Park availability and major depression in individuals with chronic conditions: Is there an association in urban India?

Green spaces exposure and the risk of common psychiatric disorders: A meta-analysis

Objective

To explore the effects of green spaces exposure on common psychiatric disorders.

Methods

PubMed, Embase, Web of Science and MEDLINE were screened and articles published prior to November 15, 2023 were included. Analyses were performed on common psychiatric disorders, categorized into depression, anxiety, dementia, schizophrenia, and attention deficit hyperactivity disorder (ADHD). And the subgroup analyses were conducted for depression, anxiety, dementia, and schizophrenia.

Results

In total, 2,0064 studies were retrieved, 59 of which were included in our study; 37 for depression, 14 for anxiety, 8 for dementia, 7 for schizophrenia and 5 for ADHD. Green spaces were found to benefit the moderation of psychiatric disorders (OR = 0.91, 95% CI: 0.89 to 0.92). Green spaces positively influence depression (OR = 0.89, 95% CI: 0.86 to 0.93), regardless of the cross-sectional or cohort studies. Green spaces can also help mitigate the risk of anxiety (OR = 0.94, 95%CI:0.92 to 0.96). As an important index for measuring green spaces, a higher normalized difference vegetation index (NDVI) level related to a lower level of depression (OR = 0.95, 95%CI:0.91 to 0.98) and anxiety (OR = 0.95, 95%:0.92 to 0.98). The protection was also found in dementia (OR = 0.95, 95% CI: 0.93 to 0.96), schizophrenia (OR = 0.74, 95% CI: 0.67 to 0.82), and ADHD (OR = 0.89, 95% CI: 0.86 to 0.92) results.

Conclusion

Green spaces decrease the risk of psychiatric disorders, including depression, anxiety, dementia, schizophrenia, and ADHD. Further studies on green spaces and psychiatric disorders are needed, and more green spaces should be considered in city planning.

How does multiscale greenspace exposure affect human health? Evidence from urban parks in the central city of Beijing

While the health benefits of exposure to urban greenspace have been widely discussed at different spatial scales, the comprehensive health effects of multiscale greenspace exposure are far from understood. There is a lack of quantified evidence when conducting cost-effective greenspace management practices for promoting human health and well-being. This study proposed a conceptual model that links objective and subjective greenspace exposure metrics at different spatial scales with self-rated health of residents. The model attempted to deconstruct and explore the associations between multiscale greenspace exposure and human health, and a cross-sectional study was conducted to examine the model. Taking urban parks in the central city of Beijing as case study area, the objective greenspace exposure metrics at both the site and subdistrict scales were spatial explicitly assessed, and the subjective exposure metrics and self-rated health status of 1017 respondents were obtained through questionnaire survey and spatial positioning. The results of multiple regression analyses and path analyses suggested that greenspace exposure metrics at both site and subdistrict scales were significantly associated with the respondents' self-rated health status, with the exposure metrics at the site scale being more important than those at the subdistrict scale in affecting human health. The contribution of urban parks to self-rated physical and mental health of respondents varied across spatial scales. Specifically, the aesthetic value of urban parks at site scale contributed the most to mental health by promoting respondents' resting behaviors in urban parks, and the density of urban parks at subdistrict scale had the most significant effects on self-rated physical health by increasing the usage frequency of urban parks. Findings of this study can contribute to understanding the complex associations between urban greenspace and human health from a multiscale perspective, and are also expected to provide quantified information for health-oriented urban greenspace planning and management practices.

The role of park size on ecosystem services in urban environment: a review

Urban parks play an important role in urban ecosystems with multifunctional services. Park size is one of the important attributes to explain the potential capacity of urban parks. In recent years, the number of studies that focus on the relationship between park size and ecosystem services in the context of ecosystem services has been increasing. This study aims to focus on investigating the relationship between ecosystem services and urban park size. The Web of Science online databases were searched using the keywords "green space", "size" and "urban" as well as related terms. A total of 129 papers meeting the inclusion criteria were examined within the scope of the research aims. The results obtained from the systematic search were summarized and presented in the three categories with sub-categories: (i) cultural services with sub-categories of physical activity (n = 42) and housing prices (n = 10), (ii) supporting services with sub-categories of fauna (n = 44), and flora (n = 3) and (iii) regulating services with sub-categories of microclimate (n = 25) and air quality (n = 5). The results indicated that park size influences a wide range of services by providing more spaces for physical activities, increasing housing prices, creating habitats for birds, insects, and bats, and effects on their richness, diversity and density, increasing the cooling effect capacity and reducing air pollution of urban parks. In conclusion, a comprehensive approach is needed, recognizing the potential of both large and small green spaces to optimize ecosystem services delivery, promote resilience, and enhance urban well-being. This includes considering supply and demand aspects and improving measurement methods. Furthermore, exploring optimal improvements across diverse park sizes remains a promising avenue for research, contributing to the development of more efficient urban green spaces.

