Does greenery experienced indoors and outdoors provide an escape and support mental health during the COVID-19 quarantine?

Quantitative evaluation of urban green exposure and its impact on human health: A case study on the 3-30-300 green space rule

BACKGROUND AND AIMS

Urban green spaces offer various health benefits, yet the impact of comprehensive green exposure criteria on multidimensional health remains unclear. The 3-30-300 green space rule represents the green exposure indicators with specific thresholds. This study aims to quantitatively evaluate urban green exposure in cities and can support investigation of its relationship with human health.

METHODS

We conducted a cross-sectional study based on 902 investigated individuals in 261 residential locations aged 11-95 years from Xiamen City, China. 3-30-300 green exposure was calculated using field surveys, GIS, and Baidu Maps Application Programming Interface (API). Physical health data was based on Occupational Stress Indicator (OSI)-2. Mental health was from the 12-item General Health Questionnaire (GHQ-12). Social health was from a self-constructed evaluation questionnaire. Statistical analyses were conducted using Geographically Weighted Regression and Geographically Weighted Logistic Regression for global and local effects on green exposure and multidimensional health.

RESULT

Among the investigated individuals, only 3.55 % (32/902) fully meet the 3-30-300 rule in Xiamen. Global results show that individuals achieved at least 30 % vegetation coverage (Yes) is associated with better physical (β: 0.76, p < 0.01) and social (β: 0.5, p < 0.01) health. GWLR global results indicate that individuals can "see at least 3 trees from home" meeting one (OR = 0.46, 95%CI: 0.25-0.86, p < 0.05) or two (OR = 0.41, 95%CI: 0.22,0.78, p < 0.01; OR = 0.24, 95%CI: 0.07-0.77, p < 0.05) 3-30-300 rule components are significantly associated with reduced medical visits and hospitalizations refer to not met these criterias. In the GWR local analysis, achieved 30 % vegetation cover is significantly related to improved social health at all locations. Meeting any two indicators also contribute to improved social health (n = 511, β: 0.46-0.51, P < 0.05).

CONCLUSION

Green exposure indicators based on the 3-30-300 rule guiding healthy urban green space development. We observed multidimensional health benefits when 1/3 or 2/3 of the indicators were met.

A systematic review of the relationship between natural environments and physiological and mental health during different stages of the COVID-19 pandemic

COVID-19 has altered how individuals interact with natural environments. Numerous studies have investigated the effects of such environments on health. However, how natural environments influenced individuals' physiological and mental health during various stages of the COVID-19 pandemic remains unclear. Therefore, we conducted this study to investigate the effects of natural environments on individuals' physiological and mental health during different stages of the pandemic; we also identified factors that mediated these effects. Overall, we evaluated the importance of natural environments during challenging times. This study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The pandemic period was divided into three stages on the basis of severity: pandemic (March 2020 - February 2022), easing (February 2022-September 2022), and post-acute COVID pandemic (September 2022 - present). An initial pool of 3018 studies was narrowed down to a final sample of 73 studies. During the pandemic stage, individuals frequenting public green spaces exhibited improved well-being, reduced stress levels, and a sense of nature deprivation. Private green spaces played crucial roles in maintaining health during the pandemic stage. Highquality window views were associated with improved well-being and reduced depression. During the easing stage, the environmental quality of public green spaces influenced individuals' perceived safety and sense of belonging. And coastal areas were the preferred natural destinations in this stage. During the post-acute COVID pandemic stage, individuals acknowledged the importance of natural environments in maintaining physiological and mental health as they gradually returned to prepandemic normalcy. In conclusion, the COVID-19 pandemic highlighted humanity's reliance on nature. Therefore, sufficient urban spaces should be dedicated to preservation of natural environments to mitigate negative emotions arising from prolonged indoor stays.

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

Introduction

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

Methods

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

Results

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

Discussion

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

How can plant-enriched natural environments benefit human health: a narrative review of relevant theories

Plant-enriched environments, the most common terrestrial landscapes, are usually coded as "green space" in urban studies. To understand how these natural environments can benefit human health, many theories have been developed, such as the well-known Attention Restoration Theory. Nowadays, more theories are emerging with regard to various and complex health dimensions. In this context, we searched online databases (from 2000 to 2022) and conducted a narrative review aiming to introduce relevant theories concerning psychological (e.g. Perceptual Fluency Account and Conditioned Restoration Theory), physiological (e.g. volatile organic compounds and environmental microbiomes), and behavioural (e.g. physical activity and social contact) perspectives. We also slightly mentioned some limitations and directions to be considered when using these theories. These results may offer general readers insights into the value of nature exposure and also help relevant researchers with study design and result interpretation.

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.

Beneficial effects of short-term exposure to indoor biophilic environments on psychophysiological health: Evidence from electrophysiological activity and salivary metabolomics

BACKGROUND

The utilization of short-term natural exposure as a health intervention has great potential in the field of public health. However, previous studies have mostly focused on outdoor urban green spaces, with limited research on indoor biophilic environments, and the physiological regulatory mechanisms involved remain unclear.

OBJECTIVES

To explore the affective and physiological impact of short-term exposure to indoor biophilic environments and their potential regulatory mechanisms.

METHODS

A between-group design experiment was conducted, and the psychophysiological responses of participants to the indoor plants (Vicks Plant) were measured by a method combined the subjective survey, electrophysiological measurements, and salivary biochemical analysis. Volatile organic compounds (VOCs) from plants were also detected to analyze the main substances that caused olfactory stimuli.

RESULTS

Compared with the non-biophilic environment, short-term exposure to the indoor biophilic environment was associated with psychological and physiological relaxation, including reduced negative emotions, improved positive emotions, lower heart rate, skin conductance level, salivary cortisol and pro-inflammatory cytokines, and increased alpha brainwave power. Salivary metabolomics analysis revealed that the differential metabolites observed between the groups exhibited enrichment in two metabolic pathways related to neural function and immune response: phenylalanine, tyrosine and tryptophan biosynthesis, and ubiquinone and other terpenoid-quinone biosynthesis. These changes may be associated with the combined visual and olfactory stimuli of the biophilic environment, in which D-limonene was the dominant substance in plant-derived VOCs.

