The role of natural environments within women’s everyday health and wellbeing in Copenhagen, Denmark

Nature-based interventions to support mental health and well-being of young women in pregnancy: exploratory work for future feasibility RCT

Background

The prevalence of mental health and well-being issues among young women is increasing. Pregnancy is a time when new mental health challenges may arise, or existing conditions can be exacerbated. This project presents preparatory work on how nature-based interventions may help to support the mental health and well-being of young pregnant women (aged 16-24 years) in a future study.

Methods

This project was formed of three main phases conducted from March to August 2022: (1) mapping nature activities available across the East Midlands region and two focus groups with providers of nature activities (n = 6); (2) public participation and involvement work to inform future research. This included four focus groups with young women (n = 11), leading to the formation of a new young women's panel (Research Influencers Group). Networking and stakeholder engagement to support future research.

Results

The mapping survey identified 68 nature-based organisations/projects operating in the region, many of whom expressed interest in being involved in future research. The young women's focus groups confirmed the importance of the topic and generated a wealth of information to support the intervention design. A Research Influencer Group of five young women was established from the focus group participants. The Research Influencer Group chose the nature-based intervention and had input into all aspects of the study design. This group will continue into future projects. Focus groups with providers of nature activities have further advanced the study design. The project team have developed relationships with relevant stakeholders and networks that will inform the future trial.

Conclusion

This preparatory co-design work suggested that a nature-based intervention may be acceptable to young women, and providers of such interventions felt it was feasible to offer these activities to young pregnant women. This preparatory work has led to an outline research plan which has been co-produced with public contributors and stakeholders throughout.

Limitations

This preparatory work is limited by small focus group samples, and the possibility that not all providers were reached through the snowballing approach to the mapping survey.

Future work

Future research is needed to test the nature-based intervention; this would be in the form of a feasibility randomised controlled trial of nature-based interventions to promote the mental health and well-being of young pregnant women.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135167.

"This family and the Games are my world": Conceptualizing the British and European Transplant Games as therapeutic landscapes

The first Transplant Games took place in 1978 in Portsmouth, England. Since then, numerous Olympic-style sporting 'Games' have been established, each aiming to increase public awareness of organ donation, demonstrate the benefits of transplantation, and encourage patient fitness. Despite this, there is limited research exploring the psycho-social and health impacts of the Games. Drawing on qualitative research conducted at the 2022 British Transplant Games and the 2022 European Transplant and Dialysis Games, this paper explores the Games through a therapeutic landscapes framework, a concept that examines the ways in which environments contribute to health and wellbeing. Building upon work that acknowledges the relational and contingent nature of health-in-place, I argue that the Games are a therapeutic landscape of social relations for transplant recipients in three ways: providing a landscape of belonging, a landscape of hope, and a landscape of motivation. Through this therapeutic landscapes perspective, the Transplant Games are presented as a peer-to-peer clinic - a care space where individuals are more actively involved in their health on a reciprocal level than in the traditional hospital clinic. In turn, this paper emphasises the crucial role of affective peer support in producing health-promoting environments. This research seeks to make a practical contribution to the wider transplant community by promoting the Games as an environment which may positively contribute to both physical and mental wellbeing.

Nature-Based Interventions in the UK: A Mixed Methods Study Exploring Green Prescribing for Promoting the Mental Wellbeing of Young Pregnant Women

Green prescribing is gaining in popularity internationally for the promotion of mental wellbeing. However, the evidence base is limited, particularly in young pregnant women, a population with known risk factors for anxiety and depression. The aim of this mixed-methods study was to provide insights into the availability, processes, and suitability of nature-based interventions for young pregnant women. First, an online mapping survey of nature-based activities in the East Midlands region of the United Kingdom (UK) was undertaken. Second, focus groups (n = 6) were conducted with nature activity providers and young mothers (n = 11). This study found there were many diverse nature-based activities available to promote mental wellbeing. The organisational challenges highlighted include a lack of sufficient funding for service provision and disappointing experiences with some green prescribing programmes. The young women felt that nature-based activities helped to promote their mental wellbeing, and also offered an opportunity for social support. The facilitators, such as having detailed information and being accompanied to initial sessions to ease anxieties, were found to maximise the women's engagement with nature-based interventions. This study provides new perspectives on nature-based interventions from service providers and young women. Findings on the organisational barriers and facilitators to delivering interventions will inform the design of much needed future experimental research.

