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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

Rebecca S Geary, Daniel Thompson, Amy Mizen Orcid Logo, Ashley Akbari Orcid Logo, Joanne K Garrett, Francis M Rowney, Alan Watkins Orcid Logo, Ronan Lyons Orcid Logo, Gareth Stratton Orcid Logo, Rebecca Lovell, Mark Nieuwenhuijsen, Sarah C Parker, Jiao Song Orcid Logo, Dialechti Tsimpida, James White, Mathew P White, Susan Williams, Benedict W Wheeler, Rich Fry Orcid Logo, Sarah E Rodgers

The Lancet Planetary Health, Volume: 7, Issue: 10, Pages: e809 - e818

Swansea University Authors: Amy Mizen Orcid Logo, Ashley Akbari Orcid Logo, Alan Watkins Orcid Logo, Ronan Lyons Orcid Logo, Gareth Stratton Orcid Logo, Jiao Song Orcid Logo, Rich Fry Orcid Logo

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DOI (Published version): 10.1016/s2542-5196(23)00212-7

Abstract

Background: Evidence suggests living in greener areas, or close to green blue spaces (GBS; parks, lakes, or beaches) benefits mental health, but longitudinal evidence when GBS exposures precede outcomes is limited. We aimed to analyse the impact of living in greener areas, or close to GBS over time...

