Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales
Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales
Background: Living in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities. Methods: A cohort of the people in Wales, UK (≥16 years; n=2 341 591) was constructed from electronic health record data sources from Jan 1, 2008 to Oct 31, 2019, comprising 19 141 896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index [EVI]), access to GBS (counts, distance to nearest), and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression [treated or untreated in the preceding 1-year period], or treatment of historical diagnoses from before the current cohort [up to 8 years previously, to 2000], where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out of Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation. Findings: After adjustment, exposure to greater ambient greenness over time (+0·1 increased EVI on a 0–1 scale) was associated with lower odds of subsequent CMD (adjusted odds ratio 0·80, 95% CI 0·80–0·81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding 1-year period), or treatments. Ten percentile points more access to GBS was associated with lower odds of a later CMD (0·93, 0·93–0·93). Every additional 360 m to the nearest GBS was associated with higher odds of CMD (1·05, 1·04–1·05). We found that positive effects of GBS on mental health appeared to be greater in more deprived quintiles. Interpretation: Ambient exposure is associated with the greatest reduced risk of CMD, particularly for those who live in deprived communities. These findings support authorities responsible for GBS, who are attempting to engage planners and policy makers, to ensure GBS meets residents' needs. Funding: National Institute for Health and Care Research Public Health Research programme.
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Geary, Rebecca S.
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Thompson, Daniel
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Mizen, Amy
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Akbari, Ashley
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Garrett, Joanne K.
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Rowney, Francis M.
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Watkins, Alan
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Lyons, Ronan A.
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Stratton, Gareth
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Lovell, Rebecca
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Nieuwenhuijsen, Mark
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Parker, Sarah C.
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Song, Jiao
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Tsimpida, Dialechti
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White, James
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White, Mathew P.
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Williams, Susan
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Wheeler, Benedict W.
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Fry, Richard
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Rodgers, Sarah E.
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19 October 2023
Geary, Rebecca S.
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Thompson, Daniel
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Mizen, Amy
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Akbari, Ashley
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Garrett, Joanne K.
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Rowney, Francis M.
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Watkins, Alan
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Lyons, Ronan A.
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Stratton, Gareth
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Lovell, Rebecca
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Nieuwenhuijsen, Mark
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Parker, Sarah C.
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Song, Jiao
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Tsimpida, Dialechti
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White, James
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White, Mathew P.
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Williams, Susan
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Wheeler, Benedict W.
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Fry, Richard
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Rodgers, Sarah E.
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Geary, Rebecca S., Thompson, Daniel, Mizen, Amy, Akbari, Ashley, Garrett, Joanne K., Rowney, Francis M., Watkins, Alan, Lyons, Ronan A., Stratton, Gareth, Lovell, Rebecca, Nieuwenhuijsen, Mark, Parker, Sarah C., Song, Jiao, Tsimpida, Dialechti, White, James, White, Mathew P., Williams, Susan, Wheeler, Benedict W., Fry, Richard and Rodgers, Sarah E.
(2023)
Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales.
The Lancet Planetary Health, 7 (10), .
(doi:10.1016/S2542-5196(23)00212-7).
Abstract
Background: Living in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities. Methods: A cohort of the people in Wales, UK (≥16 years; n=2 341 591) was constructed from electronic health record data sources from Jan 1, 2008 to Oct 31, 2019, comprising 19 141 896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index [EVI]), access to GBS (counts, distance to nearest), and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression [treated or untreated in the preceding 1-year period], or treatment of historical diagnoses from before the current cohort [up to 8 years previously, to 2000], where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out of Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation. Findings: After adjustment, exposure to greater ambient greenness over time (+0·1 increased EVI on a 0–1 scale) was associated with lower odds of subsequent CMD (adjusted odds ratio 0·80, 95% CI 0·80–0·81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding 1-year period), or treatments. Ten percentile points more access to GBS was associated with lower odds of a later CMD (0·93, 0·93–0·93). Every additional 360 m to the nearest GBS was associated with higher odds of CMD (1·05, 1·04–1·05). We found that positive effects of GBS on mental health appeared to be greater in more deprived quintiles. Interpretation: Ambient exposure is associated with the greatest reduced risk of CMD, particularly for those who live in deprived communities. These findings support authorities responsible for GBS, who are attempting to engage planners and policy makers, to ensure GBS meets residents' needs. Funding: National Institute for Health and Care Research Public Health Research programme.
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e-pub ahead of print date: 19 October 2023
Published date: 19 October 2023
Additional Information:
Funding Information:
This project was funded by the NIHR Public Health Research programme (project number 16/07/07). Time for SER to contribute to this project was funded by the NIHR Applied Research Collaboration North West Coast. We thank Roberto Villegas-Diaz for drawing the forest plots.
Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Identifiers
Local EPrints ID: 483230
URI: http://eprints.soton.ac.uk/id/eprint/483230
ISSN: 2542-5196
PURE UUID: 65d67586-68ed-41c8-9e05-dae9605e6d7a
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Date deposited: 26 Oct 2023 16:50
Last modified: 18 Mar 2024 04:15
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Contributors
Author:
Rebecca S. Geary
Author:
Daniel Thompson
Author:
Amy Mizen
Author:
Ashley Akbari
Author:
Joanne K. Garrett
Author:
Francis M. Rowney
Author:
Alan Watkins
Author:
Ronan A. Lyons
Author:
Gareth Stratton
Author:
Rebecca Lovell
Author:
Mark Nieuwenhuijsen
Author:
Sarah C. Parker
Author:
Jiao Song
Author:
Dialechti Tsimpida
Author:
James White
Author:
Mathew P. White
Author:
Susan Williams
Author:
Benedict W. Wheeler
Author:
Richard Fry
Author:
Sarah E. Rodgers
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