVID-related health outcomes, while nature visits might be associated with greater rates of COVID-19 transmission and mortality when proper social distancing measures were not maintained. Findings on whether nature exposure during lockdowns helped ameliorate health inequities by impacting the health of lower-socioeconomic populations more than their higher-socioeconomic counterparts for example were mixed. Based on these findings, we argue that nature exposure may have buffered the negative mental and behavioral impacts of lockdowns during the COVID-19 pandemic. Recovery and resilience during the current crises and future public health crises might be improved with nature-based infrastructure, interventions, designs, and governance.

Analysis of students' positive emotions around the green space in the university campus during the COVID-19 pandemic in China

Green space around the university campus is of paramount importance for emotional and psychological restorations in students. Positive emotions in students can be aroused when immersed in green space and naturalness. However, to what extent can perceived naturalness influence students' positive emotion remains unclear, especially in the context of COVID-19 countermeasures. This study, therefore, attempts to investigate in-depth the nature and strength of the relationships between students' positive emotion and their perceived naturalness, place attachment, and landscape preference, which are potentially varying across universities in different social and environmental contexts and different restrictions policies regarding the COVID-19 pandemic. A course of questionnaire-based surveys was administered on two university campuses in Heilongjiang and Hunan Provinces, China, resulting in 474 effective samples. Structural equation modeling was used to explore the hypothetical conceptual framework of latent variables and the indicators. The findings indicate that the higher students' perceived naturalness results in greater positive emotion. Students' perceived naturalness in green spaces of campus has a positive effect on their place attachment and landscape preference. Moreover, the difference between mediate effects of place attachment and landscape preference were addressed, which verifies the contextual influences.

Green exercise, mental health symptoms, and state lockdown policies: A longitudinal study

Lockdown policies aimed at decreasing the transmission of COVID-19 showed unintended mental health consequences; however, natural settings may offer a respite for individuals suffering from depression or anxiety symptoms. Previous cross-sectional literature reports protective effects of outdoor exposure on mental health during the COVID-19 pandemic. We longitudinally assess whether green exercise corresponded with a decline in adverse mental health symptoms, controlling for state lockdown policies. We also examine whether the relation differed by state lockdown status. As our exposure variable, we specificized participation in an outdoor walk, jog, or hike (green exercise). We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) to measure anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 8253 adults across 50 states in the US, surveyed biweekly between March 10, 2020-May 26, 2021. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, and household income. Regression results indicate a modest decline in PHQ-4 scores of approximately 0.10 (less mental health symptoms) as a function of green exercise, controlling for state lockdown status. We also find a slightly greater protective effect of green exercise on mental health symptoms during state lockdown policies. Additionally, we find that green exercise, as opposed to indoor exercise, corresponds with a decrease in PHQ-4 scores during lockdown. Contact with nature may improve mood and decrease mental health symptoms, especially during stress-inducing periods such as the COVID-19 pandemic. Green exercise as a recommended behavioral intervention may hold relevance for greater public health.

Urban parks as a potential mitigator of suicide rates resulting from global pandemics: Empirical evidence from past experiences in Seoul, Korea

Globally, the increased suicide rate of the general population has become a concern not only because of the COVID-19 pandemic, but also because of its associated socioeconomic insecurity, loss of jobs, and economic shocks. This study employed robust fixed-effects panel models to empirically identify the mitigating effects of infectious diseases, via urban parks, on the suicide rate, and to examine gender differences in this regard, based on previous experiences in Seoul, Korea. We found that the differentiating mitigating effect did not significantly affect suicide rates during the 2015 MERS epidemic. However, during the 2009 H1N1 pandemic, wherein the number of confirmed cases was very high and diffused nationwide, urban parks significantly reduced the suicide rates for both men and women. The role of parks as a mitigator was more enhanced in cities with a high number of confirmed cases if it was associated with economic shocks. However, this effect was significant only in the suicide rates of men, not women. During a pandemic, urban parks can help maintain social interaction and sustain physical activities (i.e., walking and exercise) while maintaining physical distance. National and local governments should develop urban parks to actively control the suicide rate influenced by movement restriction measures inevitably occurring during the spread of infectious diseases.

