The relationship between greenspace exposure and psychopathology symptoms: A systematic review

Unique associations among multiple facets of greenspace exposure and emotional and behavioral adjustment in preadolescence: A daily diary study

Research has shown that the frequency, duration, and intensity of greenspace exposure are significantly associated with children's adjustment. However, most studies have examined these facets separately. There is a lack of research that integrates them to offer a more comprehensive understanding of their unique associations with adjustment. This study investigates the unique associations between various facets of greenspace exposure and children's emotional (happiness and emotional problems) and behavioral (helping behavior and direct aggression) adjustment at both the daily and individual levels. The sample included 509 children (235 boys; Mage = 10.58 years, SD = 0.85 years) who completed a 14 days diary on greenspace exposure and adjustment. Multilevel analyses revealed that greenspace exposure (versus nonexposure) was associated with adjustment, and the various facets showed unique associations with adjustment. Specifically, on days when children were exposed to greenspace with more attributes than usual, they reported greater same-day happiness and fewer emotional problems. Compared with children who were exposed to greenspace with fewer attributes, children who were exposed to greenspace with more attributes on average presented greater happiness and more helping behaviors. With respect to duration, on days when children spent more time in greenspace than usual, they reported greater same-day happiness and more helping behaviors. However, frequency was not significantly associated with adjustment at either level. Our findings underscore the importance of enhancing the attributes of greenspace in the construction of child-friendly cities. Practitioners may consider increasing the number of opportunities for children to be exposed to greenspace with rich attributes in greenspace-based intervention programs.

Associations of prenatal exposure to residential greenspace and active living environments with cerebral palsy: A population-based cohort study in Ontario, Canada

Background

Prenatal exposure to environmental factors, such as greenspace and active living environments, has been associated with numerous health benefits, including improved neurodevelopmental outcomes. Although cerebral palsy (CP) is not typically linked to these exposures, emerging evidence suggests that exposure to environmental factors during pregnancy may influence brain development, making it important to explore their potential role in CP risk.

Methods

We conducted a retrospective cohort study using health administrative data from Ontario, Canada, between 1 April 2002 and 31 December 2020. We identified 1,436,411 mother-infant pairs, of which 2,883 were diagnosed with CP during the follow-up period. Exposures of interest included the Normalized Difference Vegetation Index (NDVI), Green View Index (GVI), and park proximity. The Canadian Active Living Environments index was also utilized. Cox proportional hazards models estimated hazard ratios (HRs) for CP risk associated with these environmental exposures, adjusting for potential confounders.

Results

Interquartile range (IQR) increases in NDVI (HR = 1.040; 95% confidence interval [CI]: 0.987, 1.096; per IQR = 0.1) and GVI (HR =0.989; 95% CI: 0.943, 1.038; per IQR = 10.05%) were not significantly associated with CP risk. Similar results were found for quartile increases of NDVI and GVI. Residential proximity to parks at birth was associated with a reduction in CP risk (HR = 0.946; 95% CI: 0.904, 0.990; per 0.06 increase in park proximity index), after adjusting for active living environment and air pollution.

Conclusions

Our study suggests that living closer to parks reduces the risk of CP. Further research should investigate these protective effects and consider other dimensions of greenspace quality and usability.

Virtual nature and well-being: Exploring the potential of 360° VR

This proof-of-concept study investigates the potential of immersive 360° VR nature videos to enhance emotional well-being and nature connectedness, focusing on their use as e-health interventions within social marketing initiatives. The research examined four key variables: (i) presence, or the extent to which participants felt immersed in the VR experience; (ii) emotional responses, measured by changes in participants' positive and negative affect; (iii) user experience, including enjoyment and engagement; and (iv) nature connectedness, reflecting participants' state of connection to the natural world. Using a mixed-method approach, participants (n = 63) engaged with four VR nature videos, with presence, emotional states and nature connectedness measured before and after the experience. Results showed high levels of presence, with participants reporting feelings of calmness, escape and connection to nature. Positive affect increased post-VR, although negative affect remained unchanged. Nature connectedness improved across all participants, highlighting the potential of VR nature experiences to support well-being. Individual differences, such as prior VR experience and gender, influenced perceptions, emphasising the need to tailor interventions. This study provides a foundation for using 360° VR nature videos in social marketing to promote emotional well-being, particularly for those with limited access to natural environments.

