Association between residential greenspace and mental health among cancer survivors in Shanghai, China

Ruijia Li; Mengying Liu; Jie Song; Yuan Xu; Amei He; Xiaojing Hu; Shanshi Yang; Gang Ding; Minxing Chen; Chunlin Jin

doi:10.1016/j.envres.2023.117155

Association between residential greenspace and mental health among cancer survivors in Shanghai, China

Environ Res. 2023 Dec 1;238(Pt 2):117155. doi: 10.1016/j.envres.2023.117155. Epub 2023 Sep 27.

Authors

Ruijia Li¹, Mengying Liu², Jie Song¹, Yuan Xu¹, Amei He¹, Xiaojing Hu¹, Shanshi Yang¹, Gang Ding³, Minxing Chen⁴, Chunlin Jin⁵

Affiliations

¹ Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China.
² School of Pharmacy, Anhui Xinhua University, Hefei, 230088, China.
³ Oncology Department, Shanghai International Medical Center, 200120, Shanghai, China.
⁴ Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China. Electronic address: chenminxing@shdrc.org.
⁵ Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, 200031, China. Electronic address: jinchunlin@shdrc.org.

PMID: 37775008
DOI: 10.1016/j.envres.2023.117155

Abstract

Background: Living near and enjoying visually green landscapes is associated with better mental health, but evidence focusing on vulnerable populations (such as cancer survivors) is sparse. The purpose of this study was to explore the association between residential greenspace and anxiety and depressive symptoms among cancer survivors in Shanghai, China.

Methods: In total, 4195 cancer survivors participated in this study from the 2022 Shanghai Cancer Patient Needs Survey. The estimation of residential greenspaces was based on Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI). The presence and severity of depressive and anxiety symptoms were assessed by using the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). The relation between mental health and green space was assessed using the Generalized Additive Model (GAM) after controlling for relevant individual covariates and contextual characteristics.

Results: The prevalence of anxiety and depression in cancer survivors was 36.2% and 28.3% respectively. After multivariate adjustment, each increase in inter-quartile range (IQR) for NDVI in the 250 m buffer (NDVI_-250m) was associated with a decrease in PHQ-2 score (△score (95%CI): 0.018 (-0.034, -0.002)) and GAD-2 score (△score (95%CI): 0.018 (-0.034, -0.002)), respectively. We observed that an increase in IQR for NDVI_-250m was associated with a 3.3% (Odds ratio (OR) (95%CI):0.967 (0.943, 0.991)) reduction in anxiety symptoms. More pronounced greenspace-mental health effects were found among young adults (18-65 years) and participants living in suburban areas, compared to young people over 65 and those living in urban areas (P_-interaction < 0.05).

Conclusions: Higher levels of residential green space are associated with lower risk of depression and anxiety disorders. Our findings will fill the gap in the relationship between green space and mental health among cancer survivors in urban China, and provide new evidence for garden afforestation, community planning and policy-making. To better understand this association, more longitudinal studies are necessary to investigate the mechanisms involved.

Keywords: Anxiety; Cancer survivors; Depression; Mental health; Public health; Residential greenspace.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Cancer Survivors*
China
Humans
Longitudinal Studies
Mental Health
Neoplasms*
Parks, Recreational
Young Adult