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Patwary MM, Bardhan M, Disha AS, Dzhambov AM, Parkinson C, Browning MHEM, Labib SM, Larson LR, Haque MZ, Rahman MA, Alam MA, Tareq MF, Shuvo FK. Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024:124284. [PMID: 38821342 DOI: 10.1016/j.envpol.2024.124284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024]
Abstract
Prior reviews have highlighted that nature exposure was a valuable coping strategy enchancing 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) assessment 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 OR=0.71, 95%CI=0.61, 0.82), I2=0%, n=3] and anxiety [(Pooled odds ratio [OR]=0.73, 95%CI=0.63, 0.84), I2=0%, n=3]. Increased time in green spaces were 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 estimate during COVID-19 period [ES]=0.10, 95%CI=0.07, 0.14), I2=0%, n=2] and general mental health [(Pooled standardized beta estimate [ES]=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.
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Affiliation(s)
- Muhammad Mainuddin Patwary
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh.
| | - Mondira Bardhan
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA
| | - Asma Safia Disha
- Department of Environmental Science and Management, North South University, Bashundhara, Dhaka-1229, Bangladesh; Environment and Sustainability Research Initiative, Khulna, Bangladesh
| | - Angel M Dzhambov
- Research Group "Health and Quality of Life in a Green and Sustainable Environment", Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
| | - Colby Parkinson
- Department of Recreation, Park, and Tourism Management, Pennsylvania State University, University Park, PA, USA
| | - Matthew H E M Browning
- Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA
| | - S M Labib
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Vening Meineszgebouw A, Princetonlaan 8a, 3584 CB, Utrecht, the Netherlands
| | - Lincoln R Larson
- Department of Parks, Recreation & Tourism Management, North Carolina State University, Raleigh, NC, USA
| | - Md Zahidul Haque
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh
| | - Md Atiqur Rahman
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh
| | - Md Ashraful Alam
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Md Faysal Tareq
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Institute of Environmental Sciences (CML), Leiden University, Netherlands
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Patwary MM, Sakhvidi MJZ, Ashraf S, Dadvand P, Browning MHEM, Alam MA, Bell ML, James P, Astell-Burt T. Impact of green space and built environment on metabolic syndrome: A systematic review with meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 923:170977. [PMID: 38360326 DOI: 10.1016/j.scitotenv.2024.170977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/03/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
Metabolic Syndrome presents a significant public health challenge associated with an increased risk of noncommunicable diseases such as cardiovascular conditions. Evidence shows that green spaces and the built environment may influence metabolic syndrome. We conducted a systematic review and meta-analysis of observational studies published through August 30, 2023, examining the association of green space and built environment with metabolic syndrome. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 18 studies that met the inclusion criteria and were included in our review. Most were from China (n = 5) and the USA (n = 5), and most used a cross-sectional study design (n = 8). Nine studies (50 %) reported only green space exposures, seven (39 %) reported only built environment exposures, and two (11 %) reported both built environment and green space exposures. Studies reported diverse definitions of green space and the built environment, such as availability, accessibility, and quality, particularly around participants' homes. The outcomes focused on metabolic syndrome; however, studies applied different definitions of metabolic syndrome. Meta-analysis results showed that an increase in normalized difference vegetation index (NDVI) within a 500-m buffer was associated with a lower risk of metabolic syndrome (odds ratio [OR] = 0.90, 95%CI = 0.87-0.93, I2 = 22.3 %, n = 4). A substantial number of studies detected bias for exposure classification and residual confounding. Overall, the extant literature shows a 'limited' strength of evidence for green space protecting against metabolic syndrome and an 'inadequate' strength of evidence for the built environment associated with metabolic syndrome. Studies with more robust study designs, better controlled confounding factors, and stronger exposure measures are needed to understand better what types of green spaces and built environment features influence metabolic syndrome.
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Affiliation(s)
- Muhammad Mainuddin Patwary
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh.
| | - Mohammad Javad Zare Sakhvidi
- Department of Occupational Health, School of Public Health, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sadia Ashraf
- Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Matthew H E M Browning
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Md Ashraful Alam
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Michelle L Bell
- Yale School of the Environment, Yale University, New Haven, CT, United States
| | - Peter James
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Harvard University, Boston, MA, USA
| | - Thomas Astell-Burt
- School of Architecture, Design, and Planning, University of Sydney, Australia
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Patwary MM, Bardhan M, Browning MHEM, Astell-Burt T, van den Bosch M, Dong J, Dzhambov AM, Dadvand P, Fasolino T, Markevych I, McAnirlin O, Nieuwenhuijsen MJ, White MP, Van Den Eeden SK. The economics of nature's healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 914:169635. [PMID: 38159779 DOI: 10.1016/j.scitotenv.2023.169635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77 % of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.
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Affiliation(s)
- Muhammad Mainuddin Patwary
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh.
| | - Mondira Bardhan
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Department of Park, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Matthew H E M Browning
- Department of Park, Recreation and Tourism Management, Clemson University, Clemson, SC, USA.
| | - Thomas Astell-Burt
- School of Architecture, Design, and Planning, University of Sydney, Australia
| | - Matilda van den Bosch
- ISGlobal, Barcelona, Spain; European Forest Institute, Biocities Facility, Rome, Italy; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jiaying Dong
- Department of Park, Recreation and Tourism Management, Clemson University, Clemson, SC, USA; School of Architecture, Clemson University, Clemson, SC, USA
| | - Angel M Dzhambov
- Research Group "Health and Quality of Life in a Green and Sustainable Environment", Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Iana Markevych
- Research Group "Health and Quality of Life in a Green and Sustainable Environment", Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Olivia McAnirlin
- Department of Park, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Mark J Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mathew P White
- Cognitive Science Hub, University of Vienna, Vienna, Austria
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