CONCLUSION

This research demonstrated the benefits of short-term exposure to indoor biophilic environments on psychophysiological health through evidence from both the nervous and endocrine systems.

Perceived urban green spaces and youth mental health in the post-COVID-19 era

Introduction

The urban green space (UGS) is one of the most significant urban spaces with unique visual and social features, including pleasant air, low noise, and vitality, making it a recreational place for citizens, especially the youth. According to previous studies, perceived green space and the interaction with it is associated with mental health and lower symptoms of anxiety and depression. Although the presence of urban and blue-green spaces in Isfahan has a long history, the UGSs have been out of reach, causing a significant impact on youth mental health due to the spread of COVID-19 and the forcing of the Iranian government to severe and long-term lockdown. This study investigates the relationship between the long-term isolation of youth and being away from UGSs on their mental health in Isfahan city.

Methods

In September 2022, the youth (n = 273) in 12 neighborhoods with similar socio-economic status were asked to answer the online questionnaire. To investigate the correlation between perceived UGS and the mental health of the youth, Structural Equation Modeling (SEM) is done.

Results

The results show that the perceived UGSs negatively relate to the youth's fear of the reoccurrence of COVID-19 infection, anxiety, and depression. Moreover, the model shows that perceived UGS has an inverse correlation with anxiety (β = -0.24, p = 0.00), and no meaningful correlation exists with depression.

Discussion

These results point to a practical solution for designing UDGs in residential areas for youth according to their benefits for mental health during the epidemic era.

The impact of urban green space on the health of middle-aged and older adults

Introduction

Urban green space is one of the most closely related ecosystem services to residents' lives, and it can be regarded as a preventive public health measure. Residents living in parks and other green environments can help improve their physical and mental health, reduce stress and even prevent crime and violence. Therefore, based on the actual situation in China, this paper analyzes the relationship between urban green space and the health of middle-aged and older adults and its mechanisms.

Methods

This study used multiple linear regression, based the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015, and 2018, to explore the relationship between urban green space and the health of middle-aged and older adults. At the same time, group regression was conducted to identify the heterogeneity of health effects of urban green space.

Results

The research shows that the increase of urban green space areas can significantly improve the health status of middle-aged and older adults. After a series of robustness tests, the results are still valid. In addition, the health effects of urban green space are different because of gender, age, education level, marital status residence, geographical location of the respondents and park quantity distribution. Further research found that reducing hot weather and optimizing air quality are the potential mechanisms of urban green space affecting the health of middle-aged and older adults, providing new evidence for the causal mechanism between urban green space and the health of middle-aged and older adults.

Discussion

This study expanded the research scope of the impact of urban green space on the health of middle-aged and older adults, covering a representative sample in China. The results show that urban green space has an important impact on the health of middle-aged and older adults. Policy suggestions are made to help cities optimize the landscape and residents to enjoy ecology.

Green physical activity for leisure connects perceived residential greenspace and mental well-being

Physical activity serves as a pivotal mediator in previous theoretical frameworks that link greenspace and human health. However, it remains unclear whether the domain of physical activity within and around greenspaces can alter the pathway. The present study recruited 668 participants online and examined a conceptual framework that explores the associations between residential greenspace and mental well-being, with a particular focus on the mediation effect of green physical activity (physical activity undertaken in and around greenspaces). Moreover, socio-demographic characteristics, including gender, age, household income, education status, marital status, and student status, were controlled for during the examination. The investigated green physical activities included leisure activities, transportation walking, and transportation cycling, and they were measured by a pre-established questionnaire. Meanwhile, mental well-being was measured by the WHO-5 well-being index, and residential greenspace was indicated by self-reported perceived greenspace and mean Normalized Difference Vegetation Index (NDVI) values within 500 meters (m) of residential radius. We found that both perceived greenspace (B = 1.852, p < 0.001) and NDVI 500 m (B = 3.230, p = 0.038) were positively associated with mental well-being. However, only perceived greenspace, not NDVI 500 m, exhibited positive associations with the three green physical activity items. Furthermore, only green physical activity for leisure (B = 0.223, p < 0.001), not for transportation (p > 0.05), mediated the relationship between perceived greenspace and mental well-being. Our findings reinforce previous studies on "greenspace-health" frameworks and underline the importance of leisure physical activity in promoting mental well-being.

Investigating Factors Influencing Prenatal Stress, Anxiety, and Fear of Childbirth During the COVID-19 Pandemic in Germany and Switzerland: An Online Survey

OBJECTIVES

Pregnant women are likely to experience high levels of stress during the COVID-19 pandemic. However, the factors that might influence the extent of experienced emotional distress are poorly understood. Therefore, we aimed to investigate potential correlates of prenatal emotional distress during the COVID-19 pandemic.

METHODS

In total, N = 1437 pregnant women from Germany and Switzerland participated in an online study during the first wave of the COVID-19 pandemic (May-August 2020). The survey assessed prenatal distress, pandemic-related pregnancy stress, general anxiety, fear of childbirth, and several socio-demographic, pregnancy- and COVID-19-related factors. Linear multivariate regression models were the main analytical strategy.

RESULTS

The results highlight that several factors such as full-time employment, nulliparity, high-risk pregnancy, emotional problems, cancelled prenatal appointments, and stating that COVID-19 affected the choice of birth mode were significantly associated with elevated prenatal distress, anxiety, pandemic-related pregnancy stress, and fear of childbirth. Conversely, access to an outdoor space was a protective factor for pandemic-related pregnancy stress and prenatal distress.

CONCLUSIONS FOR PRACTICE

Overall, the study highlights significant correlates influencing the levels of emotional distress pregnant women experienced during the COVID-19 pandemic. These findings may contribute to the improvement of maternal prenatal medical and psychological care during a public health crisis of international concern, such as the COVID-19 pandemic.

