What Types of Greenspaces Are Associated with Depression in Urban and Rural Older Adults? A Multilevel Cross-Sectional Study from JAGES

Different types of greenspace within urban parks and depressive symptoms among older U.S. adults living in urban areas

Access to greenspace in the form of urban parks is frequently used to study the mental health benefits of nature and may alleviate depression. However, there is a lack of research that considers the different types of vegetated and non-vegetated spaces that parks can provide. Our aim was to investigate whether different types of accessible park area, grassy; tree covered; and non-vegetated, were associated with depressive symptoms among older (≥50 years) urban US adults. We used interviews from the Health and Retirement Study spanning 2010 through 2016 as our primary data source. We calculated total grassy, tree covered, and non-vegetated park space accessible to participants using a comprehensive national database of US parks and a high resolution (10 m) landcover dataset. To measure depressive symptoms, we used the CESD-8 analyzed as a continuous scale. We used Poisson regression to estimate the percent difference in CESD-8 scores comparing quartiles of accessible park space. To control for confounding, we adjusted for sociodemographic characteristics, geography, and climate. Aggregated accessible park area was not substantively associated with depressive symptoms. However, having grassy park area near the home was associated with as much as 27 % fewer depressive symptoms. In contrast, non-vegetated park area was associated with up to 54 % more depressive symptoms. Our findings were robust to adjustment for air pollution, environmental noise, and artificial light at night. Different types of accessible park space may have disparate effects on mental health among older urban US adults.

Quantifying physiological health efficiency and benefit threshold of greenspace exposure in typical urban landscapes

Although greenspace exposure has physiological health benefits, there is insufficient research on the threshold effect of health benefits in typical urban landscapes. Here we selected five typical urban landscapes (open greenspace, semi-closed greenspace, closed greenspace, bluespace, grey space) in 15 urban parks in Xiamen, China, and applied the physiological health threshold model to calculate the efficiency threshold and benefit threshold of greenspace exposure by continuously monitoring the changes of two physiological indicators-electroencephalography (EEG) and heart rate (HR). (1) The EEG threshold results show that compared with greenspace exposure, bluespace exposure can reach the physiological health efficiency threshold faster (4-5 min) but does not show an advantage in terms of benefit threshold. The more open the greenspace, the faster it can reach the efficiency threshold (5-6 min), but the higher the canopy density of the (closed) greenspace, the shorter the time to reach the efficiency threshold (8-9 min). (2) The HR threshold shows that bluespace and open greenspace are the fastest to reach the efficiency threshold (1 min), with the remaining greenspace reaching it after 6-7 min. The benefit threshold was reached faster in the bluespace (11 min) than in the greenspace (18-21 min), and the degree of openness of the greenspace has no significant effect on the speed of benefit thresholds. (3) Combining the results of EEG and HR thresholds, it can be seen that bluespace is better at reducing stress, while open greenspace can reach efficiency thresholds more quickly. This study confirms the physiological health threshold model, offering a reference for urban greenspace planning to enhance residents' stress management and health.

Measuring Greenspace in Rural Areas for Studies of Birth Outcomes: A Comparison of Street View Data and Satellite Data

Using street view data, in replace of remotely sensed (RS) data, to study the health impact of greenspace has become popular. However, direct comparisons of these two methods of measuring greenspace are still limited, and their findings are inconsistent. On the other hand, almost all studies of greenspace focus on urban areas. The effectiveness of greenspace in rural areas remains to be investigated. In this study, we compared measures of greenspace based on the Google Street View data with those based on RS data by calculating the correlation between the two and evaluating their associations with birth outcomes. Besides the direct measures of greenness, we also compared the measures of environmental diversity, calculated with the two types of data. Our study area consists of the States of New Hampshire and Vermont, USA, which are largely rural. Our results show that the correlations between the two types of greenness measures were weak to moderate, and the greenness at an eye-level view largely reflects the immediate surroundings. Neither the street view data- nor the RS data-based measures identify the influence of greenspace on birth outcomes in our rural study area. Interestingly, the environmental diversity was largely negatively associated with birth outcomes, particularly gestational age. Our study revealed that in rural areas, the effectiveness of greenspace and environmental diversity may be considerably different from that in urban areas.

