Association of Urban Green Space With Mental Health and General Health Among Adults in Australia | Anxiety Disorders | JAMA Network Open | JAMA Network
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    1 Comment for this article
    RE: Association of urban green space with mental health and general health among adults in Australia
    Tomoyuki Kawada, MD | Nippon Medical School
    Astell-Burt and Feng conducted a prospective study to investigate the association between total green space or specific types of green space and mental health [1]. Psychological distress was measured by 10-item Kessler Psychological Distress Scale. Odds ratios (ORs) (95% confidence intervals [CIs]) of exposures of 30% or more total green space and tree canopy for incidence of psychological distress were 0.46 (0.29-0.69) and 0.69 (0.54-0.88), respectively. In addition, OR (95% CI) of exposure to tree canopy of 30% or more for incidence of fair to poor general health was 0.67 (0.57-0.80). Furthermore, ORs (95% CIs) of exposure to grass of 30% or more for incident fair to poor general health and for prevalent psychological distress were 1.47 (1.12-1.91) and 1.71 (1.25-2.28), respectively. The authors recommended that urban tree canopy may keep general health and prevent psychological distress. I have a query about their study.

    Perrino et al. examined the relationship between neighbourhood greenness and depression among older adults [2]. OR (95% CI) of the highest tertile and the middle tertile of greenness against the lowest tertile for depression were 0.84 (0.79-0.88) and 0.92 (0.88-0.96), respectively. Sarkar et al. also investigated the association between residential green exposure and prevalence of major depressive disorders [3]. OR (95% CI) per interquartile increment in Normalised Difference Vegetation Index greenness for major depressive disorder was 0.960 (0.93-0.99). Furthermore, Pun et al. examined the association between greenness and mental health [4]. They found a significant association of greenness with lower self-perceived stress among older adult. In contrast, greenness was not significantly associated with depressive and anxiety symptoms. Although there is a positive association between greenness and good mental health in general, depressive and anxiety symptoms may not be recovered by greenness.


    1. Astell-Burt T, Feng X. Association of urban green space with mental health and general health among adults in Australia. JAMA Netw Open. 2019;2(7):e198209. doi: 10.1001/jamanetworkopen.2019.8209

    2. Perrino T, Lombard J, Rundek T, et al. Neighbourhood greenness and depression among older adults. Br J Psychiatry. 2019;215(2):476-480. doi: 10.1192/bjp.2019.129

    3. Sarkar C, Webster C, Gallacher J. Residential greenness and prevalence of major depressive disorders: a cross-sectional, observational, associational study of 94 879 adult UK Biobank participants. Lancet Planet Health. 2018;2(4):e162-e173. doi: 10.1016/S2542-5196(18)30051-2

    4. Pun VC, Manjourides J, Suh HH. Association of neighborhood greenness with self-perceived stress, depression and anxiety symptoms in older U.S adults. Environ Health. 2018;17(1):39. doi: 10.1186/s12940-018-0381-2
    Original Investigation
    Public Health
    July 26, 2019

    Association of Urban Green Space With Mental Health and General Health Among Adults in Australia

    Author Affiliations
    • 1Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
    JAMA Netw Open. 2019;2(7):e198209. doi:10.1001/jamanetworkopen.2019.8209
    Key Points español 中文 (chinese)

    Question  What type of green space is associated with better mental health?

    Findings  In this cohort study of 46 786 adults older than 45 years, exposure to 30% or more tree canopy compared with 0% to 9% tree canopy was associated with 31% lower odds of incident psychological distress, whereas exposure to 30% or more grass was associated with 71% higher odds of prevalent psychological distress after adjusting for age, sex, income, economic status, couple status, and educational level. Similar results were found for self-rated fair to poor general health but not physician-diagnosed depression or anxiety.

    Meaning  Investments specifically in tree canopy may provide more support for mental health.


    Importance  Recent studies indicate that living near more green space may support mental and general health and may also prevent depression. However, most studies are cross-sectional, and few have considered whether some types of green space matter more for mental health.

    Objective  To assess whether total green space or specific types of green space are associated with better mental health.

    Design, Setting, and Participants  This cohort study included a residentially stable, city-dwelling sample of 46 786 participants from Sydney, Wollongong, and Newcastle, Australia, in the baseline of the Sax Institute’s 45 and Up Study (data collected from January 1, 2006, to December 31, 2009). Follow-up was conducted from January 1, 2012, to December 31, 2015. Analyses were conducted in January 2019.

    Exposures  Percentage of total green space, tree canopy, grass, and other low-lying vegetation measured within 1.6-km (1-mile) road network distance buffers around residential addresses at baseline.

    Main Outcomes and Measures  Three outcome variables were examined at baseline (prevalence) and follow-up (incidence without baseline affirmatives): (1) risk of psychological distress (10-item Kessler Psychological Distress Scale), (2) self-reported physician-diagnosed depression or anxiety, and (3) fair to poor self-rated general health.

    Results  This study included 46 786 participants (mean [SD] age, 61.0 [10.2] years; 25 171 [53.8%] female). At baseline, 5.1% of 37 775 reported a high risk of psychological distress, 16.0% of 46 786 reported depression or anxiety, and 9.0% of 45 577 reported fair to poor self-rated health. An additional 3.3% of 32 991 experienced psychological distress incidence, 7.5% of 39 277 experienced depression or anxiety incidence, and 7.3% of 40 741 experienced fair to poor self-rated health incidence by follow-up (mean [SD] of 6.2 [1.62] years later). Odds ratios (ORs) adjusted for age, sex, income, economic status, couple status, and educational level indicated that exposures of 30% or more total green space (OR, 0.46; 95% CI, 0.29-0.69) and tree canopy specifically (OR, 0.69; 95% CI, 0.54-0.88) were associated with lower incidence of psychological distress. Exposure to tree canopy of 30% or more, compared with 0% to 9%, was also associated with lower incidence of fair to poor general health (OR, 0.67; 95% CI, 0.57-0.80). Exposure to grass of 30% or more, compared with 0% to 4%, was associated with higher odds of incident fair to poor general health (OR, 1.47; 95% CI, 1.12-1.91) and prevalent psychological distress (OR, 1.71; 95% CI, 1.25-2.28). Exposure to low-lying vegetation was not consistently associated with any outcome. No green space indicator was associated with prevalent or incident depression or anxiety.

    Conclusions and Relevance  Protection and restoration of urban tree canopy specifically, rather than any urban greening, may be a good option for promotion of community mental health.