Impact of COVID-19 pandemic on cultural ecosystem services from urban green spaces: a case from English Bazar Urban Agglomeration, Eastern India

Urban green space (UGS) provides multiple cultural ecosystem services (CES) and enhances people's physical and mental well-being. The importance of UGS was more critical during crisis periods such as the COVID-19 pandemic. Recently, UGS has been under severe threats due to rapid urban expansion and climate change. Particularly, the cities in developing countries have experienced a dramatic loss of green spaces due to land use and land cover (LULC) change. This study aims to assess the impact of the COVID-19 pandemic on CES perception obtained from two public UGS, i.e., Subhankar Sishu Uddyan (SSU) and Bandh Road (BR) in English Bazar Urban Agglomeration (EBUA), Eastern India. A survey was performed to assess the valuation of CES, CES obtained from UGS, and the use of CES difference during partial (unlock phases) and after lockdown periods. The non-parametric tests were carried out to understand the significant differences between CES and UGS perceived by the respondents. Explanatory factor analysis was also performed to find the association among CES for each UGS. The results reported substantial variations of UGS use during partial and after lockdown periods. During the after-lockdown period, the UGS mainly were used for social relations (51%), spending time with relatives and friends (25%), spending time with children (11%) in SSU and walking (25%), spending time with relatives and friends (21%), and physical activities (17%) in BR. During the partial lockdown period, a significant difference between SSU and BR was recorded from social relations and health value among all CES. After the full lockdown period, a significant difference was observed in recreation, social relations, health, and aesthetic value. The frequency and duration of UGS use during partial lockdown periods substantially increased. About 12% of the total visitor visited UGS daily after the lockdown, whereas it was 4% during the partial lockdown. The study's findings will assist urban planners and policymakers in understanding the need for UGS to promote the well-being of the citizens.

Urban park use and self-reported physical, mental, and social health during the COVID-19 pandemic: An on-site survey in Beijing, China

The COVID-19 pandemic created unprecedented challenges for people's health. Studies have demonstrated the positive impact of urban green spaces, particularly urban parks, on physical and mental health. However, few studies have evaluated social health, which is a component of human health, and more understanding of the relationship between urban parks and human health during the COVID-19 pandemic is required. This study examined the effects of urban parks on people's health using a canonical correlation model. Physical, mental, and social health were the dependent health variables, and five factors related to urban parks were the independent variables. This study investigated 22 urban parks inside the Forth Ring Road in Beijing, China using a questionnaire survey. The results demonstrated a positive association between urban parks and human health during the pandemic. Distance to the parks, park area, and park size were positively correlated with physical, mental, and social health. Furthermore, frequency and duration of visits to urban parks were positively associated with mental health and contact with neighbors. The health effects of urban park use varied with park types and locations' urbanization background. These findings can provide insights for health-oriented urban park planning and construction.

Effects of Urban Forest Therapy Program on Depression Patients

Depression is a common serious mental health condition that can have negative personal and social consequences, and managing it is critical for treating depression patients. Forest therapy is emerging as a promising non-pharmacological intervention to improve mental health. However, although the effectiveness of forest therapy programs using forests far from the city has been proven, it is not well known that urban forests can be easily accessed in daily life. Therefore, this study aimed to examine the effects of an urban forest therapy program on depression symptoms, sleep quality, and somatization symptoms of depression patients. To evaluate this, a randomized controlled trial (RCT) design was employed. A total of 47 depression patients participated in this study (22 in the urban forest therapy program group and 25 in the control group). The Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), the Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-15 (PHQ-15) were administered to each participant to assess the effects of the urban forest therapy program. The results of this study revealed that depression patients in the urban forest therapy program had significantly alleviated depression symptoms and improved sleep quality and somatization symptoms compared to the control group. In conclusion, this study demonstrates the possibility that the urban forest therapy program could be used as an effective non-pharmacological treatment to alleviate depression disorder.