Living in public rental housing is healthier than private rental housing a 9-year cohort study from Japan Gerontological Evaluation Study

Housing tenure is an important aspect to determine health. However, even though renters tend to have more socioeconomic disadvantages than homeowners, mortality risk between private and public renters compared with homeowners remains unclear. Japanese public rented housing, such as the Urban Renaissance Agency, has been developed for supplying an adequate living environment since 1950s. This study aimed to examine the mortality risk among older Japanese residents living in private and public rented houses compared with those living in owner-occupied houses using 9-year follow-up data. This study drew upon a 9-year follow-up of participants in the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese independent adults aged ≥ 65 years. Mortality from 2010 to 2019 was analyzed for 44,007 respondents. Housing tenure was defined by a questionnaire. Cox regression models were used for calculating the hazard ratio for mortality. Bonferroni correction was used to account for multiple testing between rental houses. Overall, 10,638 deaths occurred during the follow-up period. Compared with housing owners, all rental housing groups had a significantly higher risk of mortality. Among renters, participants who lived in public rental housing had the lowest risk of mortality even after adjusting for sociodemographic characteristics, health status, social status, and environmental status. Multiple testing among renters with Bonferroni correction showed that public renters had 0.80 times (95% CI 0.72-0.89) lower mortality risk than private renters. Although Japanese older adults living in public rental housing had a higher mortality risk than homeowners, this risk was lower than that among private renters. A positive neighborhood environment based on well-planned urban development may have contributed to this result. The results suggest that planned urban development lowers the risk of mortality in older renters in Japan.

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.

Does the neighborhood built and social environment reduce long-term care costs for Japanese older people? The JAGES2010-2019 cohort study

Japan's population has been aging steadily, evidenced by it spending JPY 11 trillion (USD 110 billion) on annual long-term care (LTC) costs in 2021. In this context, understanding the factors influencing LTC costs has become increasingly vital. Although studies have reported positive relationships between neighborhood environment and health outcomes, the connection between LTC costs and neighborhood environment remains unclear. To address this gap in the literature, this cohort study, conducted from 2010 to 2019 across seven Japanese municipalities and involving 34,982 older people, examined the relationship between eight neighborhood environment elements and the mean monthly cumulate costs (MMCC) of LTC. The results showed that older people who reported the presence of fresh food stores nearby and dangerous places for walking alone at night in the neighborhood had lower MMCC, by JPY 1,367.6 and 1,383.3 per month, respectively, than respondents who did not report the presence of these neighborhood elements. Meanwhile, older people whose neighborhoods had easily accessible facilities had higher MMCC of JPY 739.4. This study's key findings reveal significant relationships between neighborhood environment elements and LTC costs and can be used to support developments in urban design to support healthy aging and reduced LTC costs.

Built Environments and Frailty in Older Adults: The JAGES Longitudinal Study Using Mediation Analysis

OBJECTIVES

The purpose of this study was to investigate the association between subjective built environment and the onset of frailty in older adults living in the community. In addition, we examined whether daily walking time, depressive symptoms, and social support from neighbors and friends are mediating factors.

DESIGN

This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study.

SETTING AND PARTICIPANTS

Participants included 38,829 older adults who were not frail recruited from 22 cities and towns.

METHODS

The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were 5 items for the subjective built environment. The mediating variables were walking time of at least 30 minutes per day, a Geriatric Depression Scale (GDS) score of at least 5 points, and social support from neighbors and friends. We performed a causal mediation analysis of mediating effects between each built environment and frailty onset. Furthermore, the proportion of mediation was estimated.