Adaptive governance of urban green spaces across Latin America - Insights amid COVID-19

Urban green spaces' well documented role as a hub for physical and mental health was enhanced by restrictions to mobility issued worldwide as a response to COVID-19. In this context, managers of urban green spaces (UGS) were prompted to provide controlled access under impromptu safety protocols. This unprecedented challenge required planning and operational strengths reflecting flexibility, innovation and learning. These management features are essential for an adaptive governance - an underdeveloped research topic within the study of UGS. Using eighteen semi-structured interviews from six countries, we analyze adaptive governance as reflected by UGS managers' responses across Latin America - a region where access to UGS is a matter of public health and of environmental justice. We document responses that can be categorized based on the governance arrangement in place. On one hand, both polycentric and dedicated-management governances have been able to learn through piloting ideas, adapting personnel roles and the function of UGS infrastructure, and adjusting their decision-making process. On the other hand, managers within municipal public services areas - the most prevalent governance arrangement across Latin America - report difficulty to adapt - likely due to their dependence on political will, limited autonomy, insufficient budgets, absence of formal paths to self-funding, shortage of technical know-how, and insufficient citizens' involvement. We discuss implications of UGS adaptive governance in terms of capacity to deal with future public health, climate-related or other types of shocks.

Evaluating the risk of accessing green spaces in COVID-19 pandemic: A model for public urban green spaces (PUGS) in London

The pandemic caused by SARS-CoV-2 (COVID-19) at the beginning of 2020 has restricted the human population indoor with some allowance for recreation in green spaces for social interaction and daily exercise. Understanding and measuring the risk of COVID-19 infection during public urban green spaces (PUGS) visits is essential to reduce the spread of the virus and improve well-being. This study builds a data-fused risk assessment model to evaluate the risk of visiting the PUGS in London. Three parameters are used for risk evaluation: the number of new cases at the middle-layer super output area (MSOA) level, the accessibility of each public green space and the Indices of Multiple Deprivation at the lower-layer super output area (LSOA) level. The model assesses 1357 PUGS and identifies the risk in three levels, high, medium and low, according to the results of a two-step clustering analysis. The spatial variability of risk across the city is demonstrated in the evaluation. The evaluation of risk can provide a better metric to the decision-making at both the individual level, on deciding which green space to visit, and the borough level, on how to implement restricting measures on green space access.

Investigating the Buffering Effects of Greenery on the Adverse Emotional, Mental and Behavioral Health during the Pandemic Period

In light of the adverse emotional, mental and behavioral outcomes caused by the pandemic period, this research analyzed the associations between emotional distress and poor health outcomes and the buffering effects of greenery on these outcomes. An online cross-sectional survey between June–November 2021 was distributed among 1314 young Italian adults. Bivariate associations and multivariate regression analyses were applied to the data. Findings showed that emotional distress was positively related to poor mental health outcomes and to some of the unhealthy behaviors. In addition, green pathways differently impacted on health: the indoor features confirmed buffering effects on adverse emotional and mental health responses, whereas the outdoor features played no salutogenic role. In conclusion, whereas the outbreak period of the pandemic has led to the rediscovering/reinforcement of the attachment to nature to cope with negative affective states, the successive waves characterized by selected limitations and new living rules of social adaptation may have brought about a reduced affinity toward nature. Target interventions in terms of biophilic design for indoor environmental sustainability are needed in order to increase the innate human–nature connection and thus to promote public health.

Change of Residents’ Attitudes and Behaviors toward Urban Green Space Pre- and Post- COVID-19 Pandemic

The COVID-19 pandemic has changed and influenced people’s attitudes and behaviors toward visiting green spaces. This paper aims to explore the association between residents’ health and urban green spaces (UGS) through an in-depth study of changes in residents’ use of UGS under the influence of the COVID-19 pandemic. The Wuhan East Lake Greenway Park was selected as the location for the field survey and in-depth interviews. At the same time, an online survey was also conducted (total number = 302) regarding participants’ physical and mental health and their attitude and behavior toward the UGS. A paired sample t-test and binary logistic regression were performed to investigate the association between participants’ health and UGS during COVID-19. The results show that: (1) the COVID-19 pandemic has primarily changed the leisure patterns of parks, with potential impacts on the physical and mental health of participants; (2) the purpose, frequency, timing, and preferred areas of participants’ park visits have changed to varying degrees after the pandemic, highlighting the important role and benefits of UGSs; (3) the physical and mental health of participants and urban development issues reflected by UGS use are prominent. This study reveals that awareness of the construction and protection of UGSs is an important prerequisite for ensuring the health of urban residents.

