Impact of Changed Use of Greenspace during COVID-19 Pandemic on Depression and Anxiety

Greenspace Use and Anxiety in Young Adults: The Role of Interoception

OBJECTIVE

Greenspace is linked to the prevention and management of anxiety, but the underlying mechanisms remain unclear. This study aims to evaluate the association between greenspace use and anxiety in Chinese young adults, focusing on the mediating role of interoception.

METHODS

This population-based study was conducted between September and October 2023 in four local universities in China. A total of 27,755 young adults were included. Greenspace use was assessed by self-report, anxiety by the Generalized Anxiety Disorder (GAD) assessment, and interoception by the Body Perception Questionnaire (BPQ). Generalized linear mixed models (GLMMs) and mediation models were utilized to analyze associations.

RESULTS

The mean age of participants was 19.39 ± 1.64 years, with 10,944 (39.4%) being female. A total of 10,273 (37.01%) participants suffered from anxiety. GLMMs indicated that compared to their counterparts who did not visit green spaces at all in the past four weeks, those who visited once or twice, once a week, or several times a week had lower odds of anxiety. A lower level of interoception was associated with reduced odds of anxiety. Furthermore, interoception mediated much of the association between greenspace use and anxiety. These associations were robust in a series of sensitivity analyses.

CONCLUSIONS

These results suggest the crucial role of green spaces on interoception and anxiety and point to the importance of promoting student well-being through interaction with greenspace and nature. Further research is needed to better understand how interoception mediates the connection of greenspace and other aspects of the built environment with anxiety.

Do environmental attitudes and personal characteristics influence how people perceive their exposure to green spaces?

Background

This study explores the relationship between perceived and objective greenspace exposure, and how sociodemographic traits and environmental attitudes influence peoples' perceptions of greenspace.

Methods

We leveraged a cross-sectional survey on greenspace exposure among residents of Denver, CO that ran from November 2019 through April 2021. We measured objective greenspace using the average NDVI (normalized difference vegetation index), average percent vegetation, and median GVI (green view index) within 300, 500, and 1,000 m of participants' residences, and in participant-drawn polygons representing their neighborhoods. We measured perceived greenspace exposure using survey responses from questions about greenspace abundance, visibility, access, usage, and quality near participants' homes. We assessed relationships between perceived and objective greenspace measures using linear models. Then, we used latent class analysis to create perceived greenspace exposure classes, and used linear models to evaluate the relationship between these classes and sociodemographic and environmental attitude variables.

Results

We found that the relationship between perceived and objective measures (NDVI in the 300-meter buffer) was strongest for abundance (OR: 5.14, [4.0, 6.28]) and visibility (OR: 3.71, [2.58, 4.84]) compared to perceived access (OR: 2.17, [1.02, 3.32]), usage (OR: 2.28, [1.19, 3.37]), and quality (OR: 2.33, [1.25, 3.41]). In fully adjusted models, objective greenspace exposure and environmental attitudes predicted perceived greenspace exposure classes, but sociodemographic variables-other than age-did not.

Conclusion

Our work suggests that objective greenspace exposure is only one factor influencing peoples' perceived greenspace exposure, and that environmental attitude variables may play an additional role in shaping peoples' perceptions.

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

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

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

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.

Social Isolation and Population Density: Racial and Ethnic Differences Among Older Adults

This study uses secondary data analysis to assess the relationship between social isolation (SI) and population density in the US, as well as any moderating influence that race/ethnicity may have on that relationship. A recent consensus on the measure of SI is that it focuses on the objective absence of social connections, whereas loneliness refers to subjective assessments of one's social connections. Therefore, while the original study measured both objective and subjective SI may be innovative, it may also be overly ambitious. SI puts older people at risk for health problems, including an increased chance of dying. The AARP Foundation gathered the initial convenience sample, which included 8149 senior citizens. The study determined population density using self-reported zip codes, measured as persons per square mile, and divided the results into tertiles. Linear mixed models were used to investigate the moderating role of race/ethnicity between population density and SI. The findings revealed that greater population density was associated with less SI for individuals residing in zip codes with a higher percentage of the same race/ethnicity, but more SI for those in zip codes with a lower percentage of the same race/ethnicity. These results suggest that race/ethnicity should be considered in future studies or when developing policies and interventions to address SI among older adults in high-population-density areas. For example, when policymakers aim to address SI in a community, they may want to collect data based on zip codes and create targeted interventions for specific racial/ethnic groups within those zip code areas.