Unraveling Visiting-Activity Patterns of Heterogeneous Communities for Urban-Park Planning and Design

Urban parks provide essential outdoor recreation space, especially for high-density cities. This study evaluated the park-visiting activity profiles of residents to inform the planning and design of community-relevant parks. The visiting and activity patterns of 465 Hong Kong adult residents were collected using a structured questionnaire. The correlations of visiting and activity patterns of the different socio-demographic groups were analyzed. Varying features of visiting and activity patterns were observed for different socio-demographic groups. Older patrons visited parks intensively for nature-enjoyment activities and had shorter travel if intended for social and physical-exercise activities. The middle-aged respondents with children mainly conducted family based recreation, visited parks more frequently, and traveled farther. The young adults reported lower patronage, but the visit frequency increased with the engagement level in outdoor and physical-exercise activities. The homemakers reported a high visit frequency and enthusiastic participation in social activities. They tended to visit more frequently and stay longer in parks for physical-exercise activities. Our study revealed the urban parks’ divergent patronage behavior and unique roles to disparate user groups. They furnished evidence to apply continually precision park planning, design, and promotion to achieve socially responsive and age-friendly parks.

Influence of External Natural Environment Including Sunshine Exposure on Public Mental Health: A Systematic Review

The COVID-19 pandemic has been raging around the world and public health measures such as lockdowns have forced people to go out less often, reducing sunlight exposure time, green space use, and physical activity. It is well known that exercise has a positive impact on mental health, but the impact of external environmental factors such as sunlight exposure and green space use on mental health has not been systematically reviewed. In this review, we categorized the major factors that may affect people’s mental health into (1) external environmental factors such as exposure to sunlight and green spaces, (2) internal life factors such as physical activity and lifestyle, and (3) mixed external and internal factors, and systematically examined the relationship between each factor and people’s mental health. The results showed that exposure to sunlight, spending leisure time in green spaces, and physical activity each had a positive impact on people’s mental health, including depression, anxiety, and stress states. Specifically, moderate physical activity in an external environment with sunlight exposure or green space was found to be an important factor. The study found that exposure to the natural environment through sunbathing and exercise is important for people’s mental health.

The Effects of Urban Green Space on Depressive Symptoms of Mid-Aged and Elderly Urban Residents in China: Evidence from the China Health and Retirement Longitudinal Study

The aim of this study is to assess the impacts of urban green space on depressive symptoms among Chinese urban residents aged 45 and older. In total, 7397 urban respondents were included in this study. Each respondent participated in the China Health and Retirement Longitudinal Study Wave 3 (2015). Environmental-level variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the multilevel regression analysis. Almost one-third of the sample population suffered from depressive symptoms (31.20%). The multilevel logistic regression model showed that green coverage ratio of city-built districts is negatively associated with the prevalence of depressive symptoms among urban mid-aged (OR = 0.79, p < 0.05) and elderly (OR = 0.75, p < 0.05) residents, and the public recreational green space helps to reduce elderly people’s depressive symptoms (OR = 0.77, p < 0.05). This study adds insights about the impact of green space and other environmental factors on depressive symptoms among mid-aged and elderly urban dwellers. It is important to provide enough and accessible overall urban green spaces; additionally, attention should also be paid to specific green space forms such as public recreational green space.

Neighbourhood green space and health disparities in the global South: Evidence from Cali, Colombia

Increasing attention has been given to the role of green space in reducing health disparities. However, robust evidence to support decision making is lacking in the global South. We investigate the relationship between green space and health as well as its underlying mechanism in Cali, Colombia. Results indicate that neighbourhood greenness is associated with enhanced self-rated 'good' health and reduced physical and mental distress. The health benefits of green space appear to be stronger for people living in wealthier neighbourhoods than those in poor neighbourhoods. Results highlight the importance of considering health disparities for future green infrastructure planning in the global South context.

