Are Rurality, Area Deprivation, Access to Outside Space, and Green Space Associated with Mental Health during the COVID-19 Pandemic? A Cross Sectional Study (CHARIS-E)

Exploration of the COVID-19 mental health implications in elite disabled athletes

The COVID-19 pandemic influenced the way individuals conducted their lives, with consequences relating to mental health deterioration. Whilst researchers explored this outcome in the general population and athletic populations, less focus was on athletes with disabilities. The aim of this study was to investigate how the pandemic influenced the mental health of elite para-athletes in the United Kingdom. Nine elite-level athletes with disabilities participated in semi-structured interviews. Three broad themes were interpreted from the data using reflexive thematic analysis, two themes reflected the negative impact of COVID-19 on mental health and one theme reflected positive outcomes of the pandemic. Athletes explained that losing face-to-face interactions and delays in major sporting events were significant factors in their mental health decline. This population group reported different challenges to able-bodied communities. Differences included increased susceptibility to contract the virus, difficulties in communication where face masks and online interactions became necessary and perceptions of vulnerability relating to shielding protocols. Finally, positive outcomes related to the additional time to recover, to prepare for major events and time to reassess their values. Exploring experiences of a pandemic on this population group warrants further exploration to enhance the effectiveness of mental health support services in para-sporting organisations.

Associations of role, area deprivation index, and race with health behaviors and body mass index among localized prostate cancer patients and their partners

PURPOSE

To examine the associations of role (localized prostate cancer (PCa) patient vs. their intimate partner), area deprivation index (ADI-higher scores indicating higher neighborhood deprivation levels), and race (Black/African American (AA) vs. White) with health behaviors and body mass index (BMI) among PCa patients and partners. The behaviors include smoking, alcohol consumption, diet quality, sedentary behaviors, and physical activity (PA).

METHODS

This study used the baseline data collected in a clinical trial. Given the nested structure of the dyadic data, multi-level models were used.

RESULTS

Significant role-race interaction effects on smoking, ADI-race effects on alcohol consumption, and role-ADI effects on BMI were found. Meanwhile, patients smoked more cigarettes, decreased alcohol consumption, had less healthful diets, spent longer time watching TV, did fewer sedentary hobbies, had more confidence in PA, and had higher BMIs than their partners. High ADI was independently associated with lower odds of drinking alcohol, using computer/Internet, and doing non-walking PA, and higher BMI compared to low ADI controlling for role and race. Black/AA dyads had less smoking amount and alcohol consumption and higher sedentary time and BMI than White dyads when adjusted for role and ADI.

CONCLUSIONS

This study identified significant interaction and main effects of role, ADI, or race on health behaviors and BMI.

IMPLICATIONS FOR CANCER SURVIVORS

Future behavioral interventions should address divergent individual needs between patients and partners, social and neighborhood barriers, and cultural indicators of racial groups to promote healthful behaviors and improve the quality of survivorship for PCa patients and partners.

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

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

Relationship between Environmental Conditions and Utilisation of Community-Based Mental Health Care: A Comparative Study before and during the COVID-19 Pandemic in Italy

(1) Background: Lower socioeconomic status increases psychiatric service use, exacerbated during the COVID-19 pandemic by environmental stressors like air pollution and limited green spaces. This study aims to assess the influence of sociodemographic and environmental factors on mental health service utilisation. (2) Methods: This retrospective study uses an administrative database focusing on community mental health services in Northeast Italy. Spatial and temporal analyses were used to address space-time dependencies. (3) Results: Findings showed that sociodemographic factors like living in rented apartments and lower education levels predicted higher mental health service use. Environmental factors, such as elevated NO2 levels and, before the pandemic, lower solar radiation and tree cover, correlated with increased service utilisation. COVID-19 reduced most of the pre-existing differences associated with these factors across census blocks with a different composition of sociodemographic and environmental factors. (4) Conclusions: These findings contribute to a better understanding of the impact of the environment on public mental health.

Current methodologies of greenspace exposure and mental health research-a scoping review

Introduction

Greenspaces can provide an important resource for human mental health. A growing body of literature investigates the interaction and the influence of diverse greenspace exposures. In order to gain a comprehensive understanding of the complex connection between greenspace and mental health, a variety of perspectives and methodological combinations are needed. The aim of this review is to assess the current methodologies researching greenspace and mental health.

Methods

A scoping review was conducted. Four electronic databases (Pubmed, Embase, PsycInfo, Web of Science) were searched for relevant studies. A wide range of greenspace and mental health keywords were included to provide a comprehensive representation of the body of research. Relevant information on publication characteristics, types of greenspaces, mental health outcomes, and measurements of greenspace exposure and mental health was extracted and assessed.

Results

338 studies were included. The included studies encompassed a multitude of methods, as well as outcomes for both greenspace and mental health. 28 combinations were found between seven categories each for greenspace and mental health assessment. Some pairings such as geoinformation systems for greenspace assessment and questionnaires investigating mental health were used much more frequently than others, implying possible research gaps. Furthermore, we identified problems and inconsistences in reporting of greenspace types and mental health outcomes.

Discussion

The identified methodological variety is a potential for researching the complex connections between greenspace and mental health. Commonly used combinations can provide important insights. However, future research needs to emphasize other perspectives in order to understand how to create living environments with mental health benefits. For this purpose, interdisciplinary research is necessary.

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.

How Much Did Urban Park Use Change under the COVID-19 Pandemic? A Comparative Study of Summertime Park Use in 2019 and 2020 in Edinburgh, Scotland

The importance of urban parks was highlighted during the COVID-19 pandemic, when a number of restrictions on social gatherings were in place and people's movements were often restricted to their local neighbourhood. This study examined the changes in patterns of park use before and during COVID-19 to understand how the pandemic influenced such use. The methods involved behaviour observation and mapping, to offer a comparison of the use of parks in Edinburgh, Scotland, before and in the first year of the COVID-19 pandemic. The findings show an overall increase in use of urban parks during COVID-19, as expected, with significantly higher use in social areas, sports and fitness areas, and playground areas. However, while there was an overall increase in people visiting parks with others during COVID, in woodland areas there was an increase in lone visitors. This study shows the importance of parks for socialisation, exercise and children's play, but also for spending time alone in natural areas during COVID-19. The value of urban parks at a time of social disruption, such as the pandemic, is highlighted, and their role in supporting a variety of urban dwellers' needs points to priorities for future park planning, design and management.