RESULTS

After 3 years of follow-up, frailty emerged in 2232 adults (6.7%) in 2016. Access to parks and sidewalks, access to fresh food stores, houses or facilities where people feel free to drop in, and fascinating views, or buildings reduced the onset of frailty. Mediators significantly associated with the built environment and onset of frailty were access to parks and sidewalks (walking time: 5.9%, GDS: 22.9%, social support: 5.9%), access to fresh food stores (GDS: 31.9%, social support: 4.0%), hills and steps (GDS: 20.6%), houses or facilities where people feel free to drop in (walking time: 4.0%, GDS 28.0%, social support: 10.4%), and fascinating views, or buildings (walking time: 7.8%, GDS: 42.1%, social support: 12.0%).

CONCLUSIONS AND IMPLICATIONS

We found that walking time, depression, and social support were mediating factors in the relationship between built environment and the onset of frailty.

Immersive virtual reality as support for the mental health of elderly women: a randomized controlled trial

Several forms of virtual reality (VR) have shown promise in treating mental disorders. However, there is a lack of research investigating the use of multicomponent immersive VR. Therefore, this study aimed to evaluate the effectiveness of an immersive virtual reality (IVR) intervention that incorporated Japanese garden aesthetics, relaxation, and elements of Erickson's psychotherapy in alleviating depression and anxiety symptoms among elderly women. Sixty women with depressive symptoms were randomly assigned to one of two treatment groups. Both groups received eight (twice a week for four weeks) low-intensity general fitness training sessions. The IVR group (n = 30) received eight additional VR-based relaxation sessions, whereas the control group (n = 30) received eight group relaxation. As outcome measures, the geriatric depression scale (GDS; primary) and Hospital Anxiety and Depression Scale (HADS; secondary) were administered before and after the interventions. The protocol was registered in the ClinicalTrials.gov PRS database (Registration number: NCT05285501). Patients receiving IVR therapy exhibited a greater significant reduction in the GDS (adjusted mean post-difference of 4.10; 95% CI = 2.27-5.93) and HADS (2.95; 95% CI = 0.98-4.92) scores than those receiving the control intervention. In conclusion, IVR with elements of psychotherapy, relaxation, and garden aesthetics may alleviate the severity of depression and anxiety symptoms in elderly women.

Residential greenness and air pollution concerning excessive gestational weight gain during pregnancy: A cross-sectional study in Wuhan, China

BACKGROUND

Previous studies have indicated that exposure to residential greenness may benefit the health status of pregnant women, and air pollution may exert a mediating effect. Gestational weight gain (GWG) is an important indicator of pregnant women and fetuses' health and nutrition status. However, evidence concerning the impact of residential greenness on excessive gestational weight gain (EGWG) is scarce, and to what extent air pollution in urban settings mediates this relationship remains unclear.

OBJECTIVE

This study aims to explore the association of residential greenness with EGWG, consider the mediating effect of air pollution, and estimate the combined impact of residential greenness and air pollution exposures on EGWG.

METHOD

This population-based cross-sectional study involved 51,507 pregnant women with individual-level data on residential addresses in the Wuhan Maternal and Child Health Management Information System. Two spectral indexes, the normalized difference vegetation index (NDVI) and soil-adjusted vegetation index (SAVI), were used to proxy residential greenness. The air pollution data included six indicators (PM_2.5, PM₁₀, SO₂, CO, NO₂, O₃) and used the Ordinary Kriging interpolation method to estimate overall pregnancy exposure to air pollutants. Generalized linear mixed regression models were utilized to explore the relationship between residential greenness and EGWG. Restricted cubic spline (RCS) models were developed to examine the dose-response relationships. Mediation analyses explored the potential mediating role of air pollution in the residential greenness-EGWG associations. Finally, the weighted-quantile-sum (WQS) regression model was used to investigate the association between residential greenness-air pollutants co-exposure and EGWG.