Relationship between Green and Blue Spaces with Mental and Physical Health: A Systematic Review of Longitudinal Observational Studies

There is growing interest in the ways natural environments influence the development and progression of long-term health conditions. Vegetation and water bodies, also known as green and blue spaces, have the potential to affect health and behaviour through the provision of aesthetic spaces for relaxation, socialisation and physical activity. While research has previously assessed how green and blue spaces affect mental and physical wellbeing, little is known about the relationship between these exposures and health outcomes over time. This systematic review summarised the published evidence from longitudinal observational studies on the relationship between exposure to green and blue space with mental and physical health in adults. Included health outcomes were common mental health conditions, severe mental health conditions and noncommunicable diseases (NCDs). An online bibliographic search of six databases was completed in July 2020. After title, abstract and full-text screening, 44 eligible studies were included in the analysis. Depression, diabetes and obesity were the health conditions most frequently studied in longitudinal relationships. The majority of exposures included indicators of green space availability and urban green space accessibility. Few studies addressed the relationship between blue space and health. The narrative synthesis pointed towards mixed evidence of a protective relationship between exposure to green space and health. There was high heterogeneity in exposure measures and adjustment for confounding between studies. Future policy and research should seek a standardised approach towards measuring green and blue space exposures and employ theoretical grounds for confounder adjustment.

The pathways linking objectively-measured greenspace exposure and mental health: A systematic review of observational studies

BACKGROUND

With an increasing volume of research exploring the pathways linking greenspace exposure to mental health, there is a need to synthesise the strength of evidence on the mediation mechanisms. Synthesising the strength of evidence on the pathways can help us better understand how greenspace exposure affects mental health and guide future green space interventions to improve mental health.

PURPOSE

The purpose of this study was to synthesise current evidence on the pathways linking objectively-measured greenspace exposure and mental health using a systematic review approach.

METHODS

Literature searches were conducted in March 2020 from five common databases (i.e., MEDLINE, Embase, PsycINFO, SPORTDiscus, and Web of Science) using search terms of green spaces and mental health. English language and human population were imposed as search limits. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guideline was followed to synthesise and report results.

RESULTS

The initial systematic searches yielded 16,415 records, of which 26 studies met the inclusion criteria. Mixed or non-significant evidence was revealed for the mediating effects of air quality, physical activity, perceived stress, perceived restorativeness, residential noise, social cohesion, and social support on the pathways from greenspace exposure to mental illness. The effect of greenspace exposure on mental well-being was mediated by air quality, perceived stress, and physical activity. In addition, mixed evidence was revealed for the mediating role of social cohesion on the path from greenspace exposure to mental well-being.

CONCLUSIONS

This systematic review highlighted the key pathways linking green spaces to mental well-being via harmful mitigation, psychological restoration, and encouragement of health-related behaviours. Evidence for the pathway between greenspace exposure and mental illness is equivocal at present. Future research is recommended to adopt well-designed longitudinal and experimental studies to establish causal inferences on mental health benefits of greenspace exposure.

Mental Health Outcome Measures in Environmental Design Research: A Critical Review

AIM

During the last several decades, researchers have produced abundant evidence of the environmental impacts on stress, attention, and physical activity. More recently, scholars have turned their focus to the influence environments have on mental wellness. Therefore, a critical review of this more recent research is both timely and crucial for setting the future research agenda.

METHODS

In this article, we examined 65 papers published between 2008 and 2019 that examined the environmental correlates of a wide variety of mental health outcomes. We coded each study by type of environment, research design, mental health measurement scale used, and p-value.

RESULTS

We categorized the research studies into six groups based on mental health outcomes: emotions, moods, vitality, executive function, stress, and general well-being. Our review revealed several trends among the studies, including a heavy focus on nature and outdoor environments with little attention to workplace or residential environments; a lack of consensus on how to operationalize the environment; a heavy reliance on self-reported ratings using a wide variety of scales, many focused on the same outcome; and a disproportionate focus on short-term health effects.

CONCLUSIONS

There is a need for greater consensus on research constructs and health outcome measurements, focused on a wider variety of environmental settings and scales, in order to better inform evidence-based environmental design practice.

How can we analyze environmental health resilience and vulnerability? A joint analysis with composite indices applied to the north of France

In environmental health, vulnerability reflecting the cumulative harmful constraints and nuisances to which populations are subjected and resilience defined as the capacity of a territory to cope with health inequalities have been little extensively investigated together with the same importance. Besides the diversity of factors involved, there is no consensual framework to develop composite indices, one recognized methodology to deal with a multifaceted issue. Therefore, this research aims to establish a new transferable approach to assess the spatial heterogeneity of territorial inequalities. This new strategy relies on the simultaneous evaluation of resilience and vulnerability and the joint analysis based on the cross-interpretation of the spatialized composite indices of resilience and vulnerability. A case study was conducted to demonstrate the feasibility of this methodology, using the municipality as a spatial unit of analysis within a region in the north of France. To provide the most holistic description possible of the 3817 studied municipalities, 50 variables related to the economic, environment, policy, health, services and social dimensions were used to develop the composite indices. The vulnerability Index has a median value of 0.151 with an IQR of [0.126-0.180] and the Resilience Index has a median value of 0.341 with an IQR of [0.273-0.401]. The joint analysis was conducted to classify each municipality among four defined typologies: 1687 municipalities (44.2%) belong to the "To monitor" category, 1646 (43.1%) to the "Resilient" category, 329 (8.6%) to the "Have resources" category and 155 (4.1%) to the "Territorial blackspot" category. The methodology herein may be a diagnostic tool to identify and prioritize municipalities that could benefit from the implementation of specifically tailored public health policies.