Examining associations of air pollution and green space with depressive symptoms in adults: A LongITools cross-cohort analysis

OBJECTIVES

Evidence suggests that high levels of air pollution and less green space increase depressive symptoms in adults. However, results are mixed and cross-cohort comparisons are scarce, largely due to heterogeneity in exposure assessment. Also, the impact of these exposures on the trajectory of depressive symptoms over time has been less studied. We investigated the association of air pollution and green space with depressive symptoms in adulthood and whether these exposures modify the trajectory of depressive symptoms leveraging harmonized data from four population-based cohorts across the Netherlands and United Kingdom (UK).

METHODS

We analyzed data from the Dutch Famine Birth Cohort (DFBC) (n = 840, baseline ages: 56-61), and the Rotterdam Study (RS) (RS-I n = 4,049, baseline ages: 61-101 and RS-II n = 2,861, baseline ages: 55-99), in the Netherlands, and the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 17,100, baseline ages: 18-71) in the UK, each using a different validated instrument for depressive symptoms, with 3-11 repeated measures. European-wide environmental data was linked to participants' addresses at baseline. Linear mixed-models were used to estimate associations of air pollution and green space with standardized cohort-specific depressive symptoms, and whether these exposures modify the trajectory of depressive symptoms.

RESULTS

Long-term exposure to fine particulate matter (PM2.5) was positively associated with overall higher standardized depressive symptom scores in ALSPAC and RS-I (β per 10 μg/m3 increase in PM2.5: 0.07 SD, 95%CI 0.02, 0.11 and 0.13 SD, 95%CI 0.02, 0.24, respectively). Exposure to higher normalized difference vegetation index (NDVI) at 300 m buffer was associated with lower depressive symptoms in DFBC (β per 0.1 increase in NDVI: 0.08, 95%CI -0.14, -0.01). In RS-II, the positive effect of higher NDVI at 300-m buffer on depressive symptoms decreased over time, but this effect was very small (β per 0.1 increase in NDVI: 0.01 SD per year, 95%CI 0.00, 0.01).

CONCLUSION

Air pollution in the form of particulate matter as well as green space were associated with depressive symptoms across multiple cohorts. In the majority of cohorts, depressive symptoms increased with age, but we found little evidence that trajectories of depressive symptoms are influenced by exposure to environmental variables.

Recovery Horizons: Nature-Based Activities as Adjunctive Treatments for Co-Occurring Post-Traumatic Stress Disorder and Substance Use Disorders

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) frequently co-occur, and individuals with co-occurring PTSD and SUD often experience more complex treatment challenges and poorer outcomes compared to those with either condition alone. Integrative treatment approaches that simultaneously address both PTSD and SUD are considered the most effective and include both pharmacological and non-pharmacological strategies. In recent years, complementary interventions have garnered increased attention due to their broad appeal and potential therapeutic benefits in enhancing existing treatments for PTSD and SUD. This review explores the existing literature on the use of nature-based activities, such as hiking, camping, sailing, and surfing in treating individuals with co-occurring PTSD and SUD. Nature-based activities offer promising adjunctive benefits, including the reduction of PTSD symptoms and craving levels. While evidence supports the therapeutic value of nature-based activities, current research remains limited. Further research is needed to better understand their therapeutic role and to refine their implementation in clinical practice.