Parent psychological distress and parent-child relationships two years into the COVID-19 pandemic: Results from a Canadian cross-sectional study

BACKGROUND

Mental health impacts of the COVID-19 pandemic have not been felt equally within populations. Parents with children living at home were early on identified as a population at heightened mental health risk, with concerns about the potential long-term impacts of the pandemic on parents' mental health, family functioning, and children's well-being. This study investigates impacts of the pandemic on parents' psychological distress, contextual sources of distress, and associations with family functioning nearly two years into the pandemic.

METHODS AND FINDINGS

Data were drawn from a national cross-sectional survey of adults living in Canada in November and December 2021 that was representative by age, gender, household income, and region. Parents with children < 18 years old living at home (N = 553) reported their experiences of psychological distress, pandemic-related stressors, coping mechanisms, and family functioning (changes in parent-child interactions, children's anxiety). Chi-square tests, logistic regression, and linear regression analyses examined sociodemographic inequities in parents' levels of psychological distress, sources and mitigating mechanisms of distress, and associations between psychological distress and family functioning. Nearly two years into the pandemic, parents with children at home reported nearly double pre-pandemic population estimates of moderate to severe psychological distress. Psychological distress was more frequently reported among parents with pre-existing mental health conditions, disabilities, and financial stressors. Parents with greater psychological distress reported increases in negative parent-child interactions due to the pandemic and higher anxiety among their children.

CONCLUSIONS

This study identifies sustained negative impacts of the pandemic on parents' mental health and family functioning in Canada nearly two years into the pandemic, despite high vaccine uptake and declining infection rates. Disparities in financial stress, social support structures, and pre-existing mental health were identified as underlying sources of psychological distress. These results highlight that meaningful responses to promote mental health among parents and families must address social and structural inequities.

Exercise Effect on Mental Health in Isolating or Quarantining Adults

INTRODUCTION: In response to coronavirus disease 2019 (COVID-19), travelers are typically subject to quarantine, which is often associated with poorer mental health (MH). While the protective benefits of community-based exercise are widely recognized, the degree to which this extends to the confined setting is unknown. This systematic review aims to evaluate the effect of exercise on MH in isolating or quarantining adults.METHODS: A literature search of Ovid MEDLINE, APA PsycInfo, and the Cochrane Database of Systematic Reviews limited to January 2019-September 2021 inclusive yielded five eligible studies.RESULTS: Data comprised a total of 2755 college and university students, most of whom were confined. Depending on the scale used, 24.9-76.7% of respondents demonstrated impaired MH, which improved with physical activity (PA), especially when regular and moderate or vigorous. The frequency, duration, and participants of exercise increased as lockdown progressed. One study showed that while sleep, diet, and PA all have an impact on MH, PA was the factor most strongly correlated with MH.DISCUSSION: Physical fitness should be optimized before and maintained during quarantine while exercise space and equipment should be accessible. Importantly, the sustainability of persistent quarantine must be considered given the pervasiveness of COVID-19.Chu V, Newman DG. Exercise effect on mental health in isolating or quarantining adults. Aerosp Med Hum Perform. 2023; 94(9):686-695.

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

Introduction

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

Aim

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

Method

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

Result

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

Conclusion

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

Is fear of COVID-19 higher in individuals residing in more deprived areas? A nationwide study

BACKGROUND

This study investigated the association between various types of coronavirus disease 2019 (COVID-19)-related fear and the level of area deprivation in Korea.

METHODS

Different types of COVID-19-related fear were examined, namely fear of infection, fear of dying from infection, fear of public criticism, fear of a family member getting infected and fear of economic loss. The level of area deprivation was measured based on the Area Deprivation Index, which was calculated based on population census data. The association between various types of COVID-19-related fear and the level of area deprivation was analyzed using multivariable logistic regression analysis.

RESULTS

This study included 199 859 individuals from the 253 administrative divisions in South Korea. Findings indicated that fear was most common in individuals residing in the most deprived areas, followed by those in the mediocre and least deprived areas (fear of infection: odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01-1.09; fear of dying from infection: OR 1.23, 95% CI 1.19-1.28; fear of public criticism: OR 1.20, 95% CI 1.15-1.24; fear of a family member getting infected: OR 1.12, 95% CI 1.07-1.18).

CONCLUSIONS

The findings suggest the need to monitor and account for area deprivation in managing the psychological health effects of the COVID-19 crisis.

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

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

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

BACKGROUND

The 2019 novel coronavirus (COVID-19) pandemic has been associated with poor mental health outcomes and widened health disparities in the United States. Given the inter-relationship between psychosocial factors and functional outcomes in orthopaedic surgery, it is important that we understand whether patients presenting for musculoskeletal care during the pandemic were associated with worse physical and mental health than before the pandemic's onset.

QUESTIONS/PURPOSES

(1) Did patients seen for an initial visit by an orthopaedic provider during the COVID-19 pandemic demonstrate worse physical function, pain interference, depression, and/or anxiety than patients seen before the pandemic, as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) instrument? (2) During the COVID-19 pandemic, did patients living in areas with high levels of social deprivation demonstrate worse patterns of physical function, pain interference, depression, or anxiety on initial presentation to an orthopaedic provider than patients living in areas with low levels of social deprivation, compared with prepandemic PROMIS scores?

