Abstract
BACKGROUND AND AIM: Surrounding green as a part of resilience environment is reported to benefit mental health by direct protection and the mitigation of hazardous environmental exposure. In this study, we aimed to evaluate the association of surrounding green with incident depression and explore whether and how the association is affected by co-exposure to PM. METHODS: Data were derived from a large-prospective cohort of community-dwelling adults in China. Depression cases were ascertained from local Health Information System linking participants to the health records of hospitals. We estimated the exposure to surrounding green (the average Normalized Difference Vegetation Index, NDVI) and particulate matter (PM, predicted by land-use regression models) at the participants’ residential addresses. We conducted Cox proportional hazards models upon adjusting a series of potential confounders including sociodemographic characteristics, lifestyle factors and health status, such as self-perceived stress and morbidity. Furthermore, we explored the confounding, interaction and mediation relationship between greenness and particulate matter on the incident depression and estimated the cumulative risk indexes (CRIs). RESULTS:In single exposure models, NDVI was inversely associated with depression incidence. The estimates were attenuated slightly when further adjusted for PM2.5 and PM10. The joint hazard ratio (JHR) of per IQR decrease of NDVI and per IQR increase of PM10 was higher than both in single exposures. Besides, we found the protective effect of greenness was not mediated by PM but was interacted with PM10. CONCLUSIONS:In this large prospective cohort study, residents living in the greener neighborhoods had a lower risk of incident depression. The protective effect was found to be confounded by the PM, since the mediation analysis showed no significance. KEYWORDS: Green space, Particulate matter, Mental health outcomes, Incidence.
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