Protective effect of restorative possibilities on cognitive function and mental health in children and adolescents: A scoping review including the role of physical activity

Background The exposome approach can be a powerful tool for understanding the intertwining of social, physical, and internal influences that shape mental health and cognitive development throughout childhood. To distil conceptual models for subsequent analyses, the EU-funded project Early Environmental quality and Life-course mental health effects (Equal-Life) has conducted literature reviews on potential mediators linking the exposome to these outcomes. We report on a scoping review and a conceptual model of the role of restorative possibilities and physical activity. Methods Peer-reviewed studies published since the year 2000 in English, on the association between the exposome and mental health/cognition in children/adolescents, and quantitatively investigating restoration/restorative quality as a mediating variable were considered. Database searches were last updated in December 2022. We used an unstructured expert-driven approach to fill in gaps in the reviewed literature. Results Five records of three distinct studies were identified, indicating a scarcity of empirical evidence in this newly developing research area. Not only were these studies few in numbers, but also cross-sectional, lending only tentative support to the idea that perceived restorative quality of adolescent's living environment might mediate the association between greenspace and mental health. Physical activity emerged as a mediator leading to better psychological outcomes in restorative environments. We provide a critical discussion of potential caveats when investigating the restoration mechanism in children and propose a hierarchical model including restoration, physical activity, and relational dynamics between children and their environment, including social context, as well as restorative environments other than nature. Conclusions It is justified to further explore the role of restoration and physical activity as mediators in the association between early-life exposome and mental health/cognitive development. It is important to consider the child perspective and specific methodological caveats. Given the evolving conceptual definitions/operationalizations, Equal-Life will attempt to fill in a critical gap in the literature.

Exploring Students' Emotional Well-Being in the Ideal University Hostel Using the Qualitative Repertory Grid Technique

One of the ramifications of the COVID-19 pandemic is that it has lent urgency to ongoing discussions on mental well-being, particularly among university students. While standard techniques are available to diagnose mental health disorders such as depression, anxiety, and stress, ambiguity persists regarding the emotional aspect of well-being. Emotional well-being (EWB) is a recently developed concept that seeks to understand the contribution of emotions to one's well-being. Interactive approaches for such investigations are recommended to understand people's contextual experiences in the built environment. This study utilizes a qualitative approach, underpinned by personal construct theory (PCT) and the qualitative repertory grid technique (RGT), to understand how university hostel designs can contribute to students' emotional well-being. We interviewed fifteen students from the United Arab Emirates University (UAEU) and obtained their perceptions of three built environments they experienced and an ideal place they imagined. The results unveiled design-related factors associated with students' emotional constructs and elucidated characteristics of an 'ideal' hostel in response to these emotional constructs. These findings enrich our knowledge of EWB within university hostels offering insights for the future design that consider the emotional aspect of well-being for residents.

Green and blue spaces, COVID-19 lockdowns, and mental health: An Australian population-based longitudinal analysis

Australia experienced some of the world's longest and most stringent lockdowns during the COVID-19 pandemic. While lockdown measures had consequences for mental health, investigation is lacking on the potential for green and blue space coverage within people's local environments to ameliorate the impact of lockdowns with varied lengths using longitudinal cohorts. This study examined the impact of lockdown durations on population mental health and tests the effect modification of neighbourhood green and inland and coastal blue space coverage in metropolitan areas. We merged population-based longitudinal data on more than 11,000 individuals collected over a ten-year period from 2012 to 2021 with national land use data describing green and blue space coverage. We used fixed effect models to estimate the relationship between lockdowns (with different durations and staggered introduction) and mental health, controlling for sociodemographic, health, and geographical confounders, and tested the significance of effect modification of green and blue space. Results show that extended lockdowns led to considerably larger decreases in mental health (COVID-y1: -2.66, 95%CI: -3.43, -1.89; COVID-y2: -2.65, 95%CI: -3.33, -1.97) relative to short lockdowns. The mental health effect of lockdowns was smaller where green spaces and inland and coastal blue spaces were available. Effect modification was statistically significant for green space, with smaller negative mental health effects observed where there was sizeable green space coverage, particularly during long lockdowns (COVID-y1: -2.69, 95%CI: -3.63, -1.76 for coverage <5%; -3.27, 95%CI: -4.70, -1.84 for coverage 5%-10%; -0.60, 95%CI: -2.03, 0.83 for coverage ≥30%; COVID-y2: -2.74, 95%CI: -3.62, -1.87 for coverage <5%, -2.95, 95%CI: -3.98, -1.92 for coverage 5%-10%; -2.08, 95%CI: -3.28, -0.88 for coverage ≥30%). Findings support the consideration of nature exposure to improve people's mental wellbeing and resilience when designing lockdown measures in response to future public health emergencies.

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

Introduction

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

Aim

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

Method

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

Result

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

Conclusion

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

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.

Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring

Policy Points Social indicators of young peoples' conditions and circumstances, such as high school graduation, food insecurity, and smoking, are improving even as subjective indicators of mental health and well-being have been worsening. This divergence suggests policies targeting the social indicators may not have improved overall mental health and well-being. There are several plausible reasons for this seeming contradiction. Available data suggest the culpability of one or several common exposures poorly captured by existing social indicators. Resolving this disconnect requires significant investments in population-level data systems to support a more holistic, child-centric, and up-to-date understanding of young people's lives.

Behavioral and psychosocial factors and their effects on insomnia among people undergoing entry quarantine in hotels during COVID-19 pandemic: a cross-sectional study in Guangzhou, China

BACKGROUND

The COVID-19 pandemic continues to impact global health and China requires a 14-day quarantine for individuals on flights with positive COVID-19 cases. This quarantine can impact mental well-being, including sleep. This study aims to examine the impact of psychosocial and behavioral factors on insomnia among individuals undergoing quarantine in hotels.

METHODS

This study was a cross-sectional survey carried out in Guangzhou, China. The data was gathered through online questionnaires distributed to international passengers who arrived in Guangzhou on flights and were required to undergo a 14-day quarantine in hotels arranged by the local government. The questionnaires were sent to the participants through the government health hotline "12,320."

RESULTS

Of the 1003 passengers who were quarantined, 6.7% reported significant anxiety and 25.0% had varying degrees of insomnia. Anxiety was positively associated with insomnia (β = 0.92, P < 0.001), while collectivism (β = -0.07, P = 0.036), indoor exercise (β = -0.50, P < 0.001), and the perceived people orientation of the public health service (β = -0.20, P = 0.001) were negatively associated with insomnia. The study also identified moderating effects, such that a higher sense of collectivism, a greater frequency of indoor exercise, and a higher perception of the people-oriented of the public health service were associated with a lower impact of anxiety on insomnia. These moderating effects were also observed in participants with varying degrees of insomnia.