Reduction in the use of green spaces during the COVID-19 pandemic and its impact on mental health

Our study examined the use of green spaces before and during the pandemic in a large cohort of Italian twins and evaluated its impact on measures of mental health (depressive, anxiety, stress symptoms). Twins were analysed as individuals and as pairs. A twin design approach was applied to minimize confounding by genetic and shared environmental factors. Questionnaires from 2,473 twins enrolled in the Italian Twin Registry were screened. Reduced green space use was associated with significantly higher levels of depression, anxiety and distress. Being a woman, residing in urban areas, and having a high perceived risk of the outbreak resulted in a higher likelihood to modify green space use, with a negative impact on mental health.

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.

Associations of greenspace use and proximity with self-reported physical and mental health outcomes during the COVID-19 pandemic

Research has shown that the COVID-19 pandemic affected individual's mental and physical health. The aim of this study was to estimate associations between greenspace use and proximity with perceived mental and physical health during the COVID-19 pandemic. We surveyed metropolitan Philadelphia residents, October 20-December 1, 2020, about walking time to the nearest greenspace from their home, frequency of greenspace use in the past 30 days, change in frequency of greenspace use during the COVID-19 pandemic, and perceived physical and mental health outcomes. We ran unadjusted and adjusted log-binomial regression models to derive Risk Ratio (RR) and 95% Confidence Intervals (CI) estimates of associations of loneliness, physical and mental health outcomes with: (1) self-reported walking time to nearest greenspace; (2) reported greenspace use frequency; and (3) changes in greenspace use frequency. Of 485 survey participants, 244 (51.4%) reported feeling lonelier, 147 (31.37%) reported higher perceived stress, 261 (54.9%) reported worsened mental health, and 137 (28.7%) reported worsened physical health during vs. before the start of pandemic-restrictions in mid-March of 2020. After adjustment for gender, age, and change in financial status, RR estimates suggested modest protective associations between visiting greenspaces more frequently during vs. before the pandemic and worsened mental (RR: 0.84, 95% CI: 0.70-1.00), and physical health (RR 0.77, 95% CI: 0.56-1.10), and loneliness (RR: 0.91, 95% CI: 0.75-1.1) and perceived stress (RR 0.83, 95% CI: 0.61-1.13). Shorter walking distances to the nearest greenspace were associated with reduced risk of reporting worsened physical health and higher perceived stress; however, living shorter walking distances from greenspace were not associated with protection against worsened mental health or loneliness. These results suggest that active greenspace use may provide mental and physical health protection, particularly during a stressful public health crisis.

How the COVID-19 pandemic changed patterns of green infrastructure use: A scoping review

The use of green infrastructure (GI) has been established as a way to alleviate stress and the COVID-19 pandemic has placed a new emphasis on the importance of GI as both a coping mechanism and a source of recreation. This scoping review seeks to address whether the COVID-19 pandemic affected the use of GI, specifically the ways in which the pandemic altered visitation patterns and the frequency of the use of GI. This review identifies studies that explore the relationship between the COVID-19 pandemic and GI use and assesses whether the pandemic has altered the use of GI, including whether GI use increased, decreased, or remained the same and examines potential changes in visitation structure as well as other effects studied. This review also discusses how future planning for GI can consider the lessons learned from the pandemic. Key findings suggest that GI use increased, as did visitors' appreciation for GI and its benefits. The use of local GI to one's home also increased in importance. Decreases in visitation were typically a result of COVID-19 lockdown restrictions and fear of viral transmission within GI.

