Sun Yi, Molitor John, Benmarhnia Tarik, Avila Chantal, Chiu Vicki, Slezak Jeff, Sacks David A, Chen Jiu-Chiuan, Getahun Darios, Wu Jun
Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
Lancet Reg Health Am. 2023 Mar 6;21:100462. doi: 10.1016/j.lana.2023.100462. eCollection 2023 May.
Little research exists regarding the relationships between green space and postpartum depression (PPD). We aimed to investigate the relationships between PPD and green space exposure, and the mediating role of physical activity (PA).
Clinical data were obtained from Kaiser Permanente Southern California electronic health records in 2008-2018. PPD ascertainment was based on both diagnostic codes and prescription medications. Maternal residential green space exposures were assessed using street view-based measures and vegetation types (i.e., street tree, low-lying vegetation, and grass), satellite-based measures [i.e., Normalized Difference Vegetation Index (NDVI), land-cover green space, and tree canopy cover], and proximity to the nearest park. Multilevel logistic regression was applied to estimate the association between green space and PPD. A causal mediation analysis was performed to estimate the proportion mediated by PA during pregnancy in the total effects of green space on PPD.
In total, we included 415,020 participants (30.2 ± 5.8 years) with 43,399 (10.5%) PPD cases. Hispanic mothers accounted for about half of the total population. A reduced risk for PPD was associated with total green space exposure based on street-view measure [500 m buffer, adjusted odds ratio (OR) per interquartile range: 0.98, 95% CI: 0.97-0.99], but not NDVI, land-cover greenness, or proximity to a park. Compared to other types of green space, tree coverage showed stronger protective effects (500 m buffer, OR = 0.98, 95% CI: 0.97-0.99). The proportions of mediation effects attributable to PA during pregnancy ranged from 2.7% to 7.2% across green space indicators.
Street view-based green space and tree coverage were associated with a decreased risk of PPD. The observed association was primarily due to increased tree coverage, rather than low-lying vegetation or grass. Increased PA was a plausible pathway linking green space to lower risk for PPD.
National Institute of Environmental Health Sciences (NIEHS; R01ES030353).
关于绿地与产后抑郁症（PPD）之间关系的研究较少。我们旨在调查PPD与绿地暴露之间的关系，以及身体活动（PA）的中介作用。
临床数据来自2008 - 2018年南加州永久医疗集团的电子健康记录。PPD的确定基于诊断代码和处方药。使用基于街景的测量方法和植被类型（即行道树、低矮植被和草地）、基于卫星的测量方法[即归一化植被指数（NDVI）、土地覆盖绿地和树冠覆盖率]以及到最近公园的距离来评估产妇居住环境的绿地暴露情况。应用多水平逻辑回归来估计绿地与PPD之间的关联。进行因果中介分析以估计孕期PA在绿地对PPD的总效应中所介导的比例。
我们总共纳入了415,020名参与者（30.2 ± 5.8岁），其中43,399例（10.5%）为PPD病例。西班牙裔母亲约占总人口的一半。基于街景测量的总绿地暴露与PPD风险降低相关[500米缓冲区，每四分位数间距调整后的优势比（OR）：0.98，95%置信区间（CI）：0.97 - 0.99]，但与NDVI、土地覆盖绿地或到公园的距离无关。与其他类型的绿地相比，树木覆盖率显示出更强的保护作用（500米缓冲区，OR = 0.98，95% CI：0.97 - 0.99）。在不同的绿地指标中，孕期PA所介导的效应比例在2.7%至7.2%之间。
基于街景的绿地和树木覆盖率与PPD风险降低相关。观察到的关联主要归因于树木覆盖率的增加，而非低矮植被或草地。PA增加是将绿地与较低PPD风险联系起来的一个合理途径。
美国国家环境健康科学研究所（NIEHS；R01ES030353）。