Attitudes towards urban green during the COVID-19 pandemic via Twitter

COVID-19 has had economic, social and environmental impacts worldwide. Governments have adopted containment measures to limit the spread of the virus. Urban green spaces (UGSs) were included among the non-essential activities and were consequently closed during the lockdown periods in some countries. This study analysed tweets posted by users to understand the citizens' perception and sentiment in relation to the closure of UGS in Italy. Results revealed that people felt a strong deprivation feeling in relation to the restrictions imposed on UGS access, which limited the number of spaces for supporting mental and physical wellbeing of citizens. Users from urban areas were more affected by the lockdowns and more willing to share thoughts on social media, demonstrating a strong emotionality. Furthermore, findings show that users seemed concerned about their children's health, expressing awareness about the benefits of being in contact with nature. UGS is able to provide services to citizens, and close-to-home parks are fundamental for the community, in particular during a health emergency. The implementation of urban design, which includes green areas to support health and environment challenges, should be addressed by policy-makers to create opportunities for a green and resilient recovery of cities, and prepare for future emergencies.

Prophylactic Architecture: Formulating the Concept of Pandemic-Resilient Homes

The lockdown instituted during the COVID-19 pandemic has drawn the world’s attention to the importance of homes as integrated structures for practicing all aspects of life. The home has been transformed from a mere place to live into a complete piece of infrastructure accommodating all activities of life, including study, work, shopping, exercise, entertainment, and even telehealth. Although quarantines were necessary to protect against viral infection, we have faced social and psychological challenges due to the failure of the current home design to accommodate the new lockdown lifestyle during the pandemic. Thus, this study aims to set a foundation for the development and design of resilient homes in a post-quarantine world by establishing a comprehensive framework for quarantine-resilient homes. The framework was established on the basis of the relevant literature and proposals from architects and experts. It brings a perspective to the future requirements of homes so as to provide architects, stakeholders, and policymakers with the appropriate knowledge to mitigate the impact of lockdowns on mental health and well-being in residential buildings by focusing on the physical and architectural environment.

Are All Urban Parks Robust to the COVID-19 Pandemic? Focusing on Type, Functionality, and Accessibility

Many people visited urban parks during the COVID-19 pandemic to reduce the negative effects of lack of physical activity, social isolation, anxiety, and depression. It is unclear whether all parks are robust against the pandemic, helping people sustain healthy daily living through the diverse activities within them. Nevertheless, few studies have identified the specific relationship between park visits and the COVID-19 pandemic. Therefore, this study aims to demonstrate how physical features such as type, functionality, and access influenced daily visiting to parks during the pandemic, using mobile phone data at a micro level. This study first classified urban parks as point-type parks with an area of less than 1 ha, plane-type parks with 1 ha or more, and line-type parks with elongated shapes, while measuring accessibility to residential, employment, transportation, and auxiliary facilities within the park. The study employed the multi-level regression model with random intercept to investigate the effects of differing park visits, focusing on Goyang city, South Korea. Our analysis results identified that easy access from home was more important than the park size during the pandemic. If we look at the types of parks, the use of both plane- and point-type parks increased more than that of line-type parks. However, line-type parks near homes, along with shopping and sports facilities, were found to be more robust to the pandemic. These findings can be informative to provide specific guidelines to fulfill the enhanced role of parks in sustaining public health during an infectious disease pandemic that may strike again.

Residential green space is associated with a buffering effect on stress responses during the COVID-19 pandemic in mothers of young children, a prospective study

Green spaces are associated with increased well-being and reduced risk of developing psychiatric disorders. In this study, we aimed to investigate how residential proximity to green spaces was associated with stress response buffering during the COVID-19 pandemic in a prospective cohort of young mothers. We collected information on stress in 766 mothers (mean age: 36.6 years) from the ENVIRONAGE birth cohort at baseline of the study (from 2010 onwards), and during the COVID-19 pandemic (from December 2020 until May 2021). Self-reported stress responses due to the COVID-19 pandemic were the outcome measure. Green space was quantified in several radiuses around the residence based on high-resolution (1 m²) data. Using ordinal logistic regression, we estimated the odds of better resistance to reported stress, while controlling for age, socio-economic status, stress related to care for children, urbanicity, and household change in income during the pandemic. In sensitivity analyses we corrected for pre-pandemic stress levels, BMI, physical activity, and changes in health-related habits during the pandemic. We found that for an inter-quartile range contrast in residential green space 300 m and 500 m around the residence, participants were respectively 24% (OR = 1.24, 95%CI: 1.03 to 1.51) and 29% (OR = 1.29, 95%CI: 1.04 to 1.60) more likely to be in a more resistant category, independent of the aforementioned factors. These results remained robust after additionally controlling for pre-pandemic stress levels, BMI, physical activity, smoking status, urbanicity, psychological disorders, and changes in health-related habits during the pandemic. This prospective study in young mothers highlights the importance of proximity to green spaces, especially during challenging times.