METHODS

This was a retrospective, comparative study of new patient evaluations that occurred in the orthopaedic department at a large, urban tertiary care academic medical center. During the study period, PROMIS computer adaptive tests were routinely administered to patients at clinical visits. Between January 1, 2019, and December 31, 2019, we identified 26,989 new patients; we excluded 4% (1038 of 26,989) for being duplicates, 4% (1034 of 26,989) for having incomplete demographic data, 44% (11,925 of 26,989) for not having a nine-digit home ZIP Code recorded, and 5% (1332 of 26,989) for not completing all four PROMIS computer adaptive tests of interest. This left us with 11,660 patients in the "before COVID-19" cohort. Between January 1, 2021 and December 31, 2021, we identified 30,414 new patients; we excluded 5% (1554 of 30,414) for being duplicates, 4% (1142 of 30,414) for having incomplete demographic data, 41% (12,347 of 30,414) for not having a nine-digit home ZIP Code recorded, and 7% (2219 of 30,414) for not completing all four PROMIS computer adaptive tests of interest. This left us with 13,152 patients in the "during COVID-19" cohort. Nine-digit home ZIP Codes were used to determine patients' Area Deprivation Indexes, a neighborhood-level composite measure of social deprivation. To ensure that patients included in the study represented our overall patient population, we performed univariate analyses on available demographic and PROMIS data between patients included in the study and those excluded from the study, which revealed no differences (results not shown). In the before COVID-19 cohort, the mean age was 57 ± 16 years, 60% (7046 of 11,660) were women, 86% (10,079 of 11,660) were White non-Hispanic, and the mean national Area Deprivation Index percentile was 47 ± 25. In the during COVID-19 cohort, the mean age was 57 ± 16 years, 61% (8051 of 13,152) were women, 86% (11,333 of 13,152) were White non-Hispanic, and the mean national Area Deprivation Index percentile was 46 ± 25. The main outcome measures in this study were the PROMIS Physical Function ([PF], version 2.0), Pain Interference ([PI], version 1.1), Depression (version 1.0), and Anxiety (version 1.0). PROMIS scores follow a normal distribution with a mean t-score of 50 and a standard deviation of 10. Higher PROMIS PF scores indicate better self-reported physical capability, whereas higher PROMIS PI, Depression, and Anxiety scores indicate more difficulty managing pain, depression, and anxiety symptoms, respectively. Clinically meaningful differences in PROMIS scores between the cohorts were based on a minimum clinically important difference (MCID) threshold of 4 points. Multivariable linear regression models were created to determine whether presentation to an orthopaedic provider during the pandemic was associated with worse PROMIS scores than for patients who presented before the pandemic. Regression coefficients (ß) represent the estimated difference in PROMIS scores that would be expected for patients who presented during the pandemic compared with patients who presented before the pandemic, after adjusting for confounding variables. Regression coefficients were evaluated in the context of clinical importance and statistical significance. Regression coefficients equal to or greater than the MCID of 4 points were considered clinically important, whereas p values < 0.05 were considered statistically significant.

RESULTS

We found no clinically important differences in baseline physical and mental health PROMIS scores between new patients who presented to an orthopaedic provider before the COVID-19 pandemic and those who presented during the COVID-19 pandemic (PROMIS PF: ß -0.2 [95% confidence interval -0.43 to 0.03]; p = 0.09; PROMIS PI: ß 0.06 [95% CI -0.13 to 0.25]; p = 0.57; PROMIS Depression: ß 0.09 [95% CI -0.14 to 0.33]; p = 0.44; PROMIS Anxiety: ß 0.58 [95% CI 0.33 to 0.84]; p < 0.001). Although patients from areas with high levels of social deprivation had worse PROMIS scores than patients from areas with low levels of social deprivation, patients from areas with high levels of social deprivation demonstrated no clinically important differences in PROMIS scores when groups before and during the pandemic were compared (PROMIS PF: ß -0.23 [95% CI -0.80 to 0.33]; p = 0.42; PROMIS PI: ß 0.18 [95% CI -0.31 to 0.67]; p = 0.47; PROMIS Depression: ß 0.42 [95% CI -0.26 to 1.09]; p = 0.23; PROMIS Anxiety: ß 0.84 [95% CI 0.16 to 1.52]; p = 0.02).

CONCLUSION

Contrary to studies describing worse physical and mental health since the onset of the COVID-19 pandemic, we found no changes in the health status of orthopaedic patients on initial presentation to their provider. Although large-scale action to mitigate the effects of worsening physical or mental health of orthopaedic patients may not be needed at this time, orthopaedic providers should remain aware of the psychosocial needs of their patients and advocate on behalf of those who may benefit from intervention. Our study is limited in part to patients who had the self-agency to access specialty orthopaedic care, and therefore may underestimate the true changes in the physical or mental health status of all patients with musculoskeletal conditions. Future longitudinal studies evaluating the impact of specific COVID-19-related factors (for example, delays in medical care, social isolation, or financial loss) on orthopaedic outcomes may be helpful to prepare for future pandemics or natural disasters.

LEVEL OF EVIDENCE

Level II, prognostic study.

The Impact of the Coronavirus Pandemic on the Contribution of Local Green Space and Nature Connection to Mental Health

BACKGROUND

Exposure to green space and feeling connected to the natural environment have independently been associated with improved mental health outcomes. During the coronavirus pandemic, people experienced restrictions on access to the outdoors, and health data indicated a decline in mental health in the UK general population.

METHODS

Data available from two independent surveys conducted prior to and during the pandemic enabled a naturally occurring comparison of mental health and its correlates prior to and during the pandemic.

RESULTS

Survey responses from 877 UK residents were included in the analyses. Independent t-tests revealed significant declines in mental health scores during the pandemic. After controlling for age and gender, greater nature connection significantly predicted lower depression and stress and improved well-being. Percentage of green space did not significantly predict any mental health outcomes. Further, time point (pre- or during COVID) and the interaction of time point with green space and nature connection did not significantly predict any of the outcome measures. The findings indicate that nature connection may play an important role in promoting mental health. Strategies to improve mental health and reduce mental illness should consider the role of nature connection and the use of interventions that involve direct interaction with natural environments.

Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study

BACKGROUND

The COVID-19 pandemic brought digital practices and engagement to the forefront of society, which were based on behavioral changes associated with adhering to different government mandates. Further behavioral changes included transitioning from working in the office to working from home, with the use of various social media and communication platforms to maintain a level of social connectedness, especially given that many people who were living in different types of communities, such as rural, urban, and city spaces, were socially isolated from friends, family members, and community groups. Although there is a growing body of research exploring how technology is being used by people, there is limited information and insight about the digital practices employed across different age cohorts living in different physical spaces and residing in different countries.

OBJECTIVE

This paper presents the findings from an international multisite study exploring the impact of social media and the internet on the health and well-being of individuals in different countries during the COVID-19 pandemic.

METHODS

Data were collected via a series of online surveys deployed between April 4, 2020, and September 30, 2021. The age of respondents varied from 18 years to over 60 years across the 3 regions of Europe, Asia, and North America. On exploring the associations of technology use, social connectedness, and sociodemographic factors with loneliness and well-being through bivariate and multivariate analyses, significant differences were observed.

RESULTS

The levels of loneliness were higher among respondents who used social media messengers or many social media apps than among those who did not use social media messengers or used ≤1 social media app. Additionally, the levels of loneliness were higher among respondents who were not members of an online community support group than among those who were members of an online community support group. Psychological well-being was significantly lower and loneliness was significantly higher among people living in small towns and rural areas than among those living in suburban and urban communities. Younger respondents (18-29 years old), single adults, unemployed individuals, and those with lower levels of education were more likely to experience loneliness.

CONCLUSIONS

From an international and interdisciplinary perspective, policymakers and stakeholders should extend and explore interventions targeting loneliness experienced by single young adults and further examine how this may vary across geographies. The study findings have implications across the fields of gerontechnology, health sciences, social sciences, media communication, computers, and information technology.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3389/fsoc.2020.574811.

Covid-19 and outdoor recreation - Lessons learned? Introduction to the special issue on "Outdoor recreation and Covid-19: Its effects on people, parks and landscapes"

The special issue presents international experiences with COVID-19 in the years 2020 and 2021 on outdoor recreation and nature-based tourism. To set the scene, a bibliometric and qualitative analysis illustrates and clusters recent publications on COVID-19. Against this background contributions from Japan, China, Brazil, Indonesia, Austria, Croatia, the United States, New Zealand, Taiwan, Australia, Sweden, Poland and Ireland draw a truly international picture of the pandemic crisis, the effects, coping behavior and related strategies. The papers contribute to the COVID-19 related research by documenting the shock in the field of outdoor recreation and tourism, by understanding the immediate consequences on behavior and the required managerial consequences and finally, by analyzing the possible follow up effects including long term effects, discussing resilient solutions and proposing new strategies. In the discussion section we try to answer the questions whether the high visitation rate in recreation facilities, forests, parks and protected areas will remain, and whether adapted visitor management concepts will be required. In addition, we discuss possible implications for urban planning and management. Finally, based on a changing connectedness to nature also possible positive effects by the pandemic are discussed which may lead to a new target group in outdoor recreation and nature-based tourism.

Management implications

The overview on the Covid-19 related literature suggests improvements in planning and management, such as-new concepts for destination and visitor management, considering an ongoing risk-management,-proactive urban planning and management considering short-term effects in the existing built environment as well as a long-term perspective with strategically planned green infrastructure, including not only the supply of green infrastructure, but also its accessibility, its amenities, and aspects of environmental justice,-the consideration of new target groups in tourism and outdoor recreation.

Towards building resilient cities to pandemics: A review of COVID-19 literature

With the global prevalence of COVID-19 disease, the concept of urban resilience against pandemics has drawn the attention of a wide range of researchers, urban planners, and policymakers. This study aims to identify the major dimensions and principles of urban resilience to pandemics through a systematic review focused on lessons learned from the COVID-19 pandemic and comparing different perspectives regarding resilient urban environments to such diseases. Based on the findings, the study proposes a conceptual framework and a series of principles of urban resilience to pandemics, consisting of four spatial levels: housing, neighborhoods, city, and the regional and national scales, and three dimensions of pandemic resilience: pandemic-related health requirements, environmental psychological principles, and general resilience principles. The findings show that resilient cities should be able to implement the pandemic-related health requirements, the psychological principles of the environment to reduce the stresses caused by the pandemic, and the general principles of resilience in the smart city context. This framework provides scholars and policymakers with a comprehensive understanding of resilience on different scales and assists them in making better-informed decisions.

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

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

Green spaces for mental disorders

PURPOSE OF REVIEW

Mental illness is a global challenge, exacerbated by the coronavirus pandemic. Research suggests access to local green spaces is associated with better mental health, yet access is not always equitable. Evaluation of how nature-based interventions protect and support mental health is therefore required.

RECENT FINDINGS

Accessible local green spaces are associated with better mental health. They encourage active behaviours and social interaction, reduce loneliness and stress. Green views from the home are associated with increased self-esteem, life satisfaction and happiness and reduced depression, anxiety and loneliness. Nature-based interventions and green social prescriptions effectively target vulnerable groups, resulting in significant reductions in depression, anxiety and anger alongside positive mental health outcomes.

SUMMARY

Although existing evidence is encouraging, robust, high-quality research that strengthens the evidence base and informs future clinical practice and policy decision making is needed. Evidence of the long-term effectiveness in individuals with diagnosed mental illness is also required to ascertain the potential social and wider returns on investment. Barriers to use of green social prescriptions like mental health symptoms and geographical accessibility need to be overcome to increase accessibility and uptake of green social prescriptions for the prevention and treatment of mental illness.