RESULT

Among all participants, 26,442 had EGWG. In the adjusted model, the negative association was found significant for NDVI_100-m, NDVI_200-m, and NDVI_500-m with EGWG. For example, each IQR increase in NDVI_100-m was associated with 2.8% (95% CI: 0.6-5.0) lower odds for EGWG. The result of WQS regression showed that, when considering the six air pollutants and NDVI_-100m together, both positive and negative WQS indices were significantly associated with EGWG, PM₁₀, PM_2.5, with SO₂ having significant weights in the positive effect direction and CO, O₃, NO₂, and NDVI_100-m having a negative effect. Our results also suggested that SO₂, NO₂, PM₁₀, PM_2.5, and CO significantly mediated the association between NDVI_-100m and EGWG, and our estimates were generally robust in the sensitivity analysis.

CONCLUSION

Exposure to a higher level of residential greenness is associated with a reduced risk of EGWG, in which air pollution may exert a mediating effect. Pregnant women might benefit more in gaining healthy gestational weight when greenness levels increase from low to medium than from medium to high. Given the current cross-sectional study design, large-sale prospective cohort studies are needed to confirm our findings further.

Built environments and frailty in older adults: A three-year longitudinal JAGES study

BACKGROUND

This study investigated the relationship between built environments and the onset of frailty after 3 years.

METHODS

This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study on 38,829 older adults nested in 562 comunnities who were not frail. The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were eight items for the built environment at the individual and community levels. To consider each level of built environment simultaneously, multilevel Poisson regression analysis was used to calculate risk ratios and 95% confidence intervals.

RESULTS

After 3 years of follow-up, the onset of frailty was 2740 (7.1%) in 2016. At the individual level, there was an increased risk of developing frailty in negative built environments, such as locations with graffiti or garbage (incidence rate ratio (IRR), 1.15; confidence interval (CI), 1.05-1.25). Positive built environments, such as areas with access to parks and sidewalks (IRR, 0.78; CI, 0.70-0.88), lowered the risk of developing frailty. At the community level, the risk of developing frailty was lower only in areas with locations difficult for walking (hills or steps) (IRR, 0.97; CI, 0.94-0.99).

CONCLUSIONS

At the individual level, frailty onset was associated with all built environments. However, irrespective of their answers, there was a lower risk of developing frailty among older adults living in areas where walking was difficult. It would be desirable to verify whether the risk of developing frailty can be reduced by changing the built environment.

Urban Green Space and Subjective Well-Being of Older People: A Systematic Literature Review

A growing number of articles have identified and reported the benefits and importance of urban green spaces for improving human well-being, but there is a significant knowledge gap regarding the impact of urban green spaces on the subjective well-being of older adults. The literature search (August 2015-August 2022) was derived from two major scientific databases, Google Scholar, and Web of Science. As a result, 2558 articles were found, 1527 of which were retrieved from WOS and the rest from Google Scholar. Bibliometric methods and VOSviewer software were used to screen and organize the articles in the relevant fields. Finally, 65 articles met the review criteria. The included studies aim to capture the benefits of various features of urban green spaces in meeting or enhancing the subjective well-being needs of older adults. The results of our review further support the existence of a strong link between older adults' subjective well-being and various features of urban green spaces, providing new insights for future in-depth reexamination and policy development. Furthermore, the relationship between urban green spaces and older adults' subjective well-being depends not only on the urban green spaces themselves but also on the characteristics of the older adult population that uses them.

Long-term exposure to residential surrounding greenness and incidence of diabetes: A prospective cohort study