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.

Assessment of Doubly Disadvantaged Neighborhoods by Healthy Living Environment Exposure

Good access to greenspace and healthy food has commonly been found to be positively associated with health outcomes, despite some studies finding no significant relationship between them. Examining inequalities in accessing greenspace and healthy food among different disadvantaged neighborhoods can help reveal the disadvantaged races/ethnicities in cities with a high level of residential segregation (i.e., population of the same race/ethnicity concentrated in the same neighborhoods). However, existing studies have mostly focused on measuring the inequalities in accessing either greenspace or healthy food alone, which can lead to the inaccurate depiction of disadvantaged neighborhoods in healthy living environments. Therefore, this paper aims at improving the assessment of doubly disadvantaged neighborhoods by considering accessibility to both greenspace and healthy food in the City of Chicago. Our results show that black-majority neighborhoods are the most doubly disadvantaged in terms of exposure to healthy living environments. This study can help guide policymakers to divert more resources towards the improvement of the urban environment for the most doubly disadvantaged neighborhoods.

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

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

Urban greenspace and anxiety symptoms during the COVID-19 pandemic: A 20-month follow up of 19,848 participants in England

This study examined the association between greenspace and the growth trajectories of anxiety symptoms during the COVID-19 pandemic. Using data from 19,848 urban residents in England who were followed for 20 months between March 2020 and October 2021, we found that living in an area with higher greenspace coverage (exposure) was associated with fewer anxiety symptoms independent of population density, area deprivation levels, socio-demographics, and health profiles. There was limited evidence that greenspace was related to the change of anxiety symptoms over time. No association with anxiety trajectories was found when considering distance to nearest greenspace (proximity), highlighting potentially differential mental health effects of simply having access to local parks and recreation areas versus living in areas of greater natural environment land cover. These findings have important implications for mental health intervention and policymaking.

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.

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

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

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

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

Designing for COVID-2x: Reflecting on Future-Proofing Human Habitation for the Inevitable Next Pandemic

The COVID-19 pandemic of 2020–2022 has revealed the vulnerability of modern society to a highly contagious airborne virus. Many spaces in the urban and built environment designed during the late twentieth and early twenty-first century are ill-suited to maintain the level of social distancing required to reduce the probability of virus transmission. Enclosed spaces—in particular, communal circulation spaces such as corridors, elevators and lobbies—have proven loci of transmission, together with circulating reticulated air and lack of proper ventilation. While urban planning needs to incorporate the lessons learnt during COVID-19 in order to future-proof our communities through the provision of well-designed greenspaces, the main burden will fall on architects, who will play an instrumental role in designing buildings that are fit-for purpose. This conceptual paper reviews the status quo and discusses a number of strategies to future-proof human habitation for the inevitable next pandemic.

Mental health and well-being in times of COVID-19: A mixed-methods study of the role of neighborhood parks, outdoor spaces, and nature among US older adults

The role of parks and nature to support well-being during the COVID-19 pandemic is uncertain. To examine this topic, we used mixed-methods data collected in April-May 2020 from US adults aged ≥55 in the COVID-19 Coping Study. We quantitatively evaluated the associations between number of neighborhood parks and depression, anxiety, and loneliness; and conducted qualitative thematic analysis of participants' outdoor experiences. Among urban residents, depression and anxiety were inversely associated with the number of neighborhood parks. Thematic analysis identified diverse engagement in greenspaces that boosted physical, mental, and social well-being. The therapeutic potential of outdoor and greenspaces should be considered for interventions during future epidemics.