CONCLUSIONS

This study reveals that a proportion of people undergoing entry quarantine experience insomnia and confirms how psychosocial and behavioral factors can alleviate insomnia in this population.

Natural land cover positively correlates with COVID-19 health outcomes

BACKGROUND

The coronavirus disease 2019 (COVID-19) poses special challenges for societies, as the disease causes millions of deaths. Although the direct prevention measures affect the prevalence and mortality the most, the other indirect factors, including natural environments and economics, could not be neglected. Evaluating the effect of natural land cover on COVID-19 health outcomes is an urgent and crucial public health topic.

METHODS

Here, we examine the relationships between natural land cover and the prevalence and mortality of COVID-19 in the United States. To probe the effects of long-term living with natural land cover, we extract county-level land cover data from 2001 to 2019. Based on statistically spatial tests, we employ the Spatial Simultaneous Autoregressive (SAC) Model to estimate natural land cover's impact and monetary values on COVID-19 health outcomes. To examine the short-term effects of natural environments, we build a seasonal panel data set about the greenery index and COVID-19 health outcomes. The panel SAC model is used to detect the relationship between the greenery index and seasonal COVID-19 health outcomes.

RESULTS

A 1% increase in open water or deciduous forest is associated with a 0.004-death and 0.163-conformed-case, or 0.006-death and 0.099-confirmed-case decrease in every 1,000 people. Converting them into monetary value, for the mortality, a 1% increase in open water, deciduous forest, or evergreen forest in a county is equivalent to a 212-, 313-, or 219-USD increase in household income in the long term. Moreover, for the prevalence, a 1% change in open water, deciduous forest, or mixed forest is worth a 382-, 230-, or 650-USD increase in household income. Furthermore, a rational development intensity is also critical to reduce the risk of the COVID-19 pandemic. More greenery in the short term is also linked to lower prevalence and mortality.

CONCLUSIONS

Our study underscores the importance of incorporating natural land cover as a means of mitigating the risks and negative consequences of future pandemics like COVID-19 and promoting overall public health.

Can Views and Contact with Nature at Home Help Combat Anxiety and Depression during the Pandemic? Results of the GreenCOVID study

BACKGROUND

The COVID-19 pandemic and the lockdown measures have had important consequences on the mental health of the population, although little is known about the role played by nature and its benefits.

OBJECTIVES

The present study aims to evaluate the risk of anxiety and depression during the first wave of the COVID-19 pandemic in Spain and to identify the factors most strongly associated with anxiety and depression, including sociodemographic, household characteristics, and access to or contact with natural environment.

METHODS

GreenCOVID is an online cross-sectional study promoted by the Health & Territory Research (HTR) of the University of Seville in Spain, Maynooth University in Ireland, and the University of Winchester in the United Kingdom. This study includes only data from Spain which were collected between April 8, 2020 and April 27, 2020. Binary logistic regression was conducted to identify the factors associated with anxiety and depression through the HADS scale.

RESULTS

Of the total of 2,464 adults who participated in GreenCOVID Spain, mean age was 38.1 years, 72.6% were female, 58.1% were at risk of anxiety, and 32.3% of depression. In the multivariable logistic regression, the factors associated with risk of anxiety were female: gender, being a student and problems at home. Regarding the risk of depression, the factors most associated were being a student, female gender, problems at home, worse evaluation of views from home and less help from outside views to cope with lockdown.

CONCLUSIONS

Our findings show that during COVID-19 pandemic, in addition to sociodemographic factors female gender and being a student, problems at home, lack of natural elements in the home, and worse appreciation of views from home were associated with mental health problems. Thus, housing conditions and access to the natural environment were important for mental health during COVID-19 lockdown.

Anthropause appreciation, biophilia, and ecophilosophical contemplations amidst a global pandemic

In 2020, COVID-19 mitigation measures, including lockdowns and travel bans to curtail disease transmission, inadvertently led to an "Anthropause" - a unique global pause to anthropogenic activities. While there was a spike in ecological studies measuring Anthropause effects on environmental indicators, people's experiences of the Anthropause or its potential to inspire change were hardly considered. Hence, we aimed to measure people's appreciation of the environmental outcomes of the Anthropause, ecophilosophical contemplations about the pandemic, and experiences of lockdown-triggered biophilia (human's innate love for and draw towards nature) and test the hypothesis that these experiences would be consistently more prominent among the already environmentally inclined. To that end, we developed and tested three measures on a representative sample of 993 New Zealanders. Anthropause Appreciation received the highest overall mean ratings, followed by Lockdown-Biophilia and Eco-Contemplation. Pre-existing pro-environmental dispositions and behaviours did not consistently influence our three measures as expected. Demographic variables had little influence, while experiences of financial and mental health impacts due to COVID-19 had no influence. We interpreted the limited influence of explanatory variables as indicative of a degree of uniformity in people's experiences. High appreciation of Anthropause benefits suggests that the public may be supportive of policies and ways of living that can lead to similar outcomes post-pandemic - offering environmental policymakers and communicators a basis for action. Ecophilosophical contemplations and biophilic draw among the public suggest an awareness of the significance of the human-nature relationship - offering a symbolic global keystone for communicating and advocating conservation and the many values of pauses in life to connect with nature. Building women's environmental leadership capabilities and the ongoing greening of Christianity may be essential steps for global post-pandemic environmental behaviour transformations.