Exposure to residential greenness might affect population health through increasing physical activity and social engagement, improving mental health, and reducing harmful environmental exposure. However, evidence on the association of greenness with risk of diabetes is still controversial. In this study, we recruited a total of 22,535 participants aged ≥18 years from Yinzhou District, Ningbo, Zhejiang Province, China to investigate the associations between residential greenness and risk of diabetes incidence. Residential greenness was estimated using Normalized Difference Vegetation Index (NDVI), Enhanced Vegetation Index (EVI), and Vegetation Continuous Field (VCF). We also calculated cumulative average NDVI, EVI and VCF values, and changes in NDVI, EVI and VCF during the follow-up period. We used Cox proportional hazards models controlling for demographic characteristics, lifestyles, individual socioeconomic status, history of diseases and particulate matter with an aerodynamic diameter ≤2.5 μm (PM_2.5) to examine hazard ratios (HRs) and 95% confidence intervals (95% CIs) and assessed physical activity, body mass index (BMI) or PM_2.5 as potential mediators. During 84,992.64 person-years of follow-up, a total of 1,154 incident cases of diabetes occurred. In multivariable models, living in the highest quartile of cumulative average NDVI, EVI and VCF within 250-m buffer was associated with 57% (HR = 0.43, 95% CI: 0.36, 0.52), 62% (HR = 0.38, 95% CI: 0.32, 0.45), and 55% (HR = 0.45, 95% CI: 0.38, 0.54) reduction in diabetes risk compared with the lowest quartile, respectively. Results remained similar for NDVI, EVI, and VCF within 500-m and 1000-m buffers. Stratified analyses showed stronger association for residential greenness and diabetes among older people. The association between greenness and diabetes did not appear to be mediated by physical activity, PM_2.5 or BMI. Our findings suggested that higher residential greenness was significantly associated with lower risk of diabetes.

Neighborhood-level socioeconomic factors moderate the association between physical activity and relative age effect: a cross-sectional survey study with Japanese adolescents

BACKGROUND

Relative age effect is defined as a phenomenon where children born early generally perform better than children born later in the same cohort. Physical activity is an important factor that might be influenced by the relative age effect. Socioeconomic factors (e.g., parent's income, education level) are also associated with the adolescent's physical activity. However, no existing study has examined whether socioeconomic factors moderate the relative age effect on the adolescent's physical activity. This study aims to clarify whether and how birth month and socioeconomic factors relate to organized sports and physical activity among adolescents in Japan.

METHODS

We conducted a questionnaire survey targeting 21,491 adolescents who live in a widespread neighborhood. We included 8102 adolescents (4087 males and 4015 females: mean age 13.1 ± 1.4) in the analysis. Based on the participants' birth months, we divided them into four groups (April to June, July to September, October to December, January to March). We asked participants to report their organized sports participation. Using the International Physical Activity Questionnaire for Japanese Early Adolescents, we identified their moderate to vigorous physical activity (MVPA). Neighborhood-level socioeconomic factors (areal deprivation, average annual income, education level) were analyzed based on national surveys, such as the population census. We performed multilevel logistic and linear regression analysis for organized sports participation and MVPA, respectively. Moreover, a simple slope analysis was implemented if the interaction between birth month and socioeconomic factor was significant in the multilevel linear regression analysis.

RESULTS

Among males, relatively younger adolescents (adolescents who were born later in the same grade) were less likely to participate in organized sports activites (OR=0.90, 95% CI 0.82-0.97, p<0.05), while both males and females engaged in less MVPA (b=-0.54, b=-0.25, p< 0.01, respectively). We observed an interaction between birth month and socioeconomic factors. Among males in low-income neighborhoods, and females in more deprived neighborhoods, relatively younger adolescents engaged in less MVPA.

CONCLUSIONS

Socioeconomic factors moderate the relative age effect on adolescents' physical activity. The relative age effect on adolescents' physical activity might be more likely to appear among adolescents from socioeconomically disadvantaged neighborhoods.