Relationships between Green Space Attendance, Perceived Crowdedness, Perceived Beauty and Prosocial Behavior in Time of Health Crisis

An emergent body of evidence shows the impact of exposure to nature on prosocial attitudes and interpersonal relationships. This study examines relationships between green space (GS) attendance, perceived beauty of the space, perceived crowdedness of the space, and prosocial behavior. A cross-sectional study with snowball sampling was conducted in April 2020. All participants (N = 1206) responded to an online survey that included a French version of the social value orientation slider measure (used as a proxy for prosocial behavior), questions about the lockdown, and their GS attendance. After retaining only participants who had visited a GS at least once since the beginning of their lockdown (N = 610), multiple linear regressions showed that social orientation scores demonstrated associations with the interaction between GS attendance and perceived crowdedness of the GS, suggesting that attending low crowded GS is linked to increasing prosociality. These results provide insight into the roles that GS can have during a health crisis and suggest some practical implications.

Outdoor Activities Associated with Lower Odds of SARS-CoV-2 Acquisition: A Case-Control Study

Access to recreational physical activities, particularly in outdoor spaces, has been a crucial outlet for physical and mental health during the COVID-19 pandemic. There is a need to understand how conducting these activities modulates the risk of SARS-CoV-2 infection. In this case–control study of unvaccinated individuals conducted in San Francisco, California, the odds of testing positive to SARS-CoV-2 were lower for those who conducted physical activity in outdoor locations (adjusted odds ratio [aOR]: 0.16, 95% confidence interval [CI]: 0.05, 0.40) in the two weeks prior to testing than for those who conducted no activity or indoor physical activity only. Individuals who visited outdoor parks, beaches, or playgrounds also had lower odds of testing positive to SARS-CoV-2 (aOR: 0.28, 95% CI: 0.11, 0.68) as compared with those who did not visit outdoor parks, beaches, or playgrounds. These findings, albeit in an unvaccinated population, offer observational data to support pre-existing ecological studies that suggest that activity in outdoor spaces lowers COVID-19 risk.

The mental health of children and young people living in big cities in a revolving postpandemic world

PURPOSE OF REVIEW

The world's population is increasingly urban, with most children and young people growing up and living in cities. Evidence suggests that urbanicity is linked to an increased risk for the development of mental health disorders. Rather than an accumulation of risk factors, urbanization is a complex process that profoundly structures living conditions. In this sense, it is timely to discuss what are the social and structural determinants of mental health of children and young people in such settings.

RECENT FINDINGS

Three domains of determinants of mental health were selected for discussion: economics and living conditions, crime and violence, and urban layouts. For each, we debated realities faced by urban children and young people, providing an overview of recent evidence on implications for mental disorders and well being. We also discuss the potential impacts of the covid-19 pandemic on each domain, as well as recommendations for future action.

SUMMARY

Structural factors are of major relevance for the mental health of children and young people living in cities. The agenda of mental health promotion and prevention must include whole-of-society interventions aimed at improving living conditions, including economic and social capital, violence prevention and urbanistic planning.

Barriers Affecting Women’s Access to Urban Green Spaces during the COVID-19 Pandemic

During the COVID-19 pandemic, urban green spaces (UGS) have gained relevance as a resilience tool that can sustain or increase well-being and public health in cities. However, several cities in Latin America have seen a decrease in their UGS use rates during the health emergency, particularly among vulnerable groups such as women. Using Mexico City as a case study, this research examines the main barriers affecting women’s access to UGS during the COVID-19 pandemic in Latin America. We applied a sequential mixed-methods approach in which the results of a survey distributed via social media in June 2020 to women aged 18 and older were used to develop semi-structured interviews with 12 women during October 2020. One year later, in November 2021, the continuity of the themes was evaluated through focus groups with the same group of women who participated in the interviews. Our results suggest that (1) prohibiting access to some UGS during the first months of the pandemic negatively impacted UGS access for women in marginalized neighborhoods; (2) for women, the concept of UGS quality and safety are intertwined, including the security level of the surrounding streets; and (3) women who live in socially cohesive neighborhoods indicated using UGS to a greater extent. Our findings highlight that while design interventions can affect women’s willingness to use UGS by improving their perceived safety and comfort, they remain insufficient to fully achieve equity in access to UGS.