Understanding the Role of Nature Engagement in Supporting Health and Wellbeing during COVID-19

The importance of natural environments in supporting health and wellbeing has been well evidenced in supporting positive mental and physical health outcomes, including during periods of crisis and stress. Given the disproportionate impacts of the COVID-19 pandemic have been greatest for those who are most vulnerable, understanding the role of natural environment and alternative forms of nature engagement in supporting health and wellbeing for vulnerable groups is important. This study explored how nature engagement supported health and wellbeing in those with a pre-existing health condition during the first UK lockdown. Semi-structured interviews were conducted with 17 adults with a pre-existing health condition and analysed using Interpretative Phenomenological Analysis (IPA). Four themes were identified: COVID-19 versus nature; Nature as an extension and replacement; Nature connectedness; and Therapeutic nature. The findings show the importance of nature in supporting health and wellbeing in those with a pre-existing health condition through engagement with private and public natural environments, micro-restorative opportunities, nature connection as an important pathway, and the therapeutic benefits of nature engagement. The present research extends the evidence-base beyond patterns of nature engagement to a deeper understanding of how those with existing health conditions perceived and interacted with nature in relation to their health and wellbeing during the first UK lockdown. Findings are discussed in relation to health supporting environments, micro-restorative opportunities, and policy implications.

Impact of COVID19 restrictions on organic micropollutants in wastewater treatment plants and human consumption rates

COVID19 pandemic and the consequent restrictions to constrain SARS-CoV-2 spreading produced several impacts on the worldwide population. The present study focused on 10 Organic Micropollutants (illicit drugs, pharmaceuticals including some antibiotics and caffeine) and aimed to assess: (1) if COVID19 pandemic restrictions affected the load of those contaminants released into the sewage network and consequently the removal achieved by the Wastewater Treatment Plants; (2) if pursuant to the COVID19 pandemic, there was a change in population consumption rates of the same compounds through the wastewater-based epidemiology (WBE) approach. Two full-scale wastewater treatment plants (WWTPs) located in Central Italy were chosen as case studies, which are distinguished by different characteristics of the catchment area and water treatment layouts. The study was based on a 2-years monitoring activity of the concentration of the above organic micropollutants, traditional water quality parameters (COD, TSS, nitrogen compounds, total phosphorous) and flow rate in the influent and effluent. The statistical analysis of the monitoring data showed an increase of the influent load of most of the organic micropollutants. A decrease from 22% to -18% of the median removal efficiency was observed for carbamazepine in the WWTP with the lower treatment capacity only. The other compounds were removed roughly at the same rate. The application of the WBE approach demonstrated an increase in the consumption rate of cocaine, trimethoprim, sulfamethoxazole, sulfadiazine, carbamazepine and above all caffeine during the COVID19 restrictions period. These results highlight that COVID19 pandemic affected people's lifestyle and habits also as far as drugs consumption is concerned, which in turn might have an impact on the treatment efficacy of plants and finally on the receiving water body quality. Therefore, it is mandatory to keep monitoring to improve knowledge and eventually to implement the required measures to address this new problem.

Perceptions of green space usage, abundance, and quality of green space were associated with better mental health during the COVID-19 pandemic among residents of Denver

BACKGROUND

The COVID-19 pandemic has impacted both physical and mental health. This study aimed to understand whether exposure to green space buffered against stress and distress during the COVID-19 pandemic while taking into account significant stressors of the pandemic.

METHODS

We leveraged a cross-sectional survey on green space exposure and mental health among residents of Denver, CO that ran from November 2019 through January 2021. We measured objective green space as the average NDVI (normalized difference vegetation index) from aerial imagery within 300m and 500m of the participant's residence. Perceived green space was measured through Likert scores on five questions about vegetation near the home that captured perceived abundance, visibility, access, usage, and quality of green space. We used generalized linear models to assess the relationship between each green space exposure variable and perceived stress (PSS-4), depression (CES-D-10), or anxiety (MMPI-2) adjusted for sociodemographic and COVID-19 impact variables.