The association between street connectivity and depression among older Japanese adults: the JAGES longitudinal study

Mental health is important in older age; neighborhood environment is considered a protective factor of depression. Research has established that a critical indicator of neighborhood environment, street connectivity, is related to older people's health. However, little is known about the relationship between street connectivity and depression. We examined the relationship between street connectivity and depression among older people. Using Japan Gerontological Evaluation Study 2013-2016, the target population comprised 24,141 independent older people without depression (Geriatric Depression Scale scores below 5) in 2013. The outcome variable was depression in 2016; the explanatory variable was street connectivity calculated by intersection density and space syntax within 800 m around the subject's neighborhood in 2013. We used logistic regression analysis to calculate the odds ratio and 95% confidence interval for the new occurrence of depression among participants in 2016. This analysis demonstrated incidence of new depression after 3 years that is 17% and 14% lower among participations living in high-intersection density and high-street-connectivity areas, respectively, than those living in low-intersection density and low-street-connectivity areas. The association held after adjusting for physical activities and social interaction. Given the established connection between street connectivity and mental health, the findings can contribute to healthy urban planning.

Residential green space and mental health-related prescription medication sales: An ecological study in Belgium

BACKGROUND

Residential green space has been associated with mental health benefits, but how such associations vary with green space types is insufficiently known.

OBJECTIVE

We aimed to investigate associations between types and quantities of green space and sales of mood disorder medication in Belgium.

METHODS

We used aggregated sales data of psycholeptics and psychoanaleptics prescribed to adults from 2006 to 2014. Generalized mixed effects models were used to investigate associations between relative covers of woodland, low-green, grassland, and garden, and average annual medication sales. Models were adjusted for socio-economic background variables, urban-rural differences, and administrative region, and included random effects of latitude and longitude.

RESULTS

Urban census tracts were associated with 9-10% higher medication sales. In nationwide models, a 10% increase in relative cover of woodland, garden, and grass was associated with a 1-2% decrease in medication sales. The same association was found for low green but only for men. In stratified models, a 10% increase in relative cover of any green space type in urban census tracts was associated with a decrease of medication sales by 1-3%. In rural census tracts, no protective associations between green space and mood disorder medication sales were observed, with the exception of relative woodland cover for women (-1%), and low green was associated with higher medication sales (+6-7%).

CONCLUSIONS

Taken together, these results suggest that living in green environments may be beneficial for adult mental health. Woodland exposure seemed the most beneficial, but the amount of green space was more important than the type. Results underline the importance of conserving green space in our living environment, for the conservation of biodiversity and for human health.

The impact of restorative green environment on mental health of big cities and the role of mental health professionals

PURPOSE OF REVIEW

To provide an update on insights into the effectiveness of the green environment and forest on the mental health of city dwellers; and the role of mental health professionals in advocating green restorative therapies.

RECENT FINDINGS

The studies reviewed in this paper confirmed the mental health benefits on individuals who engaged in the green environment and forest. Results of studies showed that the participants reported significantly higher positive effects. However, it is difficult to compare studies because of marked differences in methodology and often lack of biological markers. With the recent global concern about climate warming, mental health professionals have a critical role to influence city planners on the importance of the green environment and the forest. In Singapore, the 'Therapeutic Garden' project and 'Therapeutic Rainforest' program are examples of mental health professionals working with government agencies for a 'city in nature'.

SUMMARY

The benefits of the green environment and forest are emphasized especially on the psychological well being. In the light of the danger of climate warming, this review highlights the need for city planners to collaborate with mental health professionals to incorporate high-quality green spaces when planning the city of the future. There is an urgent need for better consultation between health agencies and local city government to create an appealing and diverse green environment within the city.

Association Between Natural/Built Campus Environment and Depression Among Chinese Undergraduates: Multiscale Evidence for the Moderating Role of Socioeconomic Factors After Controlling for Residential Self-Selection

Aim

Evidence on the association between natural-built environments and depression is largely derived from the general population and prone to residential self-selection bias because of the nature of cross-sectional research design. Despite emerging adulthood, which includes the university years, is a critical stage for forming life-long health habits, studies on this topic focusing on undergraduate students are limited. The current study aims to illustrate the underlying mechanisms for how the campus-based environments affect depression in undergraduate students.

