Centre for Control of Chronic Conditions, Gurgaon, India; Public Health Foundation of India, Gurgaon, India.
Public Health Foundation of India, Gurgaon, India; Jamia Milia Islamia, New Delhi, India.
Health Place. 2017 Sep;47:54-62. doi: 10.1016/j.healthplace.2017.07.004. Epub 2017 Jul 25.
Green space exposure has been positively correlated with better mental-health indicators in several high income countries, but has not been examined in low- and middle-income countries undergoing rapid urbanization. Building on a study of mental health in adults with a pre-existing chronic condition, we examined the association between park availability and major depression among 1208 adults surveyed in Delhi, India. Major depression was measured using the Mini International Neuropsychiatric Interview. The ArcGIS platform was used to quantify park availability indexed as (i) park distance from households, (ii) area of the nearest park; and within one km buffer area around households - the (iii) number and (iv) total area of all parks. Mixed-effects logistic regression models adjusted for socio-demographic characteristics indicated that relative to residents exposed to the largest nearest park areas (tertile 3), the odds [95% confidence interval] of major depression was 3.1 [1.4-7.0] times higher among residents exposed to the smallest nearest park areas (tertile 1) and 2.1 [0.9-4.8] times higher in residents with mid-level exposure (tertile 2). There was no statistically significant association between other park variables tested and major depression. We hypothesized that physical activity in the form of walking, perceived stress levels and satisfaction with the neighborhood environment may have mediating effects on the association between nearest park area and major depression. We found no significant mediation effects for any of our hypothesized variables. In conclusion, our results provide preliminary and novel evidence from India that availability of large parks in the immediate neighborhood positively impacts mental well-being of individuals with pre-existing chronic conditions, at the opportune time when India is embarking on the development of sustainable cities that aim to promote health through smart urban design - one of the key elements of which is the inclusion of urban green spaces.
绿地暴露与几个高收入国家的心理健康指标呈正相关，但在快速城市化的中低收入国家尚未得到检验。基于一项对患有预先存在的慢性疾病的成年人心理健康的研究，我们调查了德里 1208 名成年人中公园的可达性与重度抑郁症之间的关联。重度抑郁症使用迷你国际神经精神访谈进行测量。ArcGIS 平台用于量化公园的可达性，指标为 (i) 公园与家庭的距离，(ii) 最近公园的面积；以及家庭周围 1 公里缓冲区中的 (iii) 所有公园的数量和 (iv) 总面积。调整社会人口特征的混合效应逻辑回归模型表明，与暴露于最大最近公园面积的居民（三分位 3）相比，暴露于最小最近公园面积的居民（三分位 1）的重度抑郁症的几率[95%置信区间]高 3.1 倍[1.4-7.0]，暴露于中等水平的居民高 2.1 倍[0.9-4.8]。其他测试的公园变量与重度抑郁症之间没有统计学上的显著关联。我们假设步行形式的身体活动、感知压力水平和对邻里环境的满意度可能对最近公园面积与重度抑郁症之间的关联具有中介作用。我们没有发现任何假设变量的显著中介效应。总之，我们的研究结果从印度提供了初步和新颖的证据，即附近大公园的可用性对患有预先存在的慢性疾病的个体的心理健康有积极影响，正值印度着手开发旨在通过智能城市设计促进健康的可持续城市之时——其中一个关键要素是纳入城市绿地。
