McEachan R R C, Prady S L, Smith G, Fairley L, Cabieses B, Gidlow C, Wright J, Dadvand P, van Gent D, Nieuwenhuijsen M J
Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Department of Health Sciences, University of York, York, UK.
J Epidemiol Community Health. 2016 Mar;70(3):253-9. doi: 10.1136/jech-2015-205954. Epub 2015 Nov 11.
The current study explored the association between green space and depression in a deprived, multiethnic sample of pregnant women, and examined moderating and mediating variables.
7547 women recruited to the 'Born in Bradford' cohort completed a questionnaire during pregnancy. A binary measure of depressive symptoms was calculated using a validated survey. Two green space measures were used: quintiles of residential greenness calculated using the normalised difference vegetation index for three neighbourhood sizes (100, 300 and 500 m buffer zones around participant addresses); access to major green spaces estimated as straight line distance between participant address and nearest green space (>0.5 hectares). Logistic regression analyses examined relationships between green space and depressive symptoms, controlling for ethnicity, demographics, socioeconomic status (SES) and health behaviours. Multiplicative interactions explored variations by ethnic group, SES or activity levels. Mediation analysis assessed indirect effects via physical activity.
Pregnant women in the greener quintiles were 18-23% less likely to report depressive symptoms than those in the least green quintile (for within 100 m of green space buffer zone). The green space-depressive symptoms association was significant for women with lower education or who were active. Physical activity partially mediated the association of green space, but explained only a small portion of the direct effect.
Higher residential greenness was associated with a reduced likelihood of depressive symptoms. Associations may be stronger for more disadvantaged groups and for those who are already physically active. Improving green space is a promising intervention to reduce risk of depression in disadvantaged groups.
本研究在贫困、多民族的孕妇样本中探讨了绿地与抑郁症之间的关联，并检验了调节变量和中介变量。
招募到“布拉德福德出生”队列中的7547名女性在孕期完成了一份问卷。使用经过验证的调查计算抑郁症状的二元测量指标。使用了两种绿地测量指标：使用归一化植被指数计算的三个邻里规模（参与者住址周围100米、300米和500米缓冲区）的居住绿地五分位数；以参与者住址与最近绿地（>0.5公顷）之间的直线距离估计的主要绿地可达性。逻辑回归分析检验了绿地与抑郁症状之间的关系，同时控制了种族、人口统计学、社会经济地位（SES）和健康行为。乘法交互作用探讨了按种族、SES或活动水平的差异。中介分析评估了通过体育活动的间接影响。
处于绿地五分位数较高组的孕妇报告抑郁症状的可能性比处于绿地五分位数最低组的孕妇低18%-23%（对于100米绿地缓冲区范围内）。绿地与抑郁症状之间的关联在教育程度较低或活跃的女性中显著。体育活动部分介导了绿地的关联，但仅解释了直接效应的一小部分。
较高的居住绿地与抑郁症状发生可能性降低相关。对于处境更不利的群体和已经进行体育活动的人，这种关联可能更强。改善绿地是降低弱势群体抑郁症风险的一种有前景的干预措施。