Neighborhood Resources Associated With Psychological Trajectories and Neural Reactivity to Reward After Trauma

Importance

Research on resilience after trauma has often focused on individual-level factors (eg, ability to cope with adversity) and overlooked influential neighborhood-level factors that may help mitigate the development of posttraumatic stress disorder (PTSD).

Objective

To investigate whether an interaction between residential greenspace and self-reported individual resources was associated with a resilient PTSD trajectory (ie, low/no symptoms) and to test if the association between greenspace and PTSD trajectory was mediated by neural reactivity to reward.

Design, Setting, and Participants

As part of a longitudinal cohort study, trauma survivors were recruited from emergency departments across the US. Two weeks after trauma, a subset of participants underwent functional magnetic resonance imaging during a monetary reward task. Study data were analyzed from January to November 2023.

Exposures

Residential greenspace within a 100-m buffer of each participant's home address was derived from satellite imagery and quantified using the Normalized Difference Vegetation Index and perceived individual resources measured by the Connor-Davidson Resilience Scale (CD-RISC).

Main Outcome and Measures

PTSD symptom severity measured at 2 weeks, 8 weeks, 3 months, and 6 months after trauma. Neural responses to monetary reward in reward-related regions (ie, amygdala, nucleus accumbens, orbitofrontal cortex) was a secondary outcome. Covariates included both geocoded (eg, area deprivation index) and self-reported characteristics (eg, childhood maltreatment, income).

Results

In 2597 trauma survivors (mean [SD] age, 36.5 [13.4] years; 1637 female [63%]; 1304 non-Hispanic Black [50.2%], 289 Hispanic [11.1%], 901 non-Hispanic White [34.7%], 93 non-Hispanic other race [3.6%], and 10 missing/unreported [0.4%]), 6 PTSD trajectories (resilient, nonremitting high, nonremitting moderate, slow recovery, rapid recovery, delayed) were identified through latent-class mixed-effect modeling. Multinominal logistic regressions revealed that for individuals with higher CD-RISC scores, greenspace was associated with a greater likelihood of assignment in a resilient trajectory compared with nonremitting high (Wald z test = -3.92; P < .001), nonremitting moderate (Wald z test = -2.24; P = .03), or slow recovery (Wald z test = -2.27; P = .02) classes. Greenspace was also associated with greater neural reactivity to reward in the amygdala (n = 288; t277 = 2.83; adjusted P value = 0.02); however, reward reactivity did not differ by PTSD trajectory.

Conclusions and Relevance

In this cohort study, greenspace and self-reported individual resources were significantly associated with PTSD trajectories. These findings suggest that factors at multiple ecological levels may contribute to the likelihood of resiliency to PTSD after trauma.

Exposure to green spaces and schizophrenia: a systematic review

The mental health benefits of exposure to green spaces are well known. This systematic review summarizes the evidence of green space exposure for people with schizophrenia spectrum disorders (SSDs), focusing on incidence and mental health outcomes, including mental health symptoms and health service use. The study was pre-registered (PROSPERO ID: CRD42023431954), and conducted according to PRISMA guidelines. Seven databases, reference lists, and gray literature sources were searched. Methodological quality was assessed using The Quality Assessment Tool for Quantitative Studies. 126 studies were screened, and 12 studies were eligible for inclusion. Seven studies found that exposure to green space was associated with a reduced risk of schizophrenia (lowest to highest green space exposure: HRs = 0.62-0.37; IRRs = 1.52-1.18), with five studies reporting a dose-response relationship. Of these studies, four examined childhood exposure and the remainder examined adult exposure. Regarding health service use, proximity to green space was not significantly associated with length of hospital admission, though greater green space exposure was associated with reduced hospital admission rates. Three studies found reduced symptoms of anxiety (d = -0.70-2.42), depression (d = -0.97-1.70) and psychosis (d = -0.94) with greater green space exposure. Exposure to green space reduces the risk of schizophrenia, and there is emerging evidence of the potential benefits of green space for reducing symptoms and health service use among people with SSDs. Future research using experimental and longitudinal designs will provide more robust evidence of the benefits of green space for people with SSDs.