The trajectory of mental health problems for UK emerging adults during COVID-19

Initial COVID-19 restrictions were associated with declining mental health, particularly in UK emerging adults. Prior research has yet to examine changes in mental health in this demographic over the entire course of the three UK national lockdowns. Drawing upon the Understanding Society COVID-19 Survey, this study examined the trajectory of mental health problems for emerging adults (18-29-year-olds) from April 2020-September 2021. Mental health problems were assessed at nine time-points using the General Health Questionnaire. The analytic sample included 1018 participants (304 males, 714 females). Growth curve modelling was used to examine the trajectory of mental health problems and the associated sociodemographic and health covariates. Females and those with fewer household members, lower income, no private garden, and pre-existing mental or physical health diagnoses reported more mental health problems. Gender differences were evident in the rate of change. Females' mental health problems declined from the first lockdown until just after the relaxation of initial restrictive measures (September 2020), increased until April 2021 (constituting lockdowns two and three), and then slightly decreased until September 2021 during the phased exit from restrictions. Males' mental health problems followed a similar trajectory, with a greater rate of increase in mental health problems from July 2020-April 2021, and a greater rate of decline from April-September 2021. Females reported more mental health problems throughout the three national lockdowns than males. These findings can inform public health policies targeted toward young adult populations and highlight sub-populations at greater risk of worsening mental health.

Unequal impact of the COVID-19 pandemic on mental health: Role of the neighborhood environment

The COVID-19 pandemic has taken a significant toll on people's mental wellbeing. Few studies have investigated how the neighborhood environment might help to moderate the mental health impact in a natural disaster context. We aim to investigate the unequal impact of the pandemic on mental health between different population groups, and the role of the neighborhood environment in alleviating this impact. We collected survey data (n=2,741) on mental health, neighborhood environment, and pandemic-related behaviors in Beijing metropolitan region between July 10 and 28, 2020, and then applied the partial proportional odds model. Overall, we found that the pandemic has disproportionately affected the lower-income people. The lower-income residents experienced a greater psychological impact than the higher-income residents. We further found that distance to an urban park was a key built environment variable that moderates mental health impact. Residents who lived near urban parks were 4.2 to 4.6% less likely to report an increase in negative emotions, and therefore are more resilient to the mental health impact. In addition to the built environment, a cohesive neighborhood environment may have also helped to mitigate the negative mental health impacts. These findings can inform planning policies that aim to promote healthy and resilient communities.

The Feasibility and Impact of Practising Online Forest Bathing to Improve Anxiety, Rumination, Social Connection and Long-COVID Symptoms: A Pilot Study

BACKGROUND

Long-COVID affects over 144 million people globally. In the absence of treatments, there is a need to establish the efficacy of therapies that improve patient outcomes. Forest bathing has been demonstrated to improve physical and mental outcomes but there is no evidence in Long-COVID patients. Accordingly, this pilot study sought to determine the feasibility and effectiveness of online forest bathing in adults with Long-COVID.

METHODS

Feasibility was assessed by monitoring retention rates and participant feedback. In a waitlist controlled, repeated measures design, 22 Long-COVID patients completed weekly online surveys during a four-week waitlist control period, before engaging in four weekly online forest bathing sessions, completing post-intervention surveys following each session.

RESULTS

In terms of retention, 27% did not provide post-intervention data, reasons for non-adherence were: feeling too ill, having medical appointments, or having career responsibilities. Compared with the waitlist control period, there were statistically significant improvements in Anxiety (49% decrease), Rumination (48% decrease), Social Connection (78% increase), and Long-COVID symptoms (22% decrease). Written qualitative comments indicated that participants experienced feelings of calm and joy, felt more connected socially and with nature, and experienced a break from the pain and rumination surrounding their illness.

CONCLUSIONS

Online Forest bathing resulted in significant improvements in well-being and symptom severity and could be considered an accessible and inexpensive adjunct therapy for Long-COVID patients. Where people have limited access to in-person nature, virtual nature may offer an alternative to improve health and well-being outcomes.

Substance use, racial/ethnic identity, and suicidal ideation during COVID-19 lockdown in an international adult sample

Although research has examined disparities in suicidal ideation across multiple groups, few investigations have analyzed such disparities in the context of COVID-19 pandemic. Furthermore, there is limited research on differences within and across countries, further limiting the extent to which meaningful comparisons can be made. Therefore, this study examines risk and protective factors of suicidal ideation during COVID-19 lockdown in adults across five countries. Adults (N = 2,509) from the United States, Italy, Spain, Saudi Arabia, and India completed a survey to measure suicidal ideation, recent drug use, and sociodemographic factors. Prevalence of suicidal ideation was assessed using simple and multivariable logistic regression models, and severity of suicidal ideation was analyzed via a multinomial multivariable logistic regression. Cohen's d statistics were reported for all analyses to report effect size. In the United States subsample, racial/ethnic minorities endorsed a significantly greater prevalence of suicidal ideation compared to their White peers (aOR = 2.31, 95% CI: 1.26-4.27, d = 0.46). However, no significant racial differences in suicidal ideation were found in other countries. Past 90-day illicit drug use was associated with greater prevalence (aOR = 1.38, 95% CI: 1.06-1.80, d = 0.18) and severity (aRRR = 2.17, 95% CI: 1.33-3.53, (aRRR = 0.43) of suicidal ideation during COVID-19 lockdown. This study further highlights the social disparities that exist in suicidal ideation during COVID-19 lockdown in international samples, for which greater medical and mental health interventions are critical. As such, targeted multicomponent interventions that address substance use are important for reducing the rising prevalence and severity of COVID-related suicidal ideation.

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

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

COVID-19, green space exposure, and mask mandates

INTRODUCTION

Mask-wearing and social distancing are critical prevention measures that have been implemented to stem the spread of COVID-19. The degree to which these measures are adhered to in the US, however, may be influenced by access to outdoor resources such as green space, as well as mask mandates that may vary by state.

PURPOSE

To examine the association between the presence or absence of statewide mask mandates and green space exposure with COVID-19 cumulative incidence in the US.