What Factors Will Influence Chinese International Traveling for Leisure in the Post-COVID-19 Era: Role of Health Priorities and Health-Related Information Literacy

China used to be the world's leading nation in terms of international (outward) tourism till the COVID-19 outbreak. However, due to the COVID-19 crisis, several new macro and micro-level factors might affect their international (outward) traveling behavior. The purpose of the current research was to examine the avoidance of international traveling for leisure in the Chinese population. The goal of the study was to highlight the importance of information self-efficacy and digital literacy as the key factors influencing tourists' traveling readiness. To achieve the goal, the study adapted the quantitative instruments from existing sources to map media exhaustion, information overload, and perceived health concerns, i.e., perceived effectiveness of health-protective measures, fear of new possible outbreaks, and pandemic crisis at source and destination. Chinese citizens' opinions were collected during the third quarter of the year 2022. Specifically, the quantitative survey from China collected a total number of 1308 respondents. This study used the statistical analysis software SPSS to analyze collected data. The findings conclude that the role of media is pivotal to shaping and predicting future trends in tourism preferences, perception of protective measures against COVID-19, and perceived seriousness of the pandemic crisis in the Chinese population. In addition, technology readiness (as hard self-efficacy) and health-related information literacy (soft self-efficacy) are critical to cope with the dark aspects of information exhaustion, overload, and pandemic seriousness in the post-truth era. The study is unique, as it examines the role of the seriousness of the pandemic at its source and destination and fear of new outbreaks simultaneously, underlining the potential future of immersive tourism (i.e., virtual reality, augmented reality, or mixed reality-based tourism). This study has drawn interesting theoretical and practical implications for researchers, policymakers, and academicians.

A qualitative study exploring experiences, attitudes, and wellbeing of university students of a period of restricted movement and self-testing during COVID-19 “Incoming Student Wellbeing and Benefits of Serial COVID-19 testing (ISWAB)” study

Background: As part of Ireland’s response to the COVID-19 pandemic, travellers to Ireland were required to restrict movements on arrival. Worldwide compliance with measures such as quarantine and testing vary and are influenced by factors including an individual’s knowledge of trust in, and attitudes towards these measures. The aim of this study was to explore student experiences of restricted movements after entering Ireland from abroad and to assess the acceptability and feasibility of self-administered SARS-CoV-2 tests. Methods: The Incoming Student Wellbeing and the Acceptability and Benefits of serial COVID-19 testing (ISWAB) study recruited university students who travelled into Ireland and were required by national public health guidance to restrict their movements. As part of the study, students were provided with SARS-CoV-2 self-test kits. This qualitative study explored the students’ attitudes to self-testing and restricted movements using focus groups and interviews. Ethical approval was obtained. Interviews were conducted until data saturation was reached. Interview transcripts were thematically analysed. Results: Of 41 ISWAB participants, 32 agreed to participate in a follow-up qualitative study providing written consent. One focus group, two group interviews and three individual interviews were conducted in August 2021, on Microsoft Teams. Among the 11 (seven male, four female) students interviewed, self-testing was considered feasible and acceptable. Facilitators of adherence to restrictions included: support with grocery shopping and study periods coinciding with quarantine. Barriers to well-being included: living alone, being an individual who leads a social lifestyle, and the number of days of quarantine completed. Conclusions: This qualitative study demonstrated high levels of compliance with restriction of movement guidelines and self-testing, with limited impact on general well-being. Self-testing for SARS-CoV-2 was found to be practical and achievable for at home use by participants in this study. The findings of this study may inform future self-testing initiatives.

Is indoor and outdoor greenery associated with fewer depressive symptoms during COVID-19 lockdowns? A mechanistic study in Shanghai, China

Increasing numbers of studies have observed that indoor and outdoor greenery are associated with fewer depressive symptoms during COVID-19 lockdowns. However, most of these studies examined direct associations without sufficient attention to underlying pathways. Furthermore, few studies have combined different types of indoor and outdoor greenery to examine their effects on the alleviation of depressive symptoms. The present study hypothesized that indoor and outdoor exposure to greenery increased the perceived restorativeness of home environments, which, in turn, reduced loneliness, COVID-related fears, and, ultimately, depressive symptoms. To test our hypotheses, we conducted an online survey with 386 respondents in Shanghai, China, from April to May 2022, which corresponded to strict citywide lockdowns that resulted from the outbreak of the Omicron variant. Indoor greenery measures included the number of house plants, gardening activities, and digital nature exposure as well as semantic image segmentation applied to photographs from the most viewed windows to quantify indoor exposure to outdoor trees and grass. Outdoor greenery measures included total vegetative cover (normalized difference vegetation index [NDVI]) within a 300 m radius from the home and perceived quality of the community's greenery. Associations between greenery and depressive symptoms/clinical levels of depression, as measured by the Patient Health Questionnaire-9 (PHQ-9), were examined using generalized linear and logistic regression models. Structural equation modeling (SEM) was used to test pathways between greenery exposure, restorativeness, loneliness, fear of COVID-19, and depressive symptoms. The results showed that: 1) indoor and outdoor greenery were associated with fewer depressive symptoms; 2) greenery could increase the restorativeness of the home environment, which, in turn, was associated with fewer COVID-related mental stressors (i.e., loneliness and fear of COVID-19), and ultimately depressive symptoms; and 3) gender, education, and income did not modify associations between greenery and depressive symptoms. These findings are among the first to combine objective and subjective measures of greenery within and outside of the home and document their effects on mental health during lockdowns. Comprehensive enhancements of greenery in living environments could be nature-based solutions for mitigating COVID-19 related mental stressors.

When green enters a room: A scoping review of epidemiological studies on indoor plants and mental health

BACKGROUND

Increasing numbers of epidemiological studies are investigating the association between outdoor greenery and various health outcomes. However, in the case of indoor plants, although experimental studies seem relatively abundant, epidemiological studies remain scarce, and research considering the mental health effects is even more limited. Thus, we aim to identify and summarise the relevant epidemiological studies on indoor plant exposure and mental health via this scoping review, thereby presenting the current state of knowledge and research niches.

METHODS

PubMed and PsycINFO were systematically searched for epidemiological studies on indoor plant exposure and mental health, including mental and behavioural disorders, quality of life, and cognitive function. The publication period was from the inception of these two databases to 22nd June 2022. We extracted information on exposure to indoor plants and mental health-related outcomes from the relevant studies.

RESULTS

The systematic search yielded 1186 unique results. Six studies met the inclusion criteria and were finally included in this scoping review. All included studies were Europe-based cross-sectional studies on mental and behavioural disorders. One study was conducted in 2015 and investigated the office environment, whereas the other five were conducted during the COVID-19 pandemic and focused on the home environment. Despite considerable heterogeneity in outcome assessments and indoor plant exposure metrics, all six studies generally reported beneficial associations between having indoor plants and mental health, such as reducing stress, depressive symptoms, and negative emotions.

