Abstract
Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastal-blue spaces); and (b) nature connectedness, across season and country. People who lived in greener/coastal neighbourhoods reported higher positive well-being, but this association largely disappeared when recreational visits were controlled for. Frequency of recreational visits to green, inland-blue, and coastal-blue spaces in the last 4 weeks were all positively associated with positive well-being and negatively associated with mental distress. Associations with green space visits were relatively consistent across seasons and countries but associations with blue space visits showed greater heterogeneity. Nature connectedness was also positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. By contrast inland-blue space visits were associated with a greater likelihood of using anxiety medication. Results highlight the benefits of multi-exposure, multi-response, multi-country studies in exploring complexity in nature-health associations.
Highlights
Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain
In order to maintain model power for our more exploratory questions into seasonal and country variation we focused on the WHO-5 positive well-being scores, rather than the dichotomous indices of mental distress and medication use
There were no associations between residential exposure and mental distress or depression/anxiety medication use in models including or excluding visit frequency (Supplementary Tables S2, S3)
Summary
Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastalblue spaces); and (b) nature connectedness, across season and country. Nature connectedness was positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. There is a lack of clarity about the relative importance of merely living near nature, variously referred to as residential proximity, neighbourhood exposure or indirect contact[10], compared to more direct interactions including deliberate engagement through recreational visits[11]. Greater clarity about the relative importance of residential exposure and recreational visits, as well as their potentially non-linear relationships, is critical in designing public health interventions that improve availability and support the most appropriate levels of use, both locally and further afield
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