RESULTS

We found significantly higher depression scores for all covid periods compared to the "before covid" period, and significantly higher anxiety scores during the "fall wave" compared to earlier periods. Adjusted for sociodemographic and pandemic stressors, we found that spending a lot of time in green space (usage) was significantly associated with lower anxiety and depression. We also observed significantly lower depression scores associated with NDVI in both buffers (objective abundance) and significantly lower anxiety scores with perceived abundance of green space. There was some evidence of lower anxiety scores for people reporting having high quality green spaces near the home (quality). We did not observe significant associations for any green space metric and perceived stress after adjustment for confounding variables.

CONCLUSION

Our work provides further evidence of mental health benefits associated with green space exposure during the COVID-19 pandemic even after adjustment for sociodemographic variables and significant pandemic-related stressors.

Creativity, Boredom Proneness and Well-Being in the Pandemic

Throughout the course of the pandemic, it has become clear that the strictures of social isolation and various levels of lockdown constraints have impacted people’s well-being. Here, our aim was to explore relations between trait dispositions associated with boredom proneness, self-regulation and well-being using data collected early in the pandemic. Specifically, we explored whether the tendency to engage in everyday creative pursuits (e.g., making your own greeting cards) would act as a prophylactic against poor well-being. Results showed that well-being was higher for those individuals who increased engagement with creative pursuits during the early stages of the pandemic. That is, people who engaged more in everyday creative activities also reported higher levels of self-esteem, optimism, and positive affect. In contrast, those who pursued fewer creative outlets had higher levels of depression and anxiety, were higher in boredom proneness, and reported experiencing more negative affect. As we emerge from the pandemic, these data provide a clue as to how people might plan to cope adaptively with the restrictive circumstances this extreme world event engendered. More generally, these data provide support for the notion that everyday creativity (and not necessarily creative expertise) has positive associations for well-being.

Effect of Housing Quality on the Mental Health of University Students during the COVID-19 Lockdown

COVID-19 outbreak imposed rapid and severe public policies that consistently impacted the lifestyle habits and mental health of the general population. Despite vaccination, lockdown restrictions are still considered as potential measures to contrast COVID-19 variants spread in several countries. Recent studies have highlighted the impacts of lockdowns on the population’s mental health; however, the role of the indoor housing environment where people spent most of their time has rarely been considered. Data from 8177 undergraduate and graduate students were collected in a large, cross-sectional, web-based survey, submitted to a university in Northern Italy during the first lockdown period from 1 April to 1 May 2020. Logistic regression analysis showed significant associations between moderate and severe depression symptomatology (PHQ-9 scores ≥ 15), and houses with both poor indoor quality and small dimensions (OR = 4.132), either medium dimensions (OR = 3.249) or big dimensions (OR = 3.522). It was also found that, regardless of housing size, poor indoor quality is significantly associated with moderate–severe depressive symptomatology. Further studies are encouraged to explore the long-term impact of built environment parameter modifications on mental health, and therefore support housing and public health policies.

Urban green spaces and stress during COVID-19 lockdown: A case study for the city of Madrid

Due to the unexpected emergence of COVID-19, different cities improvised responses to prevent the virus from spreading and infecting the population. Madrid, capital of Spain and one of the most affected cities in Europe, confined everyone home and closed most public and private spaces, including public parks. The whole situation was surely to be responsible for stress-levels to peak. We developed an online survey to better understand the relationship between people and Urban Green Spaces prior to the COVID-19 pandemic, and the new bond that may have emerged from this interruption. We recruited participants, without gender or age preference, excluding underage children and teenagers, using a combination of convenience sample and a snowball approach. A total of 132 responses were logged. The study was limited to mental health inferences, specifically related to stress and its most frequent manifestations among the urban population. These indicators included physical, mood or behavioral changes and were studied on those participants who had access to UGS before and during confinement. Among the most important findings, we confirmed that when people are confronted with stressful situations, indoor plant interaction is not a substitute for different outdoor green experiences; those who interacted with green spaces in a daily manner managed stress levels better than people who didn't (but their effects might lose strength over time); and turning to green spaces for comfort during stressful times when you don't usually do so helps overcome difficult situations. This article contributes to the growing study of green spaces as a means towards improved mental well-being in urban areas.