CONCLUSIONS

Epidemiological evidence on exposure to indoor plants and mental health is currently limited. In general, favourable effects of indoor plants are supported, although most relevant studies were conducted in the context of COVID-19. Before conducting more studies to explore the associations, data collection methods must be refined with more elaborate designs that allow for the measurement of more comprehensive metrics of indoor plants.

REGISTRATION

Open Science Framework, osf.io/5xr6b.

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.

Subsets of the population benefitting from the pandemic: What policies and practices should be arranged to sustainably maintain beneficiaries' mental health

Here researchers have the disposition to engage in the scholarly discourse on how the pandemic adversely influenced individuals' mental health and what remedies should be exercised in response to the mental health challenges. There is a shortage of scholarly discussion about who benefitted from the occurrence of the pandemic. Mancini et al. argued that the pandemic benefitted the social and mental health functioning of a subset of the population, despite the pandemic causing considerable risks of harm to mental health. In this perspective, the author summarizes relevant findings and arguments to present which subsets of the population benefitted at school, at home, and in the workplace during the pandemic. Although COVID-19 is no longer deemed a pandemic, many by-products of the public health crisis, including the encouragement of remote work and studies, remain. In this perspective, by understanding who benefitted from the pandemic and why, the author can evaluate if any public policies formed in response to the pandemic should be kept in the long run in order to maximize individuals' mental health.

The evaluation of the 3-30-300 green space rule and mental health

BACKGROUND AND AIMS

Urban green space has many health benefits, but it is still unclear how much actually is needed for better health. Recently a new 3-30-300 rule of thumb for urban forestry and urban greening has been proposed, but this rule has not been evaluated for benefits on health. The rule requires that every citizen should be able to see at least three trees from their home, have 30 percent tree canopy cover in their neighbourhood and not live more than 300 m away from the nearest park or green space. The aim of this study was to evaluate the relationship between the 3-30-300 green space rule and its components in relation to mental health.

METHODS

We conducted a cross-sectional study based on a population-based sample of 3145 individuals aged 15-97 years from in Barcelona, Spain who participated in the Barcelona Health Survey (2016-2017). We created 3-30-300 green space indicators using questionnaire data, GIS, remote sensing and land cover maps. Mental health status was assessed with the 12-item General Health Questionnaire (GHQ-12) and also the use of tranquilizer/sedatives or antidepressants and psychiatrist or psychologist visits. Analyses were conducted using mixed effects logistic regression models with districts as the random effect, adjusted for relevant covariates.

RESULTS

We found that people in Barcelona had relatively little exposure to green space, whether through window view, living in an area with sufficient greenness, or access to a major green space, and only 4.7% met a surrogate 3-30-300 green space rule. Residential surrounding greenness, but not tree window view or access to major green space, was significantly associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits. Meeting the full surrogate 3-30-300 green space rule was associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits, but only for the latter combined the association was statistically significant (Odds ratio = 0.31, 95% CI: 0.11, 0.91).

CONCLUSION

Few people achieved the 3-30-300 green space in Barcelona and we used a surrogate measure. We observed health benefits when the full surrogate rule was met.

Promoting Strategies for Healthy Environments in University Halls of Residence under Regular Epidemic Prevention and Control: An Importance-Performance Analysis from Zhejiang, China

In the post-epidemic era, regular epidemic prevention and control is a daunting and ongoing task for nations all around the world. University halls of residence have been important spaces where university students balance their studies, work, and personal lives after COVID-19. Therefore, a healthy physical living environment deserves more attention. This paper compares situations before and after COVID-19 in an effort to evaluate the impact of indoor environments in university halls of residence on students. The study proposed eight vital dimensions for creating a healthy university hall of residence environment and, from 14 September to 4 October 2022, used an online questionnaire to collect data from 301 university students studying in Zhejiang, China. The key quality of service characteristics for fostering a healthy environment in university halls of residence were discovered using descriptive statistical analysis and revised importance-performance analysis (IPA). We found that an improved indoor physical environment and efficient arrangement of indoor space were crucial for the health of university students. The quality of educational services could be improved, and indoor exercise should be utilized effectively, both of which can contribute significantly to a healthy indoor environment. This study aims to contribute to the development of future initiatives to support healthy physical living environments in university halls of residence.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The effects of indoor plants and traffic noise on English reading comprehension of Chinese university students in home offices

Owing to the COVID-19 pandemic, working from home promotes the importance of indoor environment qualities. With the settings and functions of home offices, an experiment was carried out to determine the interaction effects between indoor plants and traffic noise levels (TNLs) on the performance and environmental evaluations of English reading comprehension tasks (ERCTs) and the performance of short-term breaks. A sample of 22 Chinese university students (12 males and 10 females) took part in the experiment. Two visual conditions (with and without plants) and five TNLs (i.e., 35, 45, 50, 55, and 60 dBA TNL) were included. Participants’ accuracy rates, eye movements, mental workload, and feelings about the environment were collected. The mental fatigue recovery (MFR), visual fatigue recovery (VFR), anxiety recovery (AR), and unfriendly recovery (UR) were measured for the analysis of a 5-min short-term break. The results demonstrate (1) plants have significant effects on ERCTs and short-term breaks, especially at 45 and 50 dBA TNL; (2) the effects of TNLs on ERCTs’ eye movements and work environment satisfaction differ by the presence of plants, e.g., the average pupil diameter (APD), lighting and layout satisfaction; (3) The effects of indoor plants on ERCT differ by the range of TNLs. In conclusion, indoor plants are beneficial to home workers engaged in ERCT when TNL does not exceed 50 dBA. The current data highlight the importance of audio-visual interaction in home offices and provide insights into the interaction mechanism between indoor plants and traffic noise.

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

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

Adventure-based mindsets helped maintain psychological well-being during COVID-19

OBJECTIVES

Research conducted during the COVID-19 pandemic underscores the value of physical activity and nature for psychological well-being in the general population when people's mobility and activities are restricted due to government mandates. Since restrictions may thwart the psychological benefits reported from participation in adventure recreation (e.g., rock-climbing, white-water kayaking), it is important to understand the psychological well-being of people who previously benefited from adventure opportunities. Thus, the purpose of this study was to investigate the lived experiences and psychological well-being of adventure recreation participants during COVID-19 restrictions.

