Associations between Changes in Exposure to Air Pollutants due to Relocation and the Incidence of 14 Major Disease Categories and All-Cause Mortality: A Natural Experiment Study

A good move for health?: Analyzing urban exposure trajectories of residential relocation and mental health in populations in Bradford

Residential relocation can be leveraged as a natural experiment. This study examined the changes in environmental exposures due to residential relocation in two samples of within-city movers in Bradford (UK); 2089 residents (66% women, mean [SD] age, 47.80 [19.88] years) with preexisting common mental disorders-related prescriptions and 12,699 residents (60% women, mean [SD] age, 42.47 [17.40] years) without the same prescriptions at baseline (January-April 2021). Study data were extracted from National Health Service health records. The outcome was the presence of an active prescription for anxiolytics or antidepressants (yes/no) 1 year after relocation (January-April 2022). Change scores were calculated for several exposures, including the normalized difference vegetation index, distance decay to green spaces, coarse (PM10) and fine particulate matter (PM2.5), and nitrogen dioxide (NO2) at pre- and postmove addresses. Logistic regression models were used for each change score exposure, adjusting for covariates selected using a direct acyclic graph validated against the data. Participants without prescriptions at baseline were likely to relocate to less green and less polluted areas compared with those with preexisting medication. A total of 15% of participants without prescriptions at baseline had an active prescription at follow-up. For these, increases in normalized difference vegetation index were associated with lower odds of having active prescriptions at follow-up [OR (odds ratio) = 0.93 (95% confidence interval [CI] = 0.88, 0.98), P = 0.007], whereas increases in PM2.5 [OR = 1.1 (95% CI = 1.04, 1.16), P < 0.001] and PM10 [OR = 1.12 (95% CI = 1.06-1.19), P < 0.001] concentrations were associated with higher odds. Changes in environmental exposures due to residential relocation showed an influence on mental health only for those participants without active prescriptions in the baseline.

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.

Perceptions of Endocrine Clinicians Regarding Climate Change and Health

The effects of climate change on the endocrine system are increasingly recognized. We aimed to evaluate endocrine clinicians' perspectives on climate change awareness and knowledge, motivation for action, and the need for climate health curricula. We designed an online questionnaire with endocrine-specific questions about climate change, which was shared through social media and email. Study data were collected between 9/2022 and 11/2022. Analyses were primarily descriptive. There were 164 responses; 98% were physicians, with a median age of 41 years. The majority (95%) reported that climate change is happening; 52% reported that they are very worried. Knowledge about climate change and health was variable (6.7% very, 40% moderately, 35% modestly, 17.7% not at all), with variable concerns regarding patient effects. The top endocrine climate-health concerns were reduced exercise, malnutrition, and weather-related disruptions. Most respondents agreed that climate change and health topics should be integrated into medical education (72.8% strongly agree or agree). The three resources perceived as most helpful were continuing medical education, patient resources, and policy statements. Endocrine clinicians are aware of and worried about climate change, with varying levels of knowledge and concern about climate change and health effects. We also exposed an untapped interest in developing endocrine-specific climate and health curricula.