Beneficial impacts of residential greenness on sleep deprivation in adults aged 19 or older living in South Korea: A nationwide community health survey in 2011-2018

Association between greenness and suicide attempts in patients with depression: A nationwide longitudinal cohort study

BACKGROUND

Although multiple emerging studies have suggested the relationship between greenness and mental health, evidence regarding associations among green space, suicide attempts, and depression is still limited. In this study, we aimed to estimate the association of greenness with suicide attempts in patients with depression.

METHODS

This study used the National Health Insurance Service database in South Korea to construct a cohort of patients diagnosed with depression during 2012-2013 (n = 677,498) with an 8-year follow-up period. Residential greenness was measured as the district-level annual average of the Enhanced Vegetation Index. The primary outcome was the suicide attempt, and categorized suicide attempts (non-violent and violent methods) were also examined. A Cox regression with time-varying variables was performed to assess the association between greenness and suicide attempts, and stratified analyses were conducted by sex, age, insurance premium, and disability status.

RESULTS

A higher level of greenness was associated with lower suicide attempts among patients with depression (HR: 0.789; 95% CI: 0.677, 0.918). The protective association was higher for suicide attempts by violent methods (HR: 0.733; 0.545, 0.987) than non-violent methods (HR: 0.812; 0.680, 0.970), based on point estimates. Among patients with depression, males, individuals aged 35-64 years, and Medical Aid beneficiaries showed a more prominent association with greenness.

CONCLUSIONS

This nationwide cohort study provides epidemiological evidence for the benefits of residential greenness in reducing suicide among patients with depression and suggests the appropriateness of public health policies for increasing green spaces.

Association of residential greenness and sleep duration in adults: A prospective cohort study in China

BACKGROUND

Exposure to residential greenness has been linked with improved sleep duration; however, longitudinal evidence is limited, and the potential mediating effect of ambient fine particulate matter (PM2.5) has yet to be assessed.

METHODS

We obtained data for 19,567 participants across seven counties in a prospective cohort in Ningbo, China. Greenness was estimated using Normalized Difference Vegetation Index (NDVI) within 250-m, 500-m and 1000-m buffer zones, while yearly average PM2.5 concentrations were measured using validated land-use regression models, both based on individual residential addresses. Sleep duration was assessed using structured questionnaires at baseline and during follow-up. The longitudinal associations between residential greenness and sleep duration were evaluated using linear mixed-effect models. Adjustments for PM2.5 and county were implemented. To identify the effect of greenness exposure on age-related declines in sleep duration, we included an interaction term between NDVI and visit (baseline and follow-up). Additionally, half-longitudinal mediation analyses were conducted to evaluate the potential mediating role of PM2.5 in this relationship.

RESULTS

Each interquartile range (IQR) increase in NDVI within 250 m, 500 m and 1000 m was associated with increases in sleep duration of 0.044 h (95% CI: 0.028,0.061), 0.045 h (95% CI: 0.028,0.062), and 0.031 h (95% CI: 0.013,0.049), respectively. Associations were attenuated after adjusting for PM2.5. Farmers, homemakers, and short-nap individuals benefited the most from greenness exposure. Higher greenness exposure significantly lowered PM2.5 levels, which was associated with a slower decline in sleep duration over the follow-up period.

CONCLUSION

Exposure to higher levels of residential greenness was associated with increased sleep duration and a slower decline in sleep over time. County-level heterogeneity in the effects of residential greenness on sleep duration was observed. PM2.5 partially mediating this relationship.