Community indicators for mental health in Europe: a scoping review

Background

Community indicators may predict and influence individuals` mental health, and support or impede mental health management. However, there is no consensus on which indicators should be included in predictions, prognostic algorithms, or management strategies for community-based mental health promotion and prevention approaches. Therefore, this scoping review provides an overview of relevant community-level indicators for mental health in the general as well as risk populations in a European context.

Methods

We conducted a scoping review in the following electronic databases: PubMed, Embase, and PsycInfo. Eligible studies focused on context factors such as either the physical or social environment, reporting at least one mental health outcome and referring to a European population. Publications between 2012 and March 8, 2022 are considered.

Results

In total, the search yielded 12,200 identified records. After the removal of duplicates, 10,059 records were screened against the eligibility criteria. In total, 169 studies were included in the final analysis. Out of these included studies, 6% focused on pan-European datasets and 94% on a specific European country. Populations were either general or high-risk populations (56 vs. 44%, respectively) with depressive disorder as the main reported outcome (49%), followed by general mental health (33%) and anxiety (23%). Study designs were cross-sectional studies (59%), longitudinal (27%), and others (14%). The final set of indicators consisted of 53 indicators, which were grouped conceptually into 13 superordinate categories of community indicators. These were divided into the domains of the physical and social environment. The most commonly measured and reported categories of community indicators associated with mental health outcomes were social networks (n = 87), attitudinal factors toward vulnerable groups (n = 76), and the characteristics of the built environment (n = 56).

Conclusion

This review provides an evidence base of existing and novel community-level indicators that are associated with mental health. Community factors related to the physical and social environment should be routinely recorded and considered as influencing factors or potentially underestimated confounders. The relevance should be analyzed and included in clinical outcomes, data, monitoring and surveillance as they may reveal new trends and targets for public mental health interventions.

Contemplative practices: The body as therapeutic site linking health and place

During times of upheaval, supporting stability, health and wellbeing on all levels is essential. While literature regarding 'therapeutic landscapes' has burgeoned over the last 30 years, to date no studies have considered the therapeutic potential of embodied contemplative practices (CP), such as yoga and meditation, within the most accessible, ordinary environment - the body at home. Equally, the field of mobilities appears to have overlooked the spiritual and political nature of these deliberately immobilising acts of resistance. Our paper draws on narrative data collected over the course of three months of daily CP. We interpret the resulting autoethnography through thematic analysis. We conclude that within a fast-paced, hyper-connected world, CPs can be a therapeutic counterpoint, connecting health and place by nurturing an appreciation for the immaterial, interdependent aspects of life.

Community gardening and wellbeing: The understandings of organisers and their implications for gardening for health

Community gardening is increasingly framed and promoted as a way to foster healthful behaviours, as a wellbeing practice, and as a public health tool. This paper draws on semi-structured interviews with community gardening organisers (n = 9) in the North East of England, who were engaged in translating and transforming discourses and ideas about community gardening into places and practices that people can draw benefit from. Here, community gardening can be understood as a bricolage of ideas, resources, and skills at the nexus of several influences and movements, assembled to produce a localised, everyday sort of social change. We conclude that framing community gardening as a simple solution to be harnessed in the promotion of health and wellbeing undermines the richness that sustains it and may lead to disenchantment within health services and community gardening organisations that could threaten the future of 'green social prescribing'.

The urban public realm and adolescent mental health and wellbeing: A systematic review

Adolescent mental health is becoming a critical concern. Mental illness rates are rising and many psychological disorders first present symptoms during teenage years. Studies consistently show associations between the built environment and mental health, including internalising mental health disorders in adults, but the evidence for adolescents is less robust and few studies attempt to isolate causality. This review examines the relationship between the urban public realm and adolescent mental health and wellbeing. Our search yielded 24 studies for inclusion. We undertook qualitative synthesis of 20 cross-sectional studies and conducted a separate quality analysis of four longitudinal studies. Greenspace and neighbourhood quality are associated with adolescent mental health and wellbeing although this may be due more to residual confounding, selection effects and same-source bias than evidence for a causal effect. Furthermore, the few longitudinal studies that seek to test causality remain prone to these biases. Overall, we find little evidence of an effect of the urban public realm on adolescent mental health and wellbeing, which, we argue, reflects the difficulty of researching complex pathways between environments and health and highlights a challenge to the field. To address this challenge, we propose a research agenda that prioritises more and better data drawn from diverse study designs, and more and better theories developed from diverse epistemologies.