Urban green space interaction and wellbeing - investigating the experience of international students in Berlin during the first COVID-19 lockdown

This qualitative study explores the topic of mental health/wellbeing with reference to exposure to urban green space (UGS). It builds on previous research, which has highlighted the potential for green space interaction for supporting positive emotional and mental wellbeing, particularly in times of stress and uncertainty. Using this basis, the paper explores whether UGS interaction also helped to mitigate the negative mental health impacts brought about by the first COVID-19 lockdown. The specific focus is on students and expatriates living in Berlin, Germany as this population groupbecame increasingly vulnerable during this time as a result of uncertainty and restrictions in their daily lives brought about the enforced lockdown measures. More specifically, this paper investigates how a change in their daily routines created opportunities to interact with and experience UGS differently and how their emotional response and perception towards these spaces changed. Semi-structured interviews allowed for stories, experiences and emotions to unfold, which revealed that the participants' gained an appreciation for the potential of UGS to support their wellbeing during a stressful and isolating time. UGS interaction also allowed them to form tangible memories of summer 2020 as it provided a safe arena for them to maintain social contact with friends outdoors, or to escape their home environment and experience respite and relaxation in a natural setting. The findings demonstrate that for this sub-group of the population UGS became a reliable constant and a valuable public health resource, which may also help to mitigate the long-term adverse mental health impacts of the pandemic.

Green Space Visits and Barriers to Visiting during the COVID-19 Pandemic: A Three-Wave Nationally Representative Cross-Sectional Study of UK Adults

Green spaces have been found to promote physical activity, social contact, and mental wellbeing, however, there are inequalities in the use and experience of green spaces. The United Kingdom’s (UK) response to the COVID-19 pandemic imposed very substantial changes on its citizens’ lives which could plausibly affect their willingness to visit green spaces. These sudden lifestyle changes severely affected the population’s mental health, leading to a greater dependency on the positive influence of nature in reducing stress and improving mood. Whilst early cross-sectional evidence suggested an increased orientation to nature and visits to green spaces as a response to COVID-19 ‘lockdowns’, there is little longitudinal evidence about how sustained and equal these changes may have been. This study explored green space visits, barriers to visiting, and the inequalities of both of those over an entire year of the pandemic in the UK. Three waves of nationally representative cross-sectional surveys were administered by YouGov in April 2020, November 2020, and April 2021 (N = 6713). Data included reported visits to green spaces and, for those with no or infrequent visiting, perceived barriers including those plausibly related to the risk of COVID-19. Green space visits increased over the year as lockdown restrictions were relaxed; 68% of respondents reported green space visits in April 2021, compared with 49% in April 2020. However, the socio-economic inequalities in use were sustained and increased. COVID-19 related barriers fell over time, but there were indications of increased interest in green spaces among younger people. Further action is required to ensure that the positive impacts of green spaces are experienced equally, and that good quality green space is accessible to all.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Nexus between Cultural Heritage Management and the Mental Health of Urban Communities

In authorized cultural heritage management discourse, heritage sites can be included in local government heritage registers if their aesthetic, scientific, historic or social values are deemed significant. While notionally providing protection from major alterations and destruction for the benefit of future generations, such listings primarily serve the present generation whose values they reflect. This paper considers the role that cultural heritage places play in terms of community identity and their contribution to a sense of place, to place attachment and, by implication, to personal and community mental health.

COVID-19 Pandemic: The Impact of COVID-19 on Mental Health and Life Habits in the Canadian Population

OBJECTIVES

The study aims to investigate the rate of clinical depression in the adult population during the COVID-19 pandemic, as well as the changes in anxiety, distress, suicidal ideation, and their relations with several personal and interpersonal/social variables.