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Published in: The Lancet Planetary Health
ISSN: 2542-5196
Published: Elsevier BV 2023
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We aimed to analyse the impact of living in greener areas, or close to GBS over time on subsequent adult mental health, explicitly considering health inequalities, and disentangling the mental health benefits of potentially accessing GBS from living in greener areas.Methods; A cohort of the adults in Wales, UK (&gt;16 years; n=2,341,591) was constructed from electronic health record (EHR) data sources, 2008-2019, 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 one-year period), or treatment of historical diagnosis(es) frombefore the ‘current’ cohort (up to 8 years prior, 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 (AOR) = 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 one-year period), or treatments). Ten percentile points more access to GBS was associated with lower odds of a later CMD (AOR = 0.93 95% CI 0.93, 0.93). Every additional 360m to the nearest GBS was associated with higher odds of CMD (AOR = 1.05, 95% CI 1.04, 1.05). We found differences across deprivation quintiles. Interpretation Ambient exposure is associated with the greatest reduced risk of CMD, particularly for adults who live in deprived communities. Findings support authorities responsible for GBS who are attempting to engage planners and policy makers, to ensure GBS meets resident needs.</abstract><type>Journal Article</type><journal>The Lancet Planetary Health</journal><volume>7</volume><journalNumber>10</journalNumber><paginationStart>e809</paginationStart><paginationEnd>e818</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2542-5196</issnElectronic><keywords>Green spaces, blue spaces, mental health, health inequalities, Wales</keywords><publishedDay>31</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-10-31</publishedDate><doi>10.1016/s2542-5196(23)00212-7</doi><url>http://dx.doi.org/10.1016/s2542-5196(23)00212-7</url><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme (Project number 16/07/07). Time for SER to contribute to this project was funded by The National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC). We thank Mr Roberto Villegas-Diaz for drawing the Forest plots.</funders><projectreference/><lastEdited>2023-10-26T11:59:03.4756003</lastEdited><Created>2023-07-31T10:13:49.7138952</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Rebecca S</firstname><surname>Geary</surname><order>1</order></author><author><firstname>Daniel</firstname><surname>Thompson</surname><order>2</order></author><author><firstname>Amy</firstname><surname>Mizen</surname><orcid>0000-0001-7516-6767</orcid><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Joanne K</firstname><surname>Garrett</surname><order>5</order></author><author><firstname>Francis M</firstname><surname>Rowney</surname><order>6</order></author><author><firstname>Alan</firstname><surname>Watkins</surname><orcid>0000-0003-3804-1943</orcid><order>7</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>8</order></author><author><firstname>Gareth</firstname><surname>Stratton</surname><orcid>0000-0001-5618-0803</orcid><order>9</order></author><author><firstname>Rebecca</firstname><surname>Lovell</surname><order>10</order></author><author><firstname>Mark</firstname><surname>Nieuwenhuijsen</surname><order>11</order></author><author><firstname>Sarah C</firstname><surname>Parker</surname><order>12</order></author><author><firstname>Jiao</firstname><surname>Song</surname><orcid>0000-0002-4976-156X</orcid><order>13</order></author><author><firstname>Dialechti</firstname><surname>Tsimpida</surname><order>14</order></author><author><firstname>James</firstname><surname>White</surname><order>15</order></author><author><firstname>Mathew P</firstname><surname>White</surname><order>16</order></author><author><firstname>Susan</firstname><surname>Williams</surname><order>17</order></author><author><firstname>Benedict W</firstname><surname>Wheeler</surname><order>18</order></author><author><firstname>Rich</firstname><surname>Fry</surname><orcid>0000-0002-7968-6679</orcid><order>19</order></author><author><firstname>Sarah E</firstname><surname>Rodgers</surname><order>20</order></author></authors><documents><document><filename>64000__28880__f45967632c984cadb41ca88b1d4e30ed.pdf</filename><originalFilename>64000.VOR.pdf</originalFilename><uploaded>2023-10-26T11:54:16.2570853</uploaded><type>Output</type><contentLength>1091659</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2023 The Author(s). 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spelling v2 64000 2023-07-31 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 9e9db8229784e27fcd79a14ee097e10b 0000-0001-7516-6767 Amy Mizen Amy Mizen true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 6d62b2ed126961bed81a94a2beba8a01 0000-0001-5618-0803 Gareth Stratton Gareth Stratton true false 00048c7531209d3238534e0b319de731 0000-0002-4976-156X Jiao Song Jiao Song true false d499b898d447b62c81b2c122598870e0 0000-0002-7968-6679 Rich Fry Rich Fry true false 2023-07-31 HDAT Background: Evidence suggests living in greener areas, or close to green blue spaces (GBS; parks, lakes, or beaches) benefits mental health, but longitudinal evidence when GBS exposures precede outcomes is limited. We aimed to analyse the impact of living in greener areas, or close to GBS over time on subsequent adult mental health, explicitly considering health inequalities, and disentangling the mental health benefits of potentially accessing GBS from living in greener areas.Methods; A cohort of the adults