Therapeutic landscape experiences of everyday geographies within the wider community: A scoping review

As community dwelling populations of older people and those living with chronic and life limiting conditions continue to grow, the role of everyday geographies, particularly of community based settings and activities, in supporting health and wellbeing has become a focus in both research and policy development. The therapeutic landscape scholarship provides a holistic view of how place promotes health and wellbeing, and has in recent years expanded its focus from reputable places of healing to everyday geographies. Based on a scoping review of 45 studies on everyday community based therapeutic landscapes, this paper identifies and critically examines the settings, populations and mechanisms of therapeutic experiences. It presents critical summaries of the scales and boundaries of landscapes; the diverse and dichotomous characteristics of places; the therapeutic benefits of proximal and distal socio-spatial interactions; the role of everyday settings and activities as sources of refuge, anchor and resonance and finally the broader social, cultural, political and economic contexts in which everyday therapeutic landscapes are embedded. In so doing the paper highlights the complex nature of everyday therapeutic landscape experiences and how this research can further inform the development of community based settings and activities that promote health and wellbeing. It also identifies areas for future research on everyday therapeutic landscapes.

Proximity to freshwater blue space and type 2 diabetes onset: the importance of historical and economic context

Salutogenic effects of living near aquatic areas (blue space) remain underexplored, particularly in non-coastal and non-urban areas. We evaluated associations of residential proximity to inland freshwater blue space with new onset type 2 diabetes (T2D) in central and northeast Pennsylvania, USA, using medical records to conduct a nested case-control study. T2D cases (n=15,888) were identified from diabetes diagnoses, medication orders, and laboratory test results and frequency-matched on age, sex, and encounter year to diabetes-free controls (n=79,435). We calculated distance from individual residences to the nearest lake, river, tributary, or large stream, and residence within the 100-year floodplain. Logistic regression models adjusted for community socioeconomic deprivation and other confounding variables and stratified by community type (townships [rural/suburban], boroughs [small towns], city census tracts). Compared to individuals living ≥1.25 miles from blue space, those within 0.25 miles had 8% and 17% higher odds of T2D onset in townships and boroughs, respectively. Among city residents, T2D odds were 38-39% higher for those living 0.25 to <0.75 miles from blue space. Residing within the floodplain was associated with 16% and 14% higher T2D odds in townships and boroughs. A post-hoc analysis demonstrated patterns of lower residential property values with nearer distance to the region's predominant waterbody, suggesting unmeasured confounding by socioeconomic disadvantage. This may explain our unexpected findings of higher T2D odds with closer proximity to blue space. Our findings highlight the importance of historic and economic context and interrelated factors such as flood risk and lack of waterfront development in blue space research.

Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research

Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.

Regulating and Cultural Ecosystem Services of Urban Green Infrastructure in the Nordic Countries: A Systematic Review

In the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), the Urban Green Infrastructure (UGI) has been traditionally targeted at reducing flood risk. However, other Ecosystem Services (ES) became increasingly relevant in response to the challenges of urbanization and climate change. In total, 90 scientific articles addressing ES considered crucial contributions to the quality of life in cities are reviewed. These are classified as (1) regulating ES that minimize hazards such as heat, floods, air pollution and noise, and (2) cultural ES that promote well-being and health. We conclude that the planning and design of UGI should balance both the provision of ES and their side effects and disservices, aspects that seem to have been only marginally investigated. Climate-sensitive planning practices are critical to guarantee that seasonal climate variability is accounted for at high-latitude regions. Nevertheless, diverging and seemingly inconsistent findings, together with gaps in the understanding of long-term effects, create obstacles for practitioners. Additionally, the limited involvement of end users points to a need of better engagement and communication, which in overall call for more collaborative research. Close relationships and interactions among different ES provided by urban greenery were found, yet few studies attempted an integrated evaluation. We argue that promoting interdisciplinary studies is fundamental to attain a holistic understanding of how plant traits affect the resulting ES; of the synergies between biophysical, physiological and psychological processes; and of the potential disservices of UGI, specifically in Nordic cities.