Visual environment in schools and student depressive symptoms: Insights from a prospective study across multiple cities in eastern China

OBJECTIVE

To investigate the effects of the school visual environment on depressive symptoms in children and adolescents based on cohort study in eastern China. The school visual environment-related indicators included in this study comprise personal factors (visual impairment) and school-related factors (classroom lighting, school green spaces and school air quality).

METHOD

The follow-up cohort comprises 15,348 students from 283 primary and secondary schools in eastern China. This represents the one-year outcomes of a school-based myopia-mental health cohort study. Data collection includes basic demographics (age, gender, region, etc.), physical examination indicators, behavioral indicators, and school visual environment-related indicators.

RESULT

After a one-year follow-up, we found that compared to the more severe vision impairment group (≤4.0), healthy vision group (≥5.0) had a positive effect against the occurrence of depressive symptoms during consecutive follow-ups, with an RR value of 0.61 (95% CI: 0.57-0.66). Higher values of blackboard illumination appear to be associated with greater positive effects, with an RR (Q75%∼Q100% range) value of 0.87(95% CI: 0.81-0.93). School green spaces seem to exhibit relatively good positive effects when in the Q25%∼Q75% range. The combination of physical activity (Weekly high-intensity exercise) with school air quality(PM2.5≤50%)showed a better positive effect, with an RR value of 0.51(95%CI:0.48-0.55).

CONCLUSION

When addressing students' depressive symptoms, it is crucial to improve the visual environment both at the school level and in students' personal level. Paying appropriate attention to modifiable behaviors, like regular participation in high-intensity exercise sessions, can help alleviate students' depressive symptoms.

The Health-Related and Learning Performance Effects of Air Pollution and Other Urban-Related Environmental Factors on School-Age Children and Adolescents-A Scoping Review of Systematic Reviews

PURPOSE OF REVIEW

This scoping review aims to assess the impact of air pollution, traffic noise, heat, and green and blue space exposures on the physical and cognitive development of school-age children and adolescents. While existing evidence indicates adverse effects of transport-related exposures on their health, a comprehensive scoping review is necessary to consolidate findings on various urban environmental exposures' effects on children's development.

RECENT FINDINGS

There is consistent evidence on how air pollution negatively affects children's cognitive and respiratory health and learning performance, increasing their susceptibility to diseases in their adult life. Scientific evidence on heat and traffic noise, while less researched, indicates that they negatively affect children's health. On the contrary, green space exposure seems to benefit or mitigate these adverse effects, suggesting a potential strategy to promote children's cognitive and physical development in urban settings. This review underscores the substantial impact of urban exposures on the physical and mental development of children and adolescents. It highlights adverse health effects that can extend into adulthood, affecting academic opportunities and well-being beyond health. While acknowledging the necessity for more research on the mechanisms of air pollution effects and associations with heat and noise exposure, the review advocates prioritizing policy changes and urban planning interventions. This includes minimizing air pollution and traffic noise while enhancing urban vegetation, particularly in school environments, to ensure the healthy development of children and promote lifelong health.

