Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK.
Department of Health Sciences, University of York, York, YO10 5NG, UK.
Environ Res. 2021 Mar;194:110625. doi: 10.1016/j.envres.2020.110625. Epub 2020 Dec 16.
Exposure to urban greenspaces promotes an array of mental health benefits. Understanding these benefits is of paramount importance, particularly in low- and middle-income countries (LMICs), where cities are expanding at an unprecedented rate. However, the existing evidence-base for the health benefits of greenspaces has a strong bias towards high-income countries. Here we systematically assess the emerging evidence regarding the mental health benefits provided by urban greenspaces in LMICs. We carried out a scoping review to assess the extent, type and quality of evidence investigating the relationship between greenspaces and mental health in LMICs. We systematically searched the literature databases Web of Science, Medline, Embase and CAB Abstracts using key terms related to greenspaces and mental health in LMICs. We analysed the resulting studies using a narrative synthesis approach, taking into account study quality, to assess the overall effects on mental health. 36 studies met the inclusion criteria and were included in the narrative synthesis. Studies were heterogeneous in design, study population, greenspace and mental health assessment. While more than 90% of LMICs remain unstudied, we found that eight out of ten studies using validated mental health screening tools detected positive associations between greenspaces and one or more mental health outcomes. These studies mostly took place in upper-middle-income countries. However, there still is a lack of evidence from regions with the highest levels of urbanisation, and only four studies assessed lower-middle and low-income countries. Furthermore, the analysis of mediating and moderating factors indicates that the relationship between greenspaces and mental health in LMICs is context dependent and needs to be assessed in relation to locally relevant environmental and cultural settings. Based on the evidence reviewed here, exposure to urban greenspaces can support multiple mental health outcomes in upper-middle-income countries. However, we still know little about poorer, rapidly urbanising countries. Our findings highlight the need for high-quality, context specific research in those urban areas with the highest levels of urbanisation, and the need to address specific challenges regarding mediating and moderating factors. Future studies should combine robust ecological assessments of greenspaces with validated mental health screening tools.
暴露在城市绿地中可以促进一系列心理健康益处。了解这些益处至关重要，特别是在城市以前所未有的速度扩张的低收入和中等收入国家（LMICs）。然而，现有的绿地健康益处证据基础对高收入国家存在严重偏见。在这里，我们系统地评估了关于城市绿地为 LMICs 提供的心理健康益处的新兴证据。我们进行了范围审查，以评估调查 LMICs 中绿地与心理健康之间关系的证据的范围、类型和质量。我们使用与 LMICs 中的绿地和心理健康相关的关键词，系统地搜索了 Web of Science、Medline、Embase 和 CAB Abstracts 等文献数据库。我们使用叙述性综合方法分析了研究结果，考虑到研究质量，以评估对心理健康的总体影响。有 36 项研究符合纳入标准，并纳入了叙述性综合分析。研究在设计、研究人群、绿地和心理健康评估方面存在异质性。虽然超过 90%的 LMICs 仍未得到研究，但我们发现，使用经过验证的心理健康筛查工具的十项研究中有八项检测到绿地与一种或多种心理健康结果之间存在正相关。这些研究大多发生在上中等收入国家。然而，仍缺乏来自城市化程度最高的地区的证据，只有四项研究评估了中下等收入和低收入国家。此外，中介和调节因素的分析表明，LMICs 中绿地与心理健康之间的关系是依赖于背景的，需要根据当地相关的环境和文化背景进行评估。基于这里审查的证据，暴露于城市绿地可以支持上中等收入国家的多种心理健康结果。然而，我们对较贫穷、快速城市化的国家了解甚少。我们的研究结果强调了在城市化水平最高的城市地区进行高质量、特定于背景的研究的必要性，以及解决中介和调节因素的具体挑战的必要性。未来的研究应该将绿地的稳健生态评估与经过验证的心理健康筛查工具相结合。