Spatial statistical analysis of the relationship between self-reported mental health during the COVID-19 lockdown and closeness to green infrastructure

The COVID-19 pandemic has produced alterations in the behaviour and psychological health of people, who have had to learn living under uncertain circumstances escaping their control. This situation has been aggravated in those countries applying strict home confinement rules to try bending their epidemic curve. This is the case of Spain, where the stringent lockdown period was extended over three months. This study aimed at proving a research hypothesis whereby living close to Green Infrastructure (GI) during the confinement period was beneficial for mental health. To this end, La Palma (Canary Islands) and Zaragoza (Peninsular Spain) were taken as case studies, since both locations distributed a questionnaire to address citizenry's self-reported mental health under strict lockdown conditions. A spatial statistical analysis of the responses collected by these questionnaires revealed that variables such as stress, anger, medication use, alcohol consumption or visits to the doctor significantly decreased if citizens were close to GI, whereas people having very high expectations of enjoying the city after the confinement were positively correlated to proximity of green areas. Although these outcomes are limited by the inferential capacity of correlation analysis, they point out to a sense of relief derived from having visual contact with vegetated landscapes and feeling stimulated about using them for recreation, aesthetical or sporting purposes. The joint consideration of these psychological gains with the social and environmental benefits provided by GI emphasizes the importance of approaching urban regeneration through the design and implementation of interconnected green spaces.

Analysis of the Window Views of the Nearby Façades

The view from the window is an important parameter of living comfort. Previous studies have defined several important characteristics of views, but there are very few studies that addressed window views in dense urban environments and their influence on the perceptual elements of the view. The scope of the study was to define the influence of design elements in window views that can trigger negative reactions from viewers. In our study the questionnaire survey was used as a method for obtaining the research data. A group of architecture students who participated as respondents selected different reactions to views and reasons for such responses. Only the window views that received poor responses were further investigated. The results were statistically analyzed according to the most frequent responses and the variability of responses. The homogeneity of the groups of responses as well as the groups of reasons was tested using the Fischer-Snedercor test. The analysis showed that the negative response to a window view depends not only on the short distance between the buildings, but also on the visual aesthetics, especially the composition quality, the surface characteristics and the maintenance of the observed building. The results show that interventions, especially natural elements such as vegetation, can increase the dynamics of the window view.

The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context

Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.

Go Greener, Less Risk: Access to Nature Is Associated with Lower Risk Taking in Different Domains during the COVID-19 Lockdown

Specific risk attitude and risky behavior had an important boost during the coronavirus disease 2019 (COVID-19) pandemic. In this contribution, we hypothesize that access to nature during home confinement will decrease both the tendency to passive risk taking and alcohol intake. To do so, we interviewed through an online survey two samples of Italian residents during the strict lockdown due to the first wave of the COVID-19 pandemic. Specifically, in Study 1, participants were 1519 Italian residents coming from different Italian regions, whilst in Study 2, participants were 182 students at a university of southern Italy who were monitored for one week. In Study 1, the hierarchical regression analysis attested that access to nature during the lockdown mitigated the tendency to passive risk taking, over and beyond the effect of socio-demographic variables and the psychological construct of impulsiveness, an important personality correlate of risk taking. In Study 2, the hierarchical regression showed that access to green was associated with fewer glasses of alcohol drunk in a week of lockdown. This effect held over and above the effect of socio-demographic variables and the drinking behavior before the outbreak of the COVID-19 pandemic. In both studies, findings confirmed the beneficial effect of access to nature in specific risk-taking domains. Theoretical future directions, as well as practical implications for the management of the COVID-19 emergency by policymakers, are discussed.

Reexamine the value of urban pocket parks under the impact of the COVID-19

While the focus of the wide-spread coronavirus is its impacts on people's lives and economic wellbeing around the world, the pandemic substantially limits people's available options of physical activities and exacerbates an enduring problem of large urban populations lack accessible green space to fulfill the essential physical and mental health needs. Under the current pandemic situation available green space is further reduced when some parks are closed or open with limited functions to reduce the spread of coronavirus. At the same time, the demand for green space has increased because of the unavailability of other activities. In this essay, we call the attention of urban planners and designers to pocket parks. Studies have shown that the tiny size of pocket parks makes them an easier fit into vacant properties scattered throughout the urban fabric. Therefore, pocket parks can improve health and encourage social cohesion of residents in often underserved high density urban neighborhoods. The potential of pocket parks in providing accessible urban green space to all urban population may have been considered desirable before the coronavirus outbreak and now it should be considered a necessary 'lifeline' to improve urban residents' health during the coronavirus. In addition, with the long-overlooked value of accessible urban green space waken by the global-scale crisis, proper attention and improvement strategy, such as introducing more pocket park could lead to a better future after the COVID-19.