Greenspaces And Cardiovascular Health

Accumulating evidence suggests that living in areas of high surrounding greenness or even brief exposures to areas of high greenery is conducive to cardiovascular health, which may be related to the environmental, social, psychological, and physiological benefits of greenspaces. Recent data from multiple cross-sectional, longitudinal, and cohort studies suggest that living in areas of high surrounding greenness is associated with a lower risk of all-cause and cardiovascular mortality. High levels of neighborhood greenery have been linked also to a decrease in the burden of cardiovascular disease risk factors as reflected by lower rates of hypertension, dyslipidemia, and diabetes. Those who live in greener environments report better mental health and more frequent social interactions, which can benefit cardiovascular health as well. In this narrative review, we discuss evidence linking greenspaces to cardiovascular health as well as the potential mechanisms underlying the beneficial effects of greenspaces, including the impact of vegetation on air, noise and light pollution, ambient temperature, physical activity, mental health, and biodiversity. We review literature on the beneficial effects of acute and chronic exposure to nature on cardiovascular disease risk factors, inflammation and immune function, and we highlight the potential cardiovascular effects of biogenic volatile organic compounds that are emitted by trees and shrubs. We identify current knowledge gaps in this area and underscore the need for additional population studies to understand more clearly and precisely the link between greenness and health. Such understanding is urgently needed to fully redeem the promise of greenspaces in preventing adverse environmental exposures, mitigating the effects of climate change, and creating healthier living environments.

Associations between the urban environment and psychotic experiences in adolescents

OBJECTIVE

In 2050 two-thirds of the world's population is predicted to live in cities, which asks for a better understanding of how the urban environment affects mental health. Urbanicity has repeatedly been found to be a risk factor, in particular for psychosis. Here, we explored what factors of the urban exposome underlie the association between urban characteristics and psychotic experiences (PE) in adolescents.

METHODS

Participants were 815 adolescents (mean age 14.84 years, SD 0.78) from an at-risk cohort (greater Rotterdam area, the Netherlands) oversampled on their self-reported emotional and behavioral problems. We used linear regression analysis to examine the association with detailed geodata on urbanicity (surrounding address density), green space density (high and low vegetation), and mixed noise levels (road, rail, air, industry, and wind power) with PE in adolescents. Analyses were adjusted for multiple socio-economic and parental confounders. Furthermore, we explored sex-interaction effects.

RESULTS

Higher surrounding address density and low greenspace density were each independently associated with more PE (B = 0.18, 95 % CI 0.02; 0.34 and B = 0.17, 95 % CI 0.01; 0.32, respectively). High mixed noise levels were only associated with more PE in boys (B = 0.23, 95 % CI 0.01; 0.46). A sex-interaction effect was found for high urbanicity (B = -0.46, 95 % CI -0.77; -0.14) and low greenspace density (B = -0.49, 95 % CI -0.73; -0.11), illustrating that these associations with PE were specific for boys.

CONCLUSION

Multiple characteristics of living in an urban area are associated with more PE in adolescent boys. Our observations provide leads for prevention of mental health problems via urban designing.

Brain capital, ecological development and sustainable environments

The importance of improving brain and mental health and developing sustainable environments is increasingly recognised. Understanding the syndemic interactions between these processes can help address contemporary societal challenges and foster global innovation. Here, we propose a green brain capital model that integrates environmental drivers of brain health and green skills necessary for long-term sustainability and discuss the role of interdisciplinary approaches in promoting individual and collective behavioural changes. We draw on existing literature and research to highlight the connections between brain health, environmental factors and green skills. Environmental factors and exposome can have long-lasting adverse effects on brain health, particularly in vulnerable populations. Investing in green brain capital can prepare societies to address global crises. Green skills, including creativity, ecological intelligence and digital literacy, are critical for promoting sustainable environments. Access to nature improves brain and mental health, and interdisciplinary fields such as neurourbanism can inform urban planning to benefit citizens' well-being. Building brain capital and environmental sustainability interactions requires increasing future generations' awareness, education and training. A comprehensive approach to green brain capital can enable greater societal scaling, synergistically protecting brain health and environmental sustainability.