Methods

Based on a nationwide representative analytical sample of 22,009 Chinese undergraduates in 2018, we examined participants' reports of depression and campus-centered natural/built environments within multiple buffer sizes including 0.5, 1.0, and 2.5 km. After disentangling residential self-selection, we explored the moderating role of the socioeconomic attributes of undergraduates. The depression outcome was measured by the nine-item Patient Health Questionnaire (PHQ9). Indicators of exposure to green and blue space, transportation infrastructure, and food environments were objectively assessed using different circular buffers around each campus address.

Results

Modeling results indicated that campus neighborhoods with more scattered trees (0.5 km), water (0.5, 1.0, and 2.5 km), and street intersections (1.0 and 2.5 km) were protective against depression. In contrast, those living near denser distributions of outlets serving take-away sweets and fast food (0.5, 1.0, and 2.5 km) were susceptible to depression. These associations were modified by undergraduates' socioeconomic attributes (e.g., grade, Hukou status, and ethnicity) and varied according to geographical scales and exposure metrics.

Conclusion

To deliver effective environmental interventions to curb the prevalence of depression among undergraduate students, further planning policies should focus on the careful conception of the campus-based environment, especially regarding different spatial scales.

Remote Support of Elderly Women Participating in Mental Health Promotion Programme during the COVID-19 Pandemic: A Single-Group Longitudinal Intervention

The aim of the study was to evaluate the longitudinal changes in mental well-being during the switch of the intervention from a personal contact to a remotely delivered Mental Health Prevention and Promotion Programme in elderly women at high risk of developing depression. The study included 70 women aged over 60 with a mean age of 72.28 years. In order to determine mental well-being, the Geriatric Depression Scale (GDS) was used at four time points: January, April, September and December 2020. A self-developed questionnaire was used to determine predictors of mental well-being. Two-way ANOVA demonstrated a lack of significant differences between the means in the GDS scores at the four data collection time points (p = 0.21). Frequent use of green areas reduced the GDS score on average by 1.52 points (p = 0.01), while owning a garden by 1.51 points (p = 0.04). The illness of a family member increased the GDS score by an average of 1.7 points (p = 0.02). No significant mood deterioration was found between January 2020 and December 2020 in the studied group of elderly women at a high risk of developing depression, which suggests that the remote support provided in the mental health promotion programme was effective.

Systematic review of quantitative studies assessing the relationship between environment and mental health in rural areas

OBJECTIVE

Physical and natural environments might strongly influence mental health and well-being. Many studies have examined this relationship in urban environments, with fewer focused on rural settings. The aim of this systematic review was to synthesise quantitative evidence for the relationship between environmental factors (drought, climate and extreme weather events, land use/environmental degradation, green space/vegetation, engagement in natural resource management activities) and mental health or well-being in rural areas.

DESIGN

Following a systematic search of three databases (PsycINFO, MEDLINE and Web of Science), 4368 articles were identified, of which 28 met eligibility criteria for inclusion in the review.

RESULTS

Poorer mental health and well-being was typically found to have an association with extreme climate or weather events and environmental degradation. The observed relationships were largely assessed at area-wide or community levels.

CONCLUSIONS

Studies examining the relationship between the environmental condition of land and mental health at an individual level, particularly within farms, are lacking. Addressing this gap in research requires interdisciplinary expertise and diverse methodology. Few studies examined the effects of natural resource management practices/principles or biodiversity on mental health. While there is evidence that extreme climate or weather events have a negative impact on mental health in rural areas, there remain considerable gaps in our knowledge of how rural environments influence mental health and well-being.

Achievements and Challenges of Social Epidemiology Research Aiming to Reduce Health Inequality: A Revised English Version of Japanese in the Journal of the Japan Medical Association 2020;149(9):1626-30

Health inequalities are defined as "gaps in health status between groups, which are created by differences in community or socioeconomic status." In response to the General Assembly Resolution (2009) of the World Health Organization, the World Medical Association issued a statement in the same year, and the Japanese health policy "Health Japan 21 (second term)" indicated a "reduction of health inequalities" as the basic direction. In 2000, we described the presence of health inequalities in Japan, which was regarded as a relatively egalitarian country. This was the starting point of the Japan Gerontological Evaluation Study. It was developed into large longitudinal studies that reveal the significance of "social determinants of health" that cause health inequalities. We verified the feasibility and effects of healthy aging policies by fostering social capital through community intervention studies. These findings and knowledge have been translated into municipal and central government policies. Here we review what has been achieved and the remaining challenges in more than 20 years of social epidemiological research.