METHODS

In October 2020, COVID-19 case data for each US county was downloaded from USA Facts, in addition to statewide mask mandates from a database maintained by the American Association of Retired Persons. The Normalized Difference Vegetation Index from the US Geological Survey (USGS), was used as a measure of greenspace, while the 2016 National Land Cover Database was used to assess tree canopy exposure as an alternative measure of greenspace. We performed generalized linear regression to evaluate associations with COVID-19 incidence, adjusting for potential confounders such as other environmental factors (i.e., air pollution and climate) and socio-economic factors derived from the CDC social vulnerability index. In addition, we also performed spatial regression analyses to account for spatial autocorrelation across counties.

RESULTS

Counties with mandatory mask-wearing policies had a lower cumulative incidence of COVID-19 (B = -0.299, SE = 0.038). Among environmental factors, precipitation (B = 0.005, SE = 0.001) and PM 2.5 (B = 0.072, SE = 0.012) were associated with a higher incidence of COVID-19, while tree canopy (B = -0.501, SE = 0.129) was associated with a lower risk of COVID-19. COVID-19 incidence was higher in counties with socially vulnerable populations regarding socioeconomic status, minority status, and housing and transportation.

CONCLUSION

Mandatory mask regulation, exposure to green space, and reduced exposure to air pollution may reduce COVID-19 incidence in the US. Additional public health policies should consider ways to mitigate environmental conditions that may contribute to the risk of COVID-19, especially for vulnerable populations.

Were anxiety, depression and psychological distress associated with local mortality rates during COVID-19 outbreak in Italy? Findings from the COMET study

BACKGROUND

The mental health of the Italian population declined at the onset of the COVID-19 pandemic. However, nationwide population prevalence estimates may not effectively reproduce the heterogeneity in distress responses to the pandemic. In particular, contextual determinants specific to COVID-19 pandemic need to be considered. We thus aimed to explore the association between local COVID-19 mortality rates and mental health response among the general population.

METHODS

We capitalised on data (N = 17,628) from a large, cross-sectional, national survey, the COMET study, run between March and May 2020. While psychological distress was measured by General Health Questionnaire-12 (GHQ-12), the Depression, Anxiety and Stress Scale-21 Items (DASS-21) was used to assess relevant domains. In addition, a Covid-19 mortality ratio was built to compare single regional mortality rates to the national estimate and official statistics were used to control for other area-level determinants.

RESULTS

Adjusted ordered regression analyses showed an association between mortality ratio and moderate (OR = 1.10, 95%CI 1.03-1.18) and severe (OR = 1.11, 95%CI 1.03-1.21) DASS-21 anxiety levels. No effects of mortality ratio on GHQ-12 scores and DASS-21 depression and stress levels, uniformly high across the country, were estimated.

CONCLUSIONS

Although we could not find any association between regional COVID-19 mortality ratio and depression or psychological distress, anxiety levels were significantly increased among subjects from areas with the highest mortality rates. Local mortality rate seems a meaningful driver for anxiety among the general population. Considering the potentially long-lasting scenario, local public health authorities should provide neighbouring communities with preventive interventions reducing psychological isolation and anxiety levels.

Longitudinal associations between going outdoors and mental health and wellbeing during a COVID-19 lockdown in the UK

The COVID-19 pandemic led to national lockdowns in countries around the world. Whilst lockdowns were shown to be effective in reducing the spread of disease, they were also associated with adverse effects on people’s mental health and wellbeing. Previous studies have suggested that time spent outside may have played a role in mitigating these negative effects, but research on this topic remains limited. Therefore, this study was designed to explore the longitudinal associations between going outdoors and people’s mental health and wellbeing during the first national lockdown (March–May 2020) in the UK. Data from 35,301 participants from the COVID-19 Social Study were analysed. Fixed effects regression was used to explore the longitudinal association between changes in going outdoors (the number of days spent outside) and changes in depressive symptoms, anxiety symptoms, life satisfaction and loneliness. A range of household and neighbourhood moderators were examined. Results show that an increase in the number of days spent outside was associated with decreases in depressive and anxiety symptoms and an increase in life satisfaction. Associations were more salient amongst people living with others, and those with greater satisfaction with their neighbourhood walkability and green spaces. No longitudinal association was found with loneliness. Overall, our analyses showed a positive association between going outdoors and improved mental health and wellbeing during the first COVID-19 lockdown in the UK. These findings are important for formulating guidance for people to stay well at home during pandemics and for the on-going nature-based social prescribing scheme.

Realising the Sustainable Development Goal 11.7 in the post-pandemic era – A case study of Taiwan

The COVID-19 pandemic has dramatically impacted our daily lives worldwide. For instance, pandemic-prevention policies restrict people’s mobility, which causes problems in accessing urban greenspaces. Indeed, unequal access to urban greenspace has been accentuated during the most stringent lockdowns of 2020 and 2021. Amid such challenging circumstances, there has been a growing attention placed on Sustainable Development Goal (SDG) 11.7, which has brought opportunities for urgent action. In this paper, we applied the Gini coefficient to our analysis of unequal access to urban greenspaces across all urban planning areas in six special municipalities in Taiwan. Moreover, we also conducted comparative analyses between the Gini coefficient and other socio-economic factors. The results show that approximately 63.98% of the urban planning area suffers from unequal access to greenspaces. In addition, urban greenspace provision and household income show significant positive correlations with the Gini coefficient, which reflects Taiwan’s environmental injustice. Furthermore, these findings can help city planners and decision-makers evaluate levels of equality in each urban planning area and decide which priority areas should be improved. Finally, this study can also be used as a reference for decision-makers to realise SDG 11.7 in the post-pandemic era.

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

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

Effect of lockdown on mental health in Australia: evidence from a natural experiment analysing a longitudinal probability sample survey

BACKGROUND

Many studies have examined population mental health during the COVID-19 pandemic but have been unable to isolate the direct effect of lockdowns. The aim of this study was to examine changes in the mental health of Australians aged 15 years and older during the COVID-19 pandemic using a quasi-experimental design to disentangle the lockdown effect.