Residential greenspace and anxiety symptoms among Australian women living in major cities: A longitudinal analysis

Despite an increasing number of studies demonstrating the potential mental health benefits of greenspace, few longitudinal studies have been reported. We aimed to assess associations between two metrics of residential greenspace exposure and anxiety symptoms in a cohort of Australian women living in major cities. Our study comprised 3,938 women, born between 1973 and 78. Anxiety symptoms in the previous month were assessed at follow-up every three years during 2003-2018, using the anxiety subscale of the Goldberg Anxiety and Depression Scale. The three-month seasonal average normalized difference vegetation index (NDVI) was estimated from 30 m Landsat satellite images in a 500 m buffer (NDVI500m) around participants' address at each survey (higher NDVI indicates more green vegetation). The annual fractional cover of non-photosynthesising vegetation was estimated (fNPV500m, with higher values indicating greater levels of dead leaf litter or dry grass). A generalised estimating equation assessed associations between greenspace measures and anxiety symptoms (as odds ratios [ORs]), adjusting for repeated outcomes and individual-level covariates. Additional analyses focused on women experiencing substantial changes in between-survey exposure due to moving, and adjusting for nitrogen dioxide (NO2) and fine particulate matter (PM2.5) exposure, among others. A standard deviation (SD) (0.12 units) increase in NDVI500m was significantly associated with lower odds of anxiety symptoms (OR: 0.96, 95% CI: 0.93-0.99) in the adjusted model. An SD (5.2%) increase in annual fNPV500m was consistent with the direction expected for that exposure, but not significant in the adjusted model (OR: 1.03, 95% CI: 0.99-1.07). NDVI500m was modestly attenuated when air pollutants were adjusted for, while fNPV500m only became significant when PM2.5 was adjusted for. Between-survey contrasts had no clear effect for NDVI500m. Moving to a higher fNPV500m area, compared with a similar fNPV500m area, was consistently associated with anxiety symptoms (OR: 1.15, 95% CI: 1.02-1.31). NDVI500m was generally associated with lower odds of anxiety symptoms, while fNPV500m was generally associated with higher odds of anxiety, depending on the covariates considered.

The Influence of Greenspace Exposure on Affect in People With and Those Without Schizophrenia: Exploratory Study

BACKGROUND

Exposure to natural vegetation (ie, "greenspace") is related to beneficial outcomes, including higher positive and lower negative affect, in individuals with and those without mental health concerns. Researchers have yet to examine dynamic associations between greenspace exposure and affect within individuals over time. Smartphone-based ecological momentary assessment (EMA) and passive sensors (eg, GPS, microphone) allow for frequent sampling of data that may reveal potential moment-to-moment mechanisms through which greenspace exposure impacts mental health.

OBJECTIVE

In this study, we examined associations between greenspace exposure and affect (both self-reported and inferred through speech) in people with and those without schizophrenia spectrum disorder (SSD) at the daily level using smartphones.

METHODS

Twenty people with SSD and 14 healthy controls reported on their current affect 3 times per day over 7 days using smartphone-based EMA. Affect expressed through speech was labeled from ambient audio data collected via the phone's microphone using Linguistic Inquiry and Word Count (LIWC). Greenspace exposure, defined as the normalized difference vegetation index (NDVI), was quantified based on continuous geo-location data collected from the phone's GPS.

RESULTS

Overall, people with SSD used significantly more positive affect words (P=.04) and fewer anger words (P=.04) than controls. Groups did not significantly differ in mean EMA-reported positive or negative affect, LIWC total word count, or NDVI exposure. Greater greenspace exposure showed small to moderate associations with lower EMA-reported negative affect across groups. In controls, greenspace exposure on a given day was associated with significantly lower EMA-reported anxiety on that day (b=-0.40, P=.03, 95% CI -0.76 to -0.04) but significantly higher use of negative affect words (b=0.66, P<.001, 95% CI 0.29-1.04). There were no significant associations between greenspace exposure and affect at the daily level among participants with SSD.

CONCLUSIONS

Our findings speak to the utility of passive and active smartphone assessments for identifying potential mechanisms through which greenspace exposure influences mental health. We identified preliminary evidence that greenspace exposure could be associated with improved mental health by reducing experiences of negative affect. Future directions will focus on furthering our understanding of the relationship between greenspace exposure and affect on individuals with and those without SSD.