Virtual Reality Representations of Nature to Improve Well-Being amongst Older Adults: a Rapid Review

Poor well-being amongst older adults poses a serious health concern. Simultaneously, research shows that contact with nature can improve various facets of well-being, including physical, social, and mental well-being. However, nature is not always accessible for older adults due to mobility restrictions and related care needs that come with age. A promising strategy aims at bringing nature inside through pervasive technologies. However, so far, there is little academic understanding of essential nature characteristics, psychological processes involved, and means for implementation in practice. The current study used a three-folded rapid review to assess current understanding and strategies used for improving well-being for older adults through virtual reality representations of nature. Searches were performed across three databases, followed-up by content-based evaluation of abstracts. In total, a set of 25 relevant articles was identified. Only three studies specifically focus on digital nature as an intervention strategy for improving well-being amongst older adults. Although these studies provide useful starting points for the design and (technological) development of such environments, they do not generate understanding of how specific characteristics of virtual nature representations impact social well-being measures in particular, and of the underlying psychological processes involved. We conclude that follow-up research is warranted to close the gap between insights and findings from nature research, gerontology, health research, and human-technology interaction.

Exploring uncharted territory: Do urban greenspaces support mental health in low- and middle-income countries?

Exposure to urban greenspaces promotes an array of mental health benefits. Understanding these benefits is of paramount importance, particularly in low- and middle-income countries (LMICs), where cities are expanding at an unprecedented rate. However, the existing evidence-base for the health benefits of greenspaces has a strong bias towards high-income countries. Here we systematically assess the emerging evidence regarding the mental health benefits provided by urban greenspaces in LMICs. We carried out a scoping review to assess the extent, type and quality of evidence investigating the relationship between greenspaces and mental health in LMICs. We systematically searched the literature databases Web of Science, Medline, Embase and CAB Abstracts using key terms related to greenspaces and mental health in LMICs. We analysed the resulting studies using a narrative synthesis approach, taking into account study quality, to assess the overall effects on mental health. 36 studies met the inclusion criteria and were included in the narrative synthesis. Studies were heterogeneous in design, study population, greenspace and mental health assessment. While more than 90% of LMICs remain unstudied, we found that eight out of ten studies using validated mental health screening tools detected positive associations between greenspaces and one or more mental health outcomes. These studies mostly took place in upper-middle-income countries. However, there still is a lack of evidence from regions with the highest levels of urbanisation, and only four studies assessed lower-middle and low-income countries. Furthermore, the analysis of mediating and moderating factors indicates that the relationship between greenspaces and mental health in LMICs is context dependent and needs to be assessed in relation to locally relevant environmental and cultural settings. Based on the evidence reviewed here, exposure to urban greenspaces can support multiple mental health outcomes in upper-middle-income countries. However, we still know little about poorer, rapidly urbanising countries. Our findings highlight the need for high-quality, context specific research in those urban areas with the highest levels of urbanisation, and the need to address specific challenges regarding mediating and moderating factors. Future studies should combine robust ecological assessments of greenspaces with validated mental health screening tools.

Heterogeneous Urban Exposures and Prevalent Hypertension in the Helsinki Capital Region, Finland