METHODS

We analysed data from ten annual waves (2011-20) of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey to identify changes in the mental health of respondents from the pre-COVID-19 period (2011-19) to the COVID-19 period (2020). Difference-in-differences models were used to compare these changes between respondents in the state of Victoria who were exposed to lockdown at the time of the 2020 interviews (treatment group) and respondents living elsewhere in Australia (who were living relatively free of restrictions; control group). The models included state, year (survey wave), and person-specific fixed effects. Mental health was assessed using the five-item Mental Health Inventory (MHI-5), which was included in the self-complete questionnaire administered during the survey.

FINDINGS

The analysis sample comprised 151 583 observations obtained from 20 839 individuals from 2011 to 2020. The treatment group included 3568 individuals with a total of 37 578 observations (34 010 in the pre-COVID-19 and 3568 in the COVID-19 period), and the control group included 17 271 individuals with 114 005 observations (102 867 in the pre-COVID-19 and 11 138 in the COVID-19 period). Mean MHI-5 scores did not differ between the treatment group (72·9 points [95% CI 72·8-73·2]) and control group (73·2 points [73·1-73·3]) in the pre-COVID-19 period. In the COVID-19 period, decreased mean scores were seen in both the treatment group (69·6 points [69·0-70·2]) and control group (70·8 points [70·5-71·2]). Difference-in-differences estimation showed a small but statistically significant effect of lockdown on MHI-5 scores, with greater decline for residents of Victoria in 2020 than for those in the rest of Australia (difference -1·4 points [95% CI -1·7 to -1·2]). Stratified analyses showed that this lockdown effect was larger for females (-2·2 points [-2·6 to -1·7]) than for males (-0·6 [-0·8 to -0·5]), and even larger for women in couples with children younger than 15 years (-4·4 points [-5·0 to -3·8]), and for females who lived in flats or apartments (-4·1 points [-5·4 to -2·8]) or semi-detached houses, terraced houses, or townhouses (-4·8 points [-6·4 to -3·2]).

INTERPRETATION

The imposition of lockdowns was associated with a modest negative change in overall population mental health. The results suggest that the mental health effects of lockdowns differ by population subgroups and for some might have exaggerated existing inequalities in mental health. Although lockdowns have been an important public health tool in suppressing community transmission of COVID-19, more research is needed into the potential psychosocial impacts of such interventions to inform their future use.

FUNDING

US National Institutes of Health.

The Role of Urban Environment Design on Health During the COVID-19 Pandemic: A Scoping Review

The COVID-19 pandemic has had a significant impact on the ways and times of living and using urban spaces, specifically referring to the dimension of daily life. The restrictive measures introduced during the lockdown periods have necessarily led to a re-evaluation of proximity scale bringing particularly attention to issues relating to public transport and mobility and to the quality and distribution of open public spaces. This scoping review explores the relationship between the urban environment design and health referring to the constraints imposed by the COVID-19 pandemic in the period from 2020 to 2021, with two main objectives: (i) to investigate the recurring urban design topics and issues related to the spatial and social needs stressed by the emergency; (ii) to identify the urban design measures both experienced during the health emergency and proposed in view of a post-COVID urban and territorial planning as they are considered impactful on health promotion. The search strategy was based on a set of keywords searched in two electronic databases which allowed the identification of a total of 1,135 contributions. After defining the eligibility criteria, we proceeded to the screening process concluded with the inclusion of 19 studies. The analysis of the contributions led to the systematization of six main urban topics-and to the corresponding spatial requirements and project proposals-highlighted as relevant and supportive in terms of the promotion of inhabitant's public health: (i) transport, mobility and accessibility; (ii) green and outdoor spaces; (iii) public and pedestrians' spaces; (iv) care services and health network; (v) communications; (vi) public and business services. The resulting framework is useful for guiding healthy city planning toward public policies, tools, regulations, urban measures, and emergency contrast provisions, that contribute to increasing the effectiveness in terms of safety and well-being.

Housing environment and mental health of Europeans during the COVID-19 pandemic: a cross-country comparison

Many studies have investigated the impact of the COVID-19 pandemic on mental health. Throughout the pandemic, time spent at home increased to a great extent due to restrictive measures. Here we set out to investigate the relationship between housing conditions and the mental health of populations across European countries. We analyzed survey data collected during spring 2020 from 69,136 individuals from four cohorts from Denmark, France, and the UK. The investigated housing conditions included household density, composition, and crowding, access to outdoor facilities, dwelling type, and urbanicity. The outcomes were loneliness, anxiety, and life satisfaction. Logistic regression models were used, and results were pooled using random-effects meta-analysis. In the meta-analysis, living alone was associated with higher levels of loneliness (OR = 3.08, 95% CI 1.87–5.07), and lower life satisfaction (OR = 1.27, 95% CI 1.05–0.55), compared to living with others. Not having access to an outdoor space and household crowding were suggestively associated with worse outcomes. Living in crowded households, living alone, or lacking access to outdoor facilities may be particularly important in contributing to poor mental health during a lockdown. Addressing the observed fundamental issues related to housing conditions within society will likely have positive effects in reducing social inequalities, as well as improving preparedness for future pandemics.

Greenspace and park use associated with less emotional distress among college students in the United States during the COVID-19 pandemic

The COVID-19 pandemic has negatively affected many people's psychological health. Impacts may be particularly severe among socially vulnerable populations such as college students, a group predisposed to mental health problems. Outdoor recreation and visits to greenspaces such as parks offer promising pathways for addressing the mental health challenges associated with COVID-19. During the early stages of the pandemic (March-May 2020), we surveyed 1280 college students at four large public universities across the United States (U.S.) to assess how, and why, outdoor recreation and park use changed since the emergence of COVID-19. We also measured students' self-reported levels of emotional distress (a proxy for psychological health) and assessed potential demographic and contextual correlates of distress, including county-level per capita park area and greenness, using generalized linear models. We found that 67% of students reported limiting outdoor activities and 54% reported reducing park use during the pandemic. Students who reduced their use of outdoor spaces cited structural reasons (e.g., lockdowns), concerns about viral transmission, and negative emotions that obstructed active lifestyles. Students who maintained pre-pandemic park use levels expressed a desire to be outdoors in nature, often with the explicit goal of improving mental and physical health. Emotional distress among students was widespread. Models showed higher levels of emotional distress were associated with reducing park use during the pandemic and residing in counties with a smaller area of parks per capita. This study of U.S. college students supports the value of park-based recreation as a health promotion strategy for diverse populations of young adults during a time of crisis.