DESIGN

A descriptive phenomenological approach was used.

METHOD

Participants were fifteen men, four women, and one non-binary person who engaged in a variety of adventure recreation activities that included ski-mountaineering, free-diving, rock-climbing, white-water kayaking, back-country skiing, skydiving, SCUBA diving, BASE jumping, and mountaineering. Participants had an average of 11.7 years of experience in at least one of their preferred adventure recreation activities. Participants were invited to take part in a visual and audio-recorded semi-structured interview on Zoom. Interviews lasted on average 69.3 min. Reflexive thematic analysis was undertaken inductively.

RESULTS

Overall, participants discussed a range of nuanced impacts that COVID-19 restrictions had on their psychological well-being. Participants discussed how negative affect resulted from restricted opportunities for physical and mental challenges, emotion regulation, connections to nature and people, and excitement. However, participants also benefited from several silver linings, such as reflecting on past adventures, a reduced need to compare themselves socially, and opportunities to spend quality time with others. Participants also explained how 'adventure-based mindsets' (e.g., resilience, focusing on controllable elements, humility) were protective strategies they used to limit the ill-being impacts of COVID-19 restrictions.

CONCLUSIONS

This study extends the alternative sport and exercise literature by illustrating how participation in adventure has the potential to enhance participants' resilience and their ability to maintain psychological well-being across diverse and novel contexts (e.g., the COVID-19 pandemic).

The More Natural the Window, the Healthier the Isolated People-A Pathway Analysis in Xi'an, China, during the COVID-19 Pandemic

This study explores how windows with a green view might affect the mental health (i.e., depressive/anxiety symptoms) of home-isolated populations. An online survey was conducted among 508 adults isolated under government quarantine policies for COVID-19 emergency pandemic control between 10 and 20 January 2022 in Xi'an, China. Structural equation modeling was employed to identify the pathways from green view through windows to isolated people's depressive/anxiety symptoms. The relative frequency of plant/water exposure through windows was associated with fewer depressive/anxiety symptoms. Home-isolated people during COVID-19 reported better mental health when they were exposed to more natural settings. These findings could inspire public health authorities to adopt nature-based solutions to mitigate the adverse mental health consequences of isolated populations during the pandemic.

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.

Green Space for Mental Health in the COVID-19 Era: A Pathway Analysis in Residential Green Space Users

Residential green space is among the most accessible types of urban green spaces and may help maintain mental health during the COVID-19 pandemic. However, it is insufficiently understood how residents use residential green space for exercise during the epidemic. The pathways between residential green space and mental health also merit further exploration. Therefore, we conducted an online study among Chinese residents in December 2021 to capture data on engagement with urban green space for green exercise, the frequency of green exercise, perceived pollution in green space, perceptions of residential green space, social cohesion, depression, and anxiety. Among the 1208 respondents who engaged in green exercise last month, 967 (80%) reported that green exercise primarily occurred in residential neighborhoods. The rest (20%) reported that green exercise occurred in more distant urban green spaces. The most common reasons that respondents sought green exercise in urban green spaces were better air and environmental qualities. Structural equation modeling (SEM) was then employed to explore the pathways between the perceived greenness of residential neighborhoods and mental health among respondents who used residential green space for exercise. The final model suggested that residential green space was negatively associated with anxiety (β = −0.30, p = 0.001) and depression (β = −0.33, p < 0.001), mainly through indirect pathways. Perceived pollution and social cohesion were the two mediators that contributed to most of the indirect effects. Perceived pollution was also indirectly associated with green exercise through less social cohesion (β = −0.04, p = 0.010). These findings suggest a potential framework to understand the mental health benefits of residential green space and its accompanying pathways during the COVID-19 era.

Investigating the Buffering Effects of Greenery on the Adverse Emotional, Mental and Behavioral Health during the Pandemic Period

In light of the adverse emotional, mental and behavioral outcomes caused by the pandemic period, this research analyzed the associations between emotional distress and poor health outcomes and the buffering effects of greenery on these outcomes. An online cross-sectional survey between June–November 2021 was distributed among 1314 young Italian adults. Bivariate associations and multivariate regression analyses were applied to the data. Findings showed that emotional distress was positively related to poor mental health outcomes and to some of the unhealthy behaviors. In addition, green pathways differently impacted on health: the indoor features confirmed buffering effects on adverse emotional and mental health responses, whereas the outdoor features played no salutogenic role. In conclusion, whereas the outbreak period of the pandemic has led to the rediscovering/reinforcement of the attachment to nature to cope with negative affective states, the successive waves characterized by selected limitations and new living rules of social adaptation may have brought about a reduced affinity toward nature. Target interventions in terms of biophilic design for indoor environmental sustainability are needed in order to increase the innate human–nature connection and thus to promote public health.

Change of Residents’ Attitudes and Behaviors toward Urban Green Space Pre- and Post- COVID-19 Pandemic

The COVID-19 pandemic has changed and influenced people’s attitudes and behaviors toward visiting green spaces. This paper aims to explore the association between residents’ health and urban green spaces (UGS) through an in-depth study of changes in residents’ use of UGS under the influence of the COVID-19 pandemic. The Wuhan East Lake Greenway Park was selected as the location for the field survey and in-depth interviews. At the same time, an online survey was also conducted (total number = 302) regarding participants’ physical and mental health and their attitude and behavior toward the UGS. A paired sample t-test and binary logistic regression were performed to investigate the association between participants’ health and UGS during COVID-19. The results show that: (1) the COVID-19 pandemic has primarily changed the leisure patterns of parks, with potential impacts on the physical and mental health of participants; (2) the purpose, frequency, timing, and preferred areas of participants’ park visits have changed to varying degrees after the pandemic, highlighting the important role and benefits of UGSs; (3) the physical and mental health of participants and urban development issues reflected by UGS use are prominent. This study reveals that awareness of the construction and protection of UGSs is an important prerequisite for ensuring the health of urban residents.

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.