Urban green space, human heat perception and sleep quality: A repeated cross-sectional study

Urban heat poses significant challenges to public health, as exposure to high temperatures is associated to heat stress, resulting in heat strain, sleep deprivation, and cardiovascular morbidity and mortality. As the frequency of heat waves is increasing due to global warming, urban green spaces are often proposed as a nature-based solution to mitigate urban heat stress. This study investigated the impact of urban green space on perceived heat stress and sleep quality, using questionnaires and detailed land cover data. We surveyed 584 respondents during four heat and four control events in the summers of 2021 and 2022, assessing perceived heat stress, sleep quality, and mental health. Using structural equation models, this study analysed the influence of both tree cover and grass and shrub cover on perceived heat stress and sleep quality, while controlling for risk and vulnerability factors. The outcomes revealed that during heat events, enhanced tree cover was associated with reduced heat stress (B = -0.484, 95% CI [-0.693, -0.275], p = 0.001), while increased grass and shrub cover was associated with both reduced heat stress (B = -0.361 [-0.529, -0.193], p = 0.000) and improved sleep quality (B = -0. 241 [-0.399, -0.083], p = 0.003). Conversely, during control events, stress indicators were more strongly associated with individual vulnerability factors rather than surrounding green space. These results emphasize the importance of combining trees with lower vegetation in urban planning to mitigate heat-related stress and enhance sleep quality, thereby improving overall well-being during heat events.

Heat and hospital admission via the emergency department for people with intellectual disability, autism, and mental disorders in South Korea: a nationwide, time-stratified, case-crossover study

BACKGROUND

Given the anticipated increase in ambient temperature due to climate change, the hazardous effects of heat on health have been extensively studied; however, its impact on people with intellectual disability, autism, and mental illness is largely unknown. We aimed to estimate the association between heat and hospitalisation through the emergency department (ED) among people with these mental disorders.

METHODS

In this nationwide study, we used data from the National Health Insurance Database (NHID) of the National Health Insurance Service, the single universal insurer in South Korea, the claims data for which is based on the ICD-10. We included individuals with identified intellectual disability, autism, and mental disorders (including schizophrenia, bipolar disorder, recurrent depressive disorder, schizoaffective disorder and persistent obsessive-compulsive disorder, Tourette's disorder, and narcolepsy) and we established two control groups of people without these disorders: one including 1 million systematically sampled individuals, and one matched to the cohort based on sex, age, and income group. Data on hospital admission via the ED were obtained from the NHID, including the primary cause of admission and corresponding medical costs, for the warm season (June-September) of the period 2006-2021. We used the Google Earth Engine with the ERA5-Land dataset to collect data on the daily mean temperature. We applied a time-stratified case-crossover design using a distributed lag non-linear model and performed a conditional logistic regression. The risk ratio was estimated as the odds ratio (OR) with calculated odds at the 99th percentile temperature compared with that at the local 75th percentile temperature. We did not include people with lived experience of mental illness in this study.

FINDINGS

Of the 456 946 people with intellectual disability, autism, or mental disorder in the NHID records, 99 845 were admitted to the ED, including 59 821 (59·9%) males and 40 024 (40·1%) females, and including 29 192 people with intellectual disability, 1428 people with autism, and 69 225 people with mental disorders. We were not able to collect data on ethnicity. The mean age at ED admission was 42·1 years (SD 17·9, range 0-102) for people with intellectual disability, 18·6 years (SD 10·4, range 1-72) for people with autism, and 50·8 years (SD 11·9, range 2-94) for people with mental disorders. The heat OR (odds at the 99th percentile vs 75th percentile of temperature) of ED admission was 1·23 (95% CI 1·11-1·36) for intellectual disability, 1·06 (0·68-1·63) for autism, and 1·20 (1·12-1·29) for mental disorders. People with intellectual disability, female individuals, people living in rural areas, or those with a low-income status were at increased risk of ED admission due to heat. The risk of ED admission due to genitourinary diseases was higher than that from other causes. Annual increase in medical costs attributable to heat among people with intellectual disability, autism, and mental disorders was US$ 224 970 per 100 000 person-years (95% empirical CI 139 784-305 770).

INTERPRETATION

People with intellectual disability, autism, and mental disorders should be included in groups considered at a high-risk for heat exposure, and heat adaptation policies should be implemented with consideration of these groups and their needs.

FUNDING

The National Research Foundation of Korea, Korean Ministry of Environment, and Korean Ministry of Education.

TRANSLATION

For the Korean translation of the abstract see Supplementary Materials section.