Willingness to Pay for Urban and Suburban Green

Peri-urban and urban green are considered among the basic priorities of the local government’s regional policy agenda, in line with the principles of spatial planning. This agenda is promoted at both the national and European levels through a variety of technical and institutional measures. Green spaces in urban and suburban areas are directly linked to the quality of life of urban residents and their environment. In this context, the purpose of this study is to investigate and identify the characteristics and factors that influence the residents of a small Greek city in terms of the value they attach to urban and suburban green spaces. These factors are identified through the residents’ willingness to pay (WTP) using the contingent valuation method (CVM). In general, the analysis aims to document the value of environmental economic methods as a tool in the management of natural heritage. According to the research, income and knowledge of environmental issues (global and local) as well as the benefits of green spaces (urban and suburban) are the key factors that drive residents to place a higher value on them. Future work may explore whether or how the COVID-19 pandemic affected city residents’ willingness to pay for green spaces.

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

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

Associations of Depressive Symptoms, COVID-19-Related Stressors, and Coping Strategies. A Comparison Between Cities and Towns in Germany

BACKGROUND

The COVID-19 pandemic has led to a wide range of stressors related to depressive symptoms. Prevention measures like physical distancing have burdened the general population, especially in highly urbanized areas. However, little is known about the associations between pandemic-related stressors, coping strategies, and depressive symptoms in highly urbanized vs. less urbanized environments.

METHODS

Participants were recruited in a cross-sectional online survey in Germany. Propensity score matching yielded a matched sample of city (n = 453) and town (n = 453) inhabitants. Depressive symptoms, COVID-19-related stressors, and coping strategies were compared between cities and towns. Multiple regression analysis was performed to determine associations between pandemic-related stressors and depressive symptoms for the two groups separately.

RESULTS

City inhabitants showed significantly higher depression scores than town inhabitants (t = 2.11, df = 897.95, p = 0.035). Seven coping strategies were more often used by the city sample. Depressive symptoms were associated with "restricted physical social contact" and "difficult housing conditions" (adjusted R 2= 0.19, F [9,443] = 12.52, p < 0.001) in city inhabitants, and with "fear of infection" and "difficult housing conditions" (adjusted R 2= 0.20, F [9,443] = 13.50, p < 0.001) in town inhabitants.

LIMITATIONS

The data were collected at the end of the first wave and represent a snapshot without causal inferences. Pandemic-related stressors were measured with a newly developed scale.

CONCLUSION

Depressive symptoms, perceived stressors, and approach/avoidance coping strategies differed between city vs. town inhabitants. These differences should be considered in policy-making and mental health care.

Parks and the Pandemic: A Scoping Review of Research on Green Infrastructure Use and Health Outcomes during COVID-19

Green infrastructure (GI) has long been known to impact human health, and many academics have used past research to argue for the potential importance of GI as a mechanism for maintaining or improving health within the context of the COVID-19 pandemic. This scoping review addresses the question: What evidence, if any, have researchers found of a relationship between green infrastructure use and health during the COVID-19 pandemic? Specifically, evaluating the (a) association of GI use with COVID-19 disease outcomes and (b) association of GI use with other health outcomes as impacted by the COVID-19 pandemic. Twenty-two studies were identified that measured GI use and studied it in relation to health outcomes during the pandemic. The studies were reviewed for the specific measures and types of GI use, level of analysis, specific types of health outcomes, and the conclusions reached with regard to GI use and health. Studies exploring COVID-19-specific health outcomes showed mixed results, while non-COVID health outcomes were more consistently improved through GI use, particularly with regard to improved mental health. While the evidence strongly suggests that GI use has played a protective role in non-COVID-19 physical and mental health during the pandemic, questions remain with regard to possible impacts on COVID transmission and mortality.

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

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

Mental Health of Young Australians during the COVID-19 Pandemic: Exploring the Roles of Employment Precarity, Screen Time, and Contact with Nature

The coronavirus disease 2019 (COVID-19) pandemic is widely understood to have contributed to mental health problems. In Australia, young people (18-24 years) have been disproportionately affected. To date, research has predominantly focused on the presence or absence of mental illness symptoms, while aspects of mental well-being have been overlooked. We aimed to explore associations between potential risk and protective factors and mental health more comprehensively, using the Complete State Model of Mental Health. An online survey of 1004 young Australians (55% female; M age = 21.23) was undertaken. Assessment of both mental illness and mental well-being enabled participants to be cross-classified into four mental health states. Those with 'Floundering' (13%) or 'Struggling' (47.5%) mental health reported symptoms of mental illness; a 'Languishing' group (25.5%) did not report symptoms of mental illness but mental well-being was compromised relative to those who were 'Flourishing' (14%) with high mental well-being. Multinomial logistic regressions were used to examine associations, adjusting for socio-demographic confounders. Protective factors associated with Flourishing mental health included being in secure employment, using screen time to connect with others, and reporting high levels of hope. Both incidental and purposive contact with nature were also associated with Flourishing, while a lack of green/bluespace within walking distance was associated with Languishing, absence of outdoor residential space was associated with Floundering, and lower neighbourhood greenness was associated with all three suboptimal mental health states. Precarious employment, financial stress, living alone, reporting decreased screen time during lockdowns, lower levels of hope, and high disruption of core beliefs were also associated with Struggling and Floundering mental health. Those who were Languishing reported somewhat less hardship and little disruption to core beliefs, but lower levels of hope compared to young people who were Flourishing. This study highlights that young adults require dedicated mental health services to deal with current burden, but should also be supported through a range of preventive strategies which target mental health risk factors, like precarious employment, and enhance protective factors, such as urban green infrastructure.