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Long-term exposure to residential greenness and decreased risk of depression and anxiety

Nature Mental Health (2024)Cite this article

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Abstract

Residential greenness is considered a unique and potentially modifiable exposure construct to reduce physiological stress and improve human health. Here this study aims to investigate the longitudinal relationships of residential greenness with incident depression and anxiety and to explore and compare the pathways in which greenery may influence mental health. After excluding participants with depression or anxiety at baseline, a family history of severe depression, loss to follow-up or missing information on greenness exposure, we analyzed data of 409,556 participants from the UK Biobank. Residential greenness was assessed utilizing the normalized difference vegetation index (NDVI) within a buffer region of 300 m, 500 m, 1,000 m and 1,500 m. Incident depression and anxiety cases were identified by linking to records on the death register, hospital admissions, primary care and self-report. Time-varying Cox proportional hazards models were used to analyze the associations between greenness and incident depression and anxiety. During a median follow-up of 11.9 years, 14,309 (3.5%, 306.9/100,000 person-years) and 16,692 (4.1%, 358.0/100,000 person-years) patients were diagnosed with depression and anxiety, respectively. The hazard ratios and 95% confidence intervals (CIs) for depression and anxiety were 0.84 (95% CI, 0.82–0.85 and P < 0.001) and 0.86 (95% CI, 0.84–0.87 and P < 0.001) in the highest quartile compared with the lowest quartile of NDVI 300 m, respectively. Similar trends were shown for NDVI 500 m, 1,000 m and 1,500 m. Air pollution (particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5), NO2, NOx, SO2 and O3) played a major mediator role in the associations. For example, the association between NDVI 300 m and depression was 52.9% (95% CI, 31.6–73.1%), 28.4% (95% CI, 13.4–50.3%), 30.9% (95% CI, 17.8–48.1%), 2.4% (95% CI, 1.4–4.1%) and 27.7% (95% CI, 19.4–37.9%) mediated by the reduced PM2.5, NO2, NOx, SO2 and O3, respectively. This national study highlights that long-term exposure to residential greenness was linked to a decreased risk of incident depression and anxiety. Reduced air pollution was a significant mediator linking green environments to depression and anxiety.

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Fig. 1: Association of NDVI with incident depression and anxiety.
Fig. 2: Exposure–response curves between residential greenness and incident depression.
Fig. 3: Exposure–response curves between residential greenness and incident anxiety.

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Data availability

Data used in this project are available from the UK Biobank by submitting a data request proposal (https://www.ukbiobank.ac.uk). NDVI is available from the Moderate Resolution Imaging Spectroradiometer instrument50.

Code availability

Codes utilized for analyses have been made available through the GitHub repository at https://github.com/DonnaWang21/Greenness-Mental.

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Acknowledgements

Funding/Support: This research was not supported by a dedicated project grant.

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Authors and Affiliations

  1. Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Jianing Wang, Yudiyang Ma, Linxi Tang, Dankang Li & Yaohua Tian

  2. Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Jianing Wang, Yudiyang Ma, Linxi Tang, Dankang Li & Yaohua Tian

  3. Center for Statistics in Medicine, NDORMS, University of Oxford, The Botnar Research Centre, Oxford, UK

    Junqing Xie

  4. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

    Yonghua Hu

  5. School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China

    Yaohua Tian

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Contributions

Y.T. and J.W. conceived and designed the study. L.T., Y.M. and D.L. prepared the data. J.W., J.X., Y.M. and Y.T. conducted the data analysis, performed interpretation of the results and drafted the paper. Y.T., J.X., Y.H. and D.L. made critical revisions. All authors agreed on the final version of the paper and take responsibility for its content. Additional contributions: we appreciate the involvement of all the participants and personnel in the UK Biobank for their contributions to our study. The investigation was carried out utilizing the UK Biobank database under authorized research application number 69741.

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Correspondence to Yaohua Tian.

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Nature Mental Health thanks Kwan Ok Lee and the other, anonymous reviewers for their contribution to the peer review of this work.

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Supplementary Texts 1 and 2, Tables 1–15 and Figs. 1–3.

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Wang, J., Ma, Y., Tang, L. et al. Long-term exposure to residential greenness and decreased risk of depression and anxiety. Nat. Mental Health (2024). https://doi.org/10.1038/s44220-024-00227-z

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