Urban dwellers are simultaneously exposed to several environmental health risk factors. This study aimed to examine the relationship between long-term exposure to fine particulate matter (PM_2.5, diameter < 2.5 µm) of residential-wood-burning and road-traffic origin, road-traffic noise, green space around participants’ homes, and hypertension. In 2015 and 2016, we conducted a survey of residents of the Helsinki Capital Region to determine their perceptions of environmental quality and safety, lifestyles, and health statuses. Recent antihypertensive medication was used as an indicator of current hypertensive illness. Individual-level exposure was estimated by linking residential coordinates with modelled outdoor levels of wood-smoke- and traffic-related PM_2.5, road-traffic noise, and coverage of natural spaces. Relationships between exposure and hypertension were modelled using multi-exposure and single-exposure binary logistic regression while taking smooth functions into account. Twenty-eight percent of the participants were current users of antihypertensive medication. The odds ratios (95% confidence interval) for antihypertensive use were 1.12 (0.78–1.57); 0.97 (0.76–1.26); 0.98 (0.93–1.04) and 0.99 (0.94–1.04) for wood-smoke PM_2.5, road-traffic PM_2.5, road-traffic noise, and coverage of green space, respectively. We found no evidence of an effect of the investigated urban exposures on prevalent hypertension in the Helsinki Capital Region.

Analytical approaches to testing pathways linking greenspace to health: A scoping review of the empirical literature

BACKGROUND

Inadequate translation from theoretical to statistical models of the greenspace - health relationship may lead to incorrect conclusions about the importance of some pathways, which in turn may reduce the effectiveness of public health interventions involving urban greening. In this scoping review we aimed to: (1) summarize the general characteristics of approaches to intervening variable inference (mediation analysis) employed in epidemiological research in the field; (2) identify potential threats to the validity of findings; and (3) propose recommendations for planning, conducting, and reporting mediation analyses.

METHODS

We conducted a scoping review, searching PubMed, Scopus, and Web of Science for peer-reviewed epidemiological studies published by December 31, 2019. The list of potential studies was continuously updated through other sources until March 2020. Narrative presentation of the results was coupled with descriptive summary of study characteristics.

RESULTS

We found 106 studies, most of which were cross-sectional in design. Most studies only had a spatial measure of greenspace. Mental health/well-being was the most commonly studied outcome, and physical activity and air pollution were the most commonly tested intervening variables. Most studies only conducted single mediation analysis, even when multiple potentially intertwined mediators were measured. The analytical approaches used were causal steps, difference-of-coefficients, product-of-coefficients, counterfactual framework, and structural equation modelling (SEM). Bootstrapping was the most commonly used method to construct the 95% CI of the indirect effect. The product-of-coefficients method and SEM as used to investigate serial mediation components were more likely to yield findings of indirect effect. In some cases, the causal steps approach thwarted tests of indirect effect, even though both links in an indirect effect were supported. In most studies, sensitivity analyses and proper methodological discussion of the modelling approach were missing.

CONCLUSIONS

We found a persistent pattern of suboptimal conduct and reporting of mediation analysis in epidemiological studies investigating pathways linking greenspace to health; however, recent years have seen improvements in these respects. Better planning, conduct, and reporting of mediation analyses are warranted.

Spatial Characteristics of Urban Green Spaces and Human Health: An Exploratory Analysis of Canonical Correlation

In highly urbanized areas, urban green spaces (UGSs) are important natural and cultural entities. Previous studies have shown some evidence of positive relationships between UGSs and human health. Most of these studies relied on self-reported health data and often used institutional quantitative measures of UGSs instead of the spatial characteristics of UGSs. This study analyzed the relationships between the spatial characteristics of UGSs and morbidity of diseases, which were considered variables of human health in the Taipei Metro. The Longitudinal Health Insurance Database of Taiwan was applied as the source of morbidity of diseases. A canonical correlation analysis was performed by using the six variables of spatial characteristics of UGSs as predictors and three variables of morbidity as criterion variables to evaluate the multivariate shared relationships between the two variable sets. The results found a strong canonical correlation between the spatial characteristics of UGSs and human health. Furthermore, the results revealed that living in districts with a higher area percentage of green spaces and denser vegetation cover, as well as exposure to more aggregative and irregular-shape green spaces, can reduce the morbidity of diseases.

Spatial dimensions of the influence of urban green-blue spaces on human health: A systematic review

BACKGROUND

There is an increasing volume of literature investigating the links between urban environments and human health, much of which involves spatial conceptualisations and research designs involving various aspects of geographical information science. Despite intensifying research interest, there has been little systematic investigation of pragmatic methodological concerns, such as how studies are realised in terms of the types of data that are gathered and the analytical techniques that are applied, both of which have the potential to impact results. The aim of this systematic review is, therefore, to understand how spatial scale, datasets, methods, and analytics are currently applied in studies investigating the relationship between green and blue spaces and human health in urban areas.