METHODS

This is an epidemiological, non-interventional study. It is part of an international multi-center study, with the main site at the Aristotle University of Thessaloniki, in Greece (COMET-G Study). We are presenting aspects of the research involving the Canadian site, based on 508 Canadian responders to the online survey (QAIRE).

RESULTS

Of the 508 responders, 72.2% were females aged 42.57 ± 14.00 years; 27.2% were males aged 42.24 ± 15.49 years; and 0.6% were others aged 46.33 ± 17.79 years. Increased anxiety during the lockdown was reported by 69.3% of those surveyed. The rate of suicidal thoughts increased in 19.5% of participants during the lockdown. Depression was reported by 22% of responders, while distress was present in 18.4%. We found a greater prevalence of depression, but not distress, in individuals with a history of any mental disorder. Based on the multiple regression analysis, we found four CORE factors equally influencing the changes in mental health during the lockdown (gender, quality of sleep, family conflicts, and changes in daily routine). In the Canadian population, two major changes acted as protective factors, significantly expressed when compared with the worldwide tendencies: fewer financial difficulties; and an increase in religious beliefs.

CONCLUSION

The rate of major depression, distress, and suicidal ideation was higher in Canadians than in the worldwide population (per COMET-G), but the relative risk to develop depression in the presence of a history of mental disorders was lower. Almost 90% of Canadians believed in the real story of COVID source of provenience.

Exercising under COVID-2x: Conceptualizing Future Green Spaces in Australia’s Neighborhoods

The COVID-19 pandemic has proven to be a social and economic disruptor on a global scale, severely curtailing people’s ability to travel and engage in many recreation activities. Periodic lockdown and stay-at-home orders have exacerbated the situation. In this social climate, urban green spaces have attained a high significance for the maintenance of the physical and mental health of the population. Given the presence of similar coronaviruses in animal populations, it can be predicted that future epidemics and even pandemics will occur. Urban planning needs to incorporate the lessons learnt during COVID-19 in order to future-proof our communities. This paper reviews the role that urban green spaces played during the COVID-19 pandemic. Based on these observations, the paper discusses a range of options for the provision of pandemic-sensitive spaces for physical exercise and mental recreation. Design concepts for long-term planning adjustments as well as for future ad-hoc solutions are provided. These include the provision of social distancing ‘pods’ embedded in design and landscaping of permanent parks, the design of ad-hoc, socially distanced ‘parklets’ on a quietened street and a rethink of the design of curb-to-boundary setbacks (nature strip) in residential streets.

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.

Lärm und Luftverschmutzung: Ihr Einfluss auf psychische Erkrankungen

Immer mehr Studien belegen die Einflüsse von Lärm und Luftverschmutzung als bedeutsame Umweltrisikofaktoren für kardiovaskuläre Erkrankungen. Weniger gut geklärt ist, wie diese Faktoren die psychische Gesundheit beeinflussen. Aktuelle Studienergebnisse zeigen, dass Umgebungslärm (vor allem Verkehrslärm) und verschiedene Bestandteile von Luftverschmutzung (vor allem Feinstaub) das Risiko für psychische Erkrankungen, insbesondere Depressionen und Angststörungen, erhöhen können. Pathophysiologische Mechanismen umfassen das enge Zusammenspiel von biologischen (wie oxidativem Stress und Inflammation) und psychosozialen Faktoren (wie mentalem Stress, subjektive Lärmbelästigung und -sensitivität). Umweltrisikofaktoren wie Lärm- und Luftverschmutzung können einen signifikanten Einfluss auf die psychische Gesundheit ausüben. Aufgrund der teils heterogenen Studienergebnisse und der limitierten Verfügbarkeit von methodisch hochwertigen Längsschnittstudien sind zwingend weitere Untersuchungen notwendig, um die zugrunde liegenden Mechanismen zu verstehen und präventive Maßnahmen abzuleiten.