Effects of the residential built environment on remote work productivity and satisfaction during COVID-19 lockdowns: An analysis of workers' perceptions

COVID-19 pandemic has forced people to stay home and switch to the remote working mode, which - reportedly - affect job satisfaction and productivity. The present study investigates the relationship between the residential environment and worker's job satisfaction and productivity in the remote working mode during the COVID-19 pandemic. A hypothetical structural equation model (SEM) of the influencing factors is constructed based on a literature review and experts' opinions. A survey-based respondents' opinions (n = 2276) were then used to test and analyze the model. The model results reveal that a residential built environment has an indirect effect on both remote work satisfaction and productivity. However, among all the factors, comfortable space (separate space and ergonomic furniture) is found to be the most important. This study presents the importance of adopting a residential built environment to respond to a crisis like a pandemic in achieving the desired comfort level of remote work. Although this study provides a holistic approach, it also proposes a base for the future country-specific analysis by providing some possible countries' differences.

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

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

The Perceived Restorativeness of Outdoor Spatial Characteristics for High School Adolescents: A Case Study from China

Heavy schoolwork and overpopulated classrooms have made high schools overstressed environments. Previous investigations have identified a wide body of naturally restorative elements. However, evidence regarding the relationship between spatial typology and its perceived restorativeness (PR) for adolescents is limited. This paper explores the connection between spatial characteristics and PR by linking their restorative quality to how they are actually used. A high school with multiple types of outdoor spaces is used as a case study and typical spatial characteristics (area, distance, and openness) are quantified. A revised perceived restorativeness scale (RPRS) is exploited to assess the restorative quality of different spaces, and a self-reported questionnaire is used to map the actual usage. The obtained results reveal that: (1) the restorativeness of the selected spaces varied considerably, with a natural garden being more restorative than a built environment; (2) the area and openness were positively correlated to the PR, but the distance was negatively correlated; (3) the theoretical dimensions of “getting away” at high school are primarily psychological, not physical; (4) the actual use of outdoor spaces during breaks does not match the students’ favorite places or their PR. These findings expand our understanding of the role of spatial characteristics in PR in high schools and indicate direct links between campus design and restorative quality.

Satisfaction with activity-support and physical home-workspace characteristics in relation to mental health during the COVID-19 pandemic

Previous research indicates that employees' mental health might be influenced by their satisfaction with physical office characteristics, such as noise, daylight, and ventilation. However, similar research on mental health in relation to working from home (WFH) is limited. Therefore, this study aimed to identify the relationships between satisfaction with physical home workspace characteristics and support of work activities and mental health while WFH during the COVID-19 pandemic. Relationships were analysed using a path analysis approach, based on a sample of 1219 office workers, who had to work fully from home. The internal relationships between the ten considered mental health variables were also studied. Results showed that satisfaction with daylight, artificial light, greenery, and views outside were directly related to one of the mental health variables and indirectly to several others. Surprisingly, satisfaction with temperature, noise, ventilation, and air quality did not seem to play a role at the home workplace. In addition, unlike at the office, personal characteristics did not relate to workspace satisfaction nor perceived support of activities at home. Furthermore, all mental health variables were related to at least one other mental health variable. Workplace managers could use these insights to formulate recommendations for employees on how to design their home-workspace.

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

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

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

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

Park access and mental health among parents and children during the COVID-19 pandemic

BACKGROUND

Time spent outdoors and in nature has been associated with numerous benefits to health and well-being. We examined relationships between park access and mental health for children and parents during the COVID-19 pandemic. We also explored associations between park access and co-participation of parent and child in time outdoors, and child and parent physical activity.

METHODS

We used data from 1,000 respondents to a nationally representative U.S. survey of parent-child dyads during October-November 2020. Park access was defined as an affirmative response to: "do you have a park that you can safely walk to within 10 min of your home?" Child mental health was operationalized as the Strengths and Difficulties Questionnaire (SDQ) total difficulties score. The Patient Health Questionnaire-4 (PHQ-4) total score assessed parent mental health and the International Physical Activity Questionnaire (IPAQ) assessed parent physical activity. Child physical activity and co-participation in outdoor activity were reported as number of days in the prior week. Linear regression was used to examine relationships between park access and health outcomes in models adjusted for child and parent characteristics and COVID-19 impact.

RESULTS

Our sample included 500 parents of children ages 6-10 years, and 500 parent-child dyads of children ages 11-17 years. Park access was associated with a lower SDQ total score among children (β: -1.26, 95% CI: -2.25, -0.27) and a lower PHQ-4 total score among parents (β: -0.89, 95% CI: -1.39, -0.40). In models stratified by child age, these associations were observed for SDQ scores among adolescents ages 11-17 and for PHQ-4 scores among parents of children ages 6-10 years. Park access was also associated with 0.50 more days/week of co-participation in outdoor time (95% CI: 0.16, 0.84), and higher levels of parent physical activity (β: 1009 MET-min/week, 95% CI: 301, 1717), but not child physical activity (β: 0.31 days/week, 95% CI: -0.03, 0.66).

CONCLUSIONS

Park access was associated with better mental health among children and parents, and more parent physical activity and parent-child co-participation in outdooractivity during the COVID-19 pandemic. Access to nearby parks may be an important resource to promote health and well-being, for both individuals and families.

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

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

Healthy cities after COVID-19 pandemic: the just ecofeminist healthy cities approach

The COVID-19 pandemic crisis has compromised the 'healthy cities' vision, as it has unveiled the need to give more prominence to caring tasks while addressing intersectional social inequities and environmental injustices. However, much-needed transdisciplinary approaches to study and address post-COVID-19 healthy cities challenges and agendas have been scarce so far. To address this gap, we propose a 'just ecofeminist healthy cities' research approach, which would be informed by the caring city, environmental justice, just ecofeminist sustainability and the healthy cities paradigms and research fields. Our proposed approach aims to achieve the highest standards of human health possible for the whole population-yet putting the health of socially underprivileged residents in the centre-through preserving and/or improving the existing physical, social and political environment. Importantly, the proposed approach recognises all spheres of daily life (productive, reproductive, personal and political) and their connections with inequities, justice and power dynamics. Last, the just ecofeminist healthy cities approach understands human health as interconnected with the health of non-human animals and the ecosystem. We illustrate the proposed new approach focusing on the implications for women's health and public green spaces research and propose principles and practices for its operationalisation.