METHOD

We systematically reviewed 93 articles following PRISMA protocol, extracted information regarding different spatial dimensions, and synthesised them in relation to various health indicators.

RESULTS AND DISCUSSION

We found a preponderance of the use of neighbourhood-scale in these studies, and a majority of the studies utilised land-use and vegetation indices gleaned from moderate resolution satellite imagery. We also observed the frequent adoption of fixed spatial units for measuring exposure to green and blue spaces based on physical proximity, typically ranging between 30 and 5000 m. The conceptual frameworks of the studies (e.g., the focus on physical vs. mental health or the definition of exposure to green space) were found to have an influence on the strength of association between exposure and health outcomes. Additionally, the strength and significance of associations also varied by study design, something which has not been considered systematically.

CONCLUSION

On the basis of our findings, we propose a set of recommendations for standardised protocols and methods for the evaluation of the impact of green-blue spaces on health. Our analysis suggests that future studies should consider conducting analyses at finer spatial scales and employing multiple exposure assessment methods to achieve a comprehensive and comparable evaluation of the association between greenspace and health along multiple pathways.

Associations of exposure to green space with problem behaviours in preschool-aged children

Background

Limited evidence is available regarding the association of green-space exposure with childhood behavioural development. This study aimed to investigate the associations of exposure to green space with multiple syndromes of behavioural development in preschool children.

Methods

This cross-sectional study was conducted in Wuhan, China from April 2016 to June 2018. We recruited a sample of 6039 children aged 5–6 years from 17 kindergartens located in five urban districts of the city. We measured the greenness using average Normalized Difference Vegetation Index (NDVI) within a circular buffer area of 100 metres surrounding the central point of residences and kindergartens. We calculated the residence–kindergarten-weighted greenness by assuming that children spent 16 hours per day at home and 8 hours at kindergarten. The problem behaviours of children were evaluated at kindergarten using the Childhood Behavioral Checklist (CBCL) and standardized into problem behavioural T scores. Linear mixed-effect models and linear-regression models were used to estimate the associations.

Results

We observed decreases in problem behaviours associated with kindergarten and residence–kindergarten-weighted surrounding greenness in preschool children. For example, a one-interquartile range increase in kindergarten and residence–kindergarten-weighted NDVI was associated with decreased T scores for total behaviour by −0.61 [95% confidence interval (CI): −1.09, −0.13) and −0.49 (95% CI −0.85, −0.12), anxiety and depression by −0.65 (95% CI: −1.13, −0.17) and −0.46 (95% CI: −0.82, −0.10), aggressive behaviour by −0.53 (95% CI: −1.01, −0.05) and −0.38 (95% CI: −0.75, −0.02) and hyperactivity and attention deficit by −0.54 (95% CI: −1.01, −0.07) and −0.48 (95% CI: −0.83, −0.12), respectively. Stratified analyses indicated that the associations of green-space exposure with problem behaviours were stronger in boys than in girls.

Conclusions

Children attending kindergartens with higher levels of surrounding green space exhibited better behavioural development. The mechanisms underlying these associations should be explored further.

Facial Expressions of Visitors in Forests along the Urbanization Gradient: What Can We Learn from Selfies on Social Networking Services?

People’s satisfaction towards the experience in forests is one of most important feedbacks that forest park managers need to meet positive visitors’ experiences. Although the drawbacks of questionnaire methodology are obvious for data collection from self-reported scores at the landscape scale, few alternative methods have been proposed. In this study, nine urban forest parks along the urbanization gradients in three capital cities of Northeast China were targeted to investigate their visitors’ selfies from social networking services (SNS) by assessing facial expressions. A total of 935 photos with location records were obtained from the SNS platform of Sina Micro-Blog in a social hot-event of ‘Golden Week Holidays of National Day of China’ of 2017. Images were recognized by FireFace software to assess scores of neutral, happy, sad, angry, surprised, scared, disgusted, and contempt expressions. Data were ranked in descending order and analyzed by Friedman’s test, correlation analysis, and Poisson regression. Visitors in downtown-forests showed fewer negative expressions at the most northern city than at the southern most one. The negative expressions tended to be alleviated with the increasing distance of forest parks from downtown. However, when the distance reached over 10 km no geographical effect was found. Female visitors showed positive emotional expressions to urban forests while male visitors showed no response. In conclusion, using data from SNS, this study found an experience in forest park less than 10 km from the downtown of a northern city resulted in female visitors showing the most positive expressions.