in Wales, UK (>16 years; n=2,341,591) was constructed from electronic health record (EHR) data sources, 2008-2019, 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 one-year period), or treatment of historical diagnosis(es) frombefore the ‘current’ cohort (up to 8 years prior, 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 (AOR) = 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 one-year period), or treatments). Ten percentile points more access to GBS was associated with lower odds of a later CMD (AOR = 0.93 95% CI 0.93, 0.93). Every additional 360m to the nearest GBS was associated with higher odds of CMD (AOR = 1.05, 95% CI 1.04, 1.05). We found differences across deprivation quintiles. Interpretation Ambient exposure is associated with the greatest reduced risk of CMD, particularly for adults who live in deprived communities. Findings support authorities responsible for GBS who are attempting to engage planners and policy makers, to ensure GBS meets resident needs. Journal Article The Lancet Planetary Health 7 10 e809 e818 Elsevier BV 2542-5196 Green spaces, blue spaces, mental health, health inequalities, Wales 31 10 2023 2023-10-31 10.1016/s2542-5196(23)00212-7 http://dx.doi.org/10.1016/s2542-5196(23)00212-7 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme (Project number 16/07/07). Time for SER to contribute to this project was funded by The National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC). We thank Mr Roberto Villegas-Diaz for drawing the Forest plots. 2023-10-26T11:59:03.4756003 2023-07-31T10:13:49.7138952 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Rebecca S Geary 1 Daniel Thompson 2 Amy Mizen 0000-0001-7516-6767 3 Ashley Akbari 0000-0003-0814-0801 4 Joanne K Garrett 5 Francis M Rowney 6 Alan Watkins 0000-0003-3804-1943 7 Ronan Lyons 0000-0001-5225-000X 8 Gareth Stratton 0000-0001-5618-0803 9 Rebecca Lovell 10 Mark Nieuwenhuijsen 11 Sarah C Parker 12 Jiao Song 0000-0002-4976-156X 13 Dialechti Tsimpida 14 James White 15 Mathew P White 16 Susan Williams 17 Benedict W Wheeler 18 Rich Fry 0000-0002-7968-6679 19 Sarah E Rodgers 20 64000__28880__f45967632c984cadb41ca88b1d4e30ed.pdf 64000.VOR.pdf 2023-10-26T11:54:16.2570853 Output 1091659 application/pdf Version of Record true © 2023 The Author(s). Published by Elsevier Ltd. Distributed under the terms of a Creative Commons Attribution 4.0 License (CC BY 4.0). true eng https://creativecommons.org/licenses/by/4.0/
title 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
spellingShingle 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
Amy Mizen
Ashley Akbari
Alan Watkins
Ronan Lyons
Gareth Stratton
Jiao Song
Rich Fry
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv 9e9db8229784e27fcd79a14ee097e10b
aa1b025ec0243f708bb5eb0a93d6fb52
81fc05c9333d9df41b041157437bcc2f
83efcf2a9dfcf8b55586999d3d152ac6
6d62b2ed126961bed81a94a2beba8a01
00048c7531209d3238534e0b319de731
d499b898d447b62c81b2c122598870e0
author_id_fullname_str_mv 9e9db8229784e27fcd79a14ee097e10b_***_Amy Mizen
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
6d62b2ed126961bed81a94a2beba8a01_***_Gareth Stratton
00048c7531209d3238534e0b319de731_***_Jiao Song
d499b898d447b62c81b2c122598870e0_***_Rich Fry
author Amy Mizen
Ashley Akbari
Alan Watkins
Ronan Lyons
Gareth Stratton
Jiao Song
Rich Fry
author2 Rebecca S Geary
Daniel Thompson
Amy Mizen
Ashley Akbari
Joanne K Garrett
Francis M Rowney
Alan Watkins
Ronan Lyons
Gareth Stratton
Rebecca Lovell
Mark Nieuwenhuijsen
Sarah C Parker
Jiao Song
Dialechti Tsimpida
James White
Mathew P White
Susan Williams
Benedict W Wheeler
Rich Fry
Sarah E Rodgers
format Journal article
container_title The Lancet Planetary Health
container_volume 7
container_issue 10
container_start_page e809
publishDate 2023
institution Swansea University
issn 2542-5196
doi_str_mv 10.1016/s2542-5196(23)00212-7
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url http://dx.doi.org/10.1016/s2542-5196(23)00212-7
document_store_str 1
active_str 0
description Background: Evidence suggests living in greener areas, or close to green blue spaces (GBS; parks, lakes, or beaches) benefits mental health, but longitudinal evidence when GBS exposures precede outcomes is limited. We aimed to analyse the impact of living in greener areas, or close to GBS over time on subsequent adult mental health, explicitly considering health inequalities, and disentangling the mental health benefits of potentially accessing GBS from living in greener areas.Methods; A cohort of the adults in Wales, UK (>16 years; n=2,341,591) was constructed from electronic health record (EHR) data sources, 2008-2019, 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 one-year period), or treatment of historical diagnosis(es) frombefore the ‘current’ cohort (up to 8 years prior, 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 (AOR) = 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 one-year period), or treatments). Ten percentile points more access to GBS was associated with lower odds of a later CMD (AOR = 0.93 95% CI 0.93, 0.93). Every additional 360m to the nearest GBS was associated with higher odds of CMD (AOR = 1.05, 95% CI 1.04, 1.05). We found differences across deprivation quintiles. Interpretation Ambient exposure is associated with the greatest reduced risk of CMD, particularly for adults who live in deprived communities. Findings support authorities responsible for GBS who are attempting to engage planners and policy makers, to ensure GBS meets resident needs.
published_date 2023-10-31T11:59:02Z
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score 11.013371

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