Freshwater blue space and population health: An emerging research agenda

Growing evidence suggests that access and exposure to water bodies or blue spaces can provide a variety of health and well-being benefits. Attempts to quantify these 'blue-health' benefits have largely focused on coastal environments, with freshwater blue spaces receiving far less attention despite over 50% of the global population living within 3 km of a body of freshwater and populations living in landlocked areas having limited coastal access. This critical review identifies opportunities to improve our understanding of the relationship between freshwater blue space and health and well-being and outlines key recommendations to broaden the portfolio of emerging research needs associated with the field of blue-health. Recognising fundamental distinctions in relationships between health outcomes and access and exposure to freshwater versus coastal blue space is critical and further research is required to determine the mechanisms that link exposure to freshwater blue space with tangible health outcomes and to understand how such mechanisms vary across a range of freshwater environments. Furthermore, methodological improvements are necessary as spatial approaches adopted to quantify access and exposure to freshwater blue space often fail to account for the unique physical characteristics of freshwater and come with a variety of limitations. Based on the findings of this review, a suite of research needs are proposed, which can be categorised into three broad themes: (i) establishing a freshwater blue-health methodological framework; (ii) advancing the empirical freshwater blue-health evidence base; and (iii) promoting freshwater blue-health opportunities. When taken together, these research themes offer opportunities to advance current understanding and better integrate freshwater blue space into the wider nature-health research agenda.

'A lot better than medicine' - Self-organised ocean swimming groups as facilitators for healthy ageing

Exercise, spending time in nature and feeling part of a supportive community all contribute to better physical and mental health and to healthy ageing. This focused ethnography investigates how participation in self-organised ocean swimming groups contributes to healthy ageing amongst older men and women in the Australian coastal city of Perth. It explores the ways marine life, personal experiences and social connectedness mediate their group use of public blue space, and highlights that group membership promotes participants' enhanced health and wellbeing, and supports development of self-efficacy and resilience. These findings suggest that more inclusive access to ocean swimming and other forms of active or adventure-based leisure activities should be advocated from a public health perspective.

Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence

The aim of this study was to review emerging evidence of novel treatments for anxiety disorders. We searched PubMed and EMBASE for evidence-based therapeutic alternatives for anxiety disorders in adults, covering the past five years. Eligible articles were systematic reviews (with or without meta-analysis), which evaluated treatment effectiveness of either nonbiological or biological interventions for anxiety disorders. Retrieved articles were summarized as an overview. We assessed methods, quality of evidence, and risk of bias of the articles. Nineteen systematic reviews provided information on almost 88 thousand participants, distributed across 811 clinical trials. Regarding the interventions, 11 reviews investigated psychological or nonbiological treatments; 5, pharmacological or biological; and 3, more than one type of active intervention. Computer-delivered psychological interventions were helpful for treating anxiety of low-to-moderate intensity, but the therapist-oriented approaches had greater results. Recommendations for regular exercise, mindfulness, yoga, and safety behaviors were applicable to anxiety. Transcranial magnetic stimulation, medication augmentation, and new pharmacological agents (vortioxetine) presented inconclusive benefits in patients with anxiety disorders who presented partial responses or refractoriness to standard treatment. New treatment options for anxiety disorders should only be provided to the community after a thorough examination of their efficacy.

Cities and Mental Health

BACKGROUND

More than half of the global population currently lives in cities, with an increasing trend for further urbanization. Living in cities is associated with increased population density, traffic noise and pollution, but also with better access to health care and other commodities.

METHODS

This review is based on a selective literature search, providing an overview of the risk factors for mental illness in urban centers.

RESULTS

Studies have shown that the risk for serious mental illness is generally higher in cities compared to rural areas. Epidemiological studies have associated growing up and living in cities with a considerably higher risk for schizophrenia. However, correlation is not causation and living in poverty can both contribute to and result from impairments associated with poor mental health. Social isolation and discrimination as well as poverty in the neighborhood contribute to the mental health burden while little is known about specific interactions between such factors and the built environment.

CONCLUSION

Further insights on the interaction between spatial heterogeneity of neighborhood resources and socio-ecological factors is warranted and requires interdisciplinary research.

Voices from the landscape: Storytelling as emergent counter-narratives and collective action from northern BC watersheds

The 'Ecohealth and Watersheds in Northern BC'' project, situated in a resource rich, settler colonial context, generated three digital stories at the request of the project's Steering Committee members that sought to connect health, environment, and community. Three Steering Committee members championed these stories from their distinct watersheds, resulting in emergent counter-narratives that respond directly to their social-ecological contexts. Nested in literature on blue and green spaces, we present and examine the process of storytelling as emergent counter-narrative and how these narratives challenge us to think of blue and green spaces in interconnected and nuanced ways.