Physical activity and mental health in India: A narrative review

BACKGROUND

Apart from its evident impact on physical health, physical activity also has a role to play in mental health. Individuals engaged in physical inactivity have been found to have higher morbidity and health care expenditure. In order to combat these issues and preserve mental health, interventions of exercise are typically advocated. This review aimed to assess the benefits of physical activity on common and severe mental disorders in the Indian context.

MATERIALS AND METHODS

A Boolean search was carried out using both relevant keywords and MeSH terms. Articles were sourced from online databases including PubMed, ScienceDirect, Cochrane Database, PsycINFO and Google Scholar. All studies included in the review were peer-reviewed articles exclusively from India with Indian subjects reporting the relationship between physical activity and at least one mental health outcome including depression, anxiety, psychosis, stress, self-esteem and cognitive functioning.

RESULTS

Nineteen articles were found eligible for the narrative review. Out of these, 7 were cross-sectional studies and 12 were intervention studies.

CONCLUSION

Existing literature from India has shown promising results towards the impact of physical activity in mental health disorders. However, more research is needed in the assessment of physical activity and physical activity interventions suitable to the Indian context. This review found that exercise and yoga are effective in reducing mean scores for both severe and common mental disorders. Yoga had a more significant impact on patients with schizophrenia than exercise or no intervention. To confirm that exercise is an effective add-on treatment, further research is required.

A Scoping Review Mapping Research on Green Space and Associated Mental Health Benefits

BACKGROUND

There is a growing interest in research investigating the association between green space (GS) and mental health and wellbeing (HWB), in order to understand the underlying mechanisms. Accordingly, there is a need to map the literature and create an overview of the research.

METHODS

A scoping review approach was used to map literature on GS, including context and co-exposures (the GS exposome), and their associations with mental HWB. The review considers mental HWB definitions and measurements and how GS is characterized. Furthermore, the review aims to identify knowledge gaps and make recommendations for future research.

RESULTS

We identified a great diversity in study designs, definitions, outcome measures, consideration of the totality of the GS exposome, and reporting of results. Around 70% of the 263 reviewed studies reported a positive association between some aspect of GS and HWB. However, there is a limited amount of research using randomized controlled crossover trails (RCTs) and mixed methods and an abundance of qualitative subjective research.

CONCLUSIONS

The discords between study designs, definitions, and the reporting of results makes it difficult to aggregate the evidence and identify any potential causal mechanisms. We propose key points to consider when defining and quantifying GS and make recommendations for reporting on research investigating GS and mental HWB. This review highlights a need for large well-designed RCTs that reliably measure the GS exposome in relation to mental HWB.

Long-term exposure to residential green and blue spaces and anxiety and depression in adults: A cross-sectional study

BACKGROUND

Although exposure to natural outdoor environments has been consistently associated with improved perceived general health, available evidence on a protective association between this exposure and specific mental health disorders such as depression and anxiety is still limited.

OBJECTIVE

The aim of this study was to evaluate the effects of long-term exposure to residential green and blue spaces on anxiety and depression and intake of related medication. Additionally, we aimed to explore potential mediators and effect modifiers of this association.

METHODS

The study was based on an existing adult cohort (ALFA - Alzheimer and Families) and includes 958 adult participants from Barcelona recruited in 2013-2014. For each participant residential green and blue exposure indicators [surrounding greenness (NDVI), amount of green (land-cover) and access to major green spaces and blue spaces] were generated for different buffers (100m, 300m and 500m). Participants reported their history of doctor-diagnosed anxiety and depressive disorders and intake of related medication. Logistic regression models were applied to assess the corresponding associations.

RESULTS

Increasing surrounding greenness was associated with reduced odds of self-reported history of benzodiazepines [e.g. Odds ratio - OR (95%CI) = 0.62 (0.43, 0.89) for 1-interquartile range (IQR) increase in NDVI in a 300m buffer] and access to major green spaces was associated with self-reported history of depression [OR (95%CI) = 0.18 (0.06, 0.58)]. No statistically significant associations were observed with blue spaces. Air pollution (between 0.8% and 29.6%) and noise (between 2.2% and 5.3%) mediated a proportion of the associations observed, whereas physical activity and social support played a minor role.

CONCLUSION

Our findings suggest a potential protective role of green spaces on mental health (depression and anxiety) in adults, but further studies, especially longitudinal studies, are needed to provide further evidence of these benefits and of the mediation role of exposures like air pollution and noise.