Green Space Quality and Health: A Systematic Review

(1) Background: As cities densify, researcher and policy focus is intensifying on which green space types and qualities are important for health. We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health outcomes. (2) Methods: We searched five databases from inception up to June 30, 2021. We included all studies examining a wide range of green space characteristics on various health outcomes. (3) Results: 68 articles from 59 studies were found, with a high degree of heterogeneity in study designs, definitions of quality and outcomes. Most studies were cross-sectional, ecological or cohort studies. Environment types, vegetation types, and the size and connectivity of green spaces were associated with improved health outcomes, though with contingencies by age and gender. Health benefits were more consistently observed in areas with greater tree canopy, but not grassland. The main outcomes with evidence of health benefits included allergic respiratory conditions, cardiovascular conditions and psychological wellbeing. Both objectively and subjectively measured qualities demonstrated associations with health outcomes. (4) Conclusion: Experimental studies and longitudinal cohort studies will strengthen current evidence. Evidence was lacking for needs-specific or culturally-appropriate amenities and soundscape characteristics. Qualities that need more in-depth investigation include indices that account for forms, patterns, and networks of objectively and subjectively measured green space qualities.

Green space and suicide mortality in Japan: An ecological study

Although numerous studies have investigated the effect of green space on mental health, as yet, little is known about the association between green space and suicide. To address this deficit, we conducted the first Japan-wide study of the relationship between green space and suicide mortality. Results from spatial analyses of municipality-level panel data for the 1975-2014 period that included 886,440 suicide deaths with a fixed-effect estimator showed that green space was associated with suicide mortality, and that this relationship was conditioned by the form of greenness, level of urbanity and demographic characteristics. In densely populated cities, park density (parks per 1000 of the population) was associated with reduced suicide mortality among females aged 18 and above and among males aged 18 to 39 and aged 65 and above. In small- and medium-sized cities, park coverage (% by area) was linked to fewer suicide deaths among middle-aged and older females (aged 40 and above). In contrast, in non-cities (rural areas), parks were not associated with suicide mortality whereas woodland coverage (% by area) was linked to reduced suicide deaths among middle-aged and older males (aged 40 and above). Our findings suggest that urban green space and rural forest coverage may have a protective effect against self-harming behavior. Future suicide prevention efforts should consider an increased greening of the residential environment in terms of both availability and accessibility, especially with better designs that accommodate population needs and local conditions.

Association between Proximity of the Elementary School and Depression in Japanese Older Adults: A Cross-Sectional Study from the JAGES 2016 Survey

Depression among older adults is one of the most critical public health issues. The proximity of elementary schools has been positively associated with neighborhood social cohesion and quality of life. However, no studies have identified an association between the proximity of elementary school and older adults' mental health. Therefore, this study aimed to examine the association between the proximity of elementary schools, one of the core facilities of neighborhood communities in Japan, and depression in older adults. A total of 131,871 participants (63,430 men 73.7 ± 6.1 years, 68,441 women 73.8 ± 6.2 years) were analyzed from the Japan Gerontological Evaluation Study (JAGES) 2016 survey. Logistic regression analysis showed that there was no association between distance to elementary school and depression among males. However, among females, compared with the participants living within 400 m from the nearest elementary school, the odds ratio of depression for those living between 400 and 799 m and more than 800 m away were 1.06 (95% confidence interval (CI) 1.00-1.12) and 1.07 (95% CI 1.00-1.15), respectively. The findings may be useful when considering the design of communities around elementary schools and the planning of facilities as a population-based approach to promote mental health of older women.