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      Residential green space quantity and quality and symptoms of psychological distress: a 15-year longitudinal study of 3897 women in postpartum

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      1 , 2 , 3 , ,   1 , 2 , 3 , 4
      BMC Psychiatry
      BioMed Central
      Mental health, Green space quality, Green space quantity, Women, Postpartum

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          Abstract

          Background

          Experiments and large-scale epidemiological studies indicate the importance of green space for mental health. However, little research has been conducted to elucidate whether these mental health benefits are more dependent upon the quantity or quality of the green space.

          Methods

          Symptoms of psychological distress were measured in 3897 women who did not change neighbourhood up to 15 years postpartum using the Kessler 6 psychological distress scale from 2004 onwards. The percentage land-use of the neighbourhood was used to ascertain a measure of green space quantity. A Likert scale was used to measure green space quality in response to the statement “ there are good parks, playgrounds and play spaces in this neighbourhood.” Multilevel negative binomial growth curve regression models were used to examine the patterning of symptoms of psychological distress across the postpartum period in relation to green space quantity and quality, adjusting for person-level and geographical markers of confounding. The same variables were also fitted in multilevel logistic regressions to examine the odds of reporting serious mental illness (as defined by K6 scores ≥ 13 out of 24).

          Results

          Symptoms of psychological distress were fewer among women who agreed (rate ratio (RR) 0.95, 95%CI 0.91 to 0.98) and strongly agreed (RR 0.89, 95%CI 0.85 to 0.93) local parks were good quality. The odds of reporting serious mental illness were also lower among women who agreed (odds ratio (OR) 0.88, 95%CI 0.77 to 1.00) and strongly agreed (OR 0.74, 95%CI 0.64 to 0.86) local parks were good quality. No association was found between green space quantity and symptoms of psychological distress or the odds of reporting serious mental illness.

          Conclusions

          This study suggests it may be how mothers perceive green space nearby and what those spaces enable them to do, rather than simply how much there is overall, that is important for promoting mental health in the postpartum period. In conclusion, community consultation is likely to be a crucial part of strategies that maximise the health benefits of urban greening for everyone.

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          Most cited references33

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          A systematic review of evidence for the added benefits to health of exposure to natural environments

          Background There is increasing interest in the potential role of the natural environment in human health and well-being. However, the evidence-base for specific and direct health or well-being benefits of activity within natural compared to more synthetic environments has not been systematically assessed. Methods We conducted a systematic review to collate and synthesise the findings of studies that compare measurements of health or well-being in natural and synthetic environments. Effect sizes of the differences between environments were calculated and meta-analysis used to synthesise data from studies measuring similar outcomes. Results Twenty-five studies met the review inclusion criteria. Most of these studies were crossover or controlled trials that investigated the effects of short-term exposure to each environment during a walk or run. This included 'natural' environments, such as public parks and green university campuses, and synthetic environments, such as indoor and outdoor built environments. The most common outcome measures were scores of different self-reported emotions. Based on these data, a meta-analysis provided some evidence of a positive benefit of a walk or run in a natural environment in comparison to a synthetic environment. There was also some support for greater attention after exposure to a natural environment but not after adjusting effect sizes for pretest differences. Meta-analysis of data on blood pressure and cortisol concentrations found less evidence of a consistent difference between environments across studies. Conclusions Overall, the studies are suggestive that natural environments may have direct and positive impacts on well-being, but support the need for investment in further research on this question to understand the general significance for public health.
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            More green space is linked to less stress in deprived communities: Evidence from salivary cortisol patterns

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              Regulation of the immune system by biodiversity from the natural environment: An ecosystem service essential to health

              Epidemiological studies suggest that living close to the natural environment is associated with long-term health benefits including reduced death rates, reduced cardiovascular disease, and reduced psychiatric problems. This is often attributed to psychological mechanisms, boosted by exercise, social interactions, and sunlight. Compared with urban environments, exposure to green spaces does indeed trigger rapid psychological, physiological, and endocrinological effects. However, there is little evidence that these rapid transient effects cause long-term health benefits or even that they are a specific property of natural environments. Meanwhile, the illnesses that are increasing in high-income countries are associated with failing immunoregulation and poorly regulated inflammatory responses, manifested as chronically raised C-reactive protein and proinflammatory cytokines. This failure of immunoregulation is partly attributable to a lack of exposure to organisms (“Old Friends”) from mankind’s evolutionary past that needed to be tolerated and therefore evolved roles in driving immunoregulatory mechanisms. Some Old Friends (such as helminths and infections picked up at birth that established carrier states) are almost eliminated from the urban environment. This increases our dependence on Old Friends derived from our mothers, other people, animals, and the environment. It is suggested that the requirement for microbial input from the environment to drive immunoregulation is a major component of the beneficial effect of green space, and a neglected ecosystem service that is essential for our well-being. This insight will allow green spaces to be designed to optimize health benefits and will provide impetus from health systems for the preservation of ecosystem biodiversity.
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                Author and article information

                Contributors
                +61 02 4221 5713 , xfeng@uow.edu.au
                thomasab@uow.edu.au
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                26 October 2018
                26 October 2018
                2018
                : 18
                : 348
                Affiliations
                [1 ]ISNI 0000 0004 0486 528X, GRID grid.1007.6, Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, , University of Wollongong, ; Wollongong, NSW Australia
                [2 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Menzies Centre for Health Policy, , University of Sydney, ; Sydney, NSW Australia
                [3 ]ISNI 0000 0004 0486 528X, GRID grid.1007.6, Illawarra Health and Medical Research Institute (IHMRI), , University of Wollongong and Illawarra and Shoalhaven Local Health District, ; Wollongong, NSW Australia
                [4 ]ISNI 0000 0001 0662 3178, GRID grid.12527.33, School of Public Health, , Peking Union Medical College and the Chinese Academy of Medical Sciences, ; Beijing, China
                Article
                1926
                10.1186/s12888-018-1926-1
                6204015
                30367610
                12968c7a-0508-4497-a655-c071c2b32067
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 April 2018
                : 10 October 2018
                Funding
                Funded by: Hort Innovation Limited
                Award ID: GC15005
                Award ID: GC15005
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001030, National Heart Foundation of Australia;
                Award ID: 100948
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: 1101065
                Award ID: 1101065
                Award ID: 1140317
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Clinical Psychology & Psychiatry
                mental health,green space quality,green space quantity,women,postpartum

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