Spano Giuseppina, Nobile Federica, Giannico Vincenzo, Elia Mario, Michelozzi Paola, Bosco Andrea, Dadvand Payam, Sanesi Giovanni, Stafoggia Massimo
Department of Education, Psychology, Communication Sciences, University of Bari Aldo Moro, Bari, Italy.
Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy.
Environ Int. 2023 Dec;182:108320. doi: 10.1016/j.envint.2023.108320. Epub 2023 Nov 10.
Evidence available on the associations between urban greenness and mental health is mainly based on cross-sectional studies and has relied on 2D indicators of greenness. This longitudinal study aimed at investigating the association between 2D and 3D indicators of green and grey spaces and incident mental health-related outcomes in a large population-based cohort.
Our study used data from 593,894 Italian adults (≥30 years) from the Rome Longitudinal Study. Mental health outcomes were defined using either drug prescriptions (antidepressants, antipsychotics, lithium and other mood stabilisers, and anxiolytics, hypnotics and sedatives), or hospitalisation records (for schizophrenia spectrum disorder, depression, anxiety, stress-related and somatoform, or substance use disorders). We obtained 2D and 3D indicators of green and grey exposures including Normalized Difference Vegetation Index (NDVI), green volume, grey volume, number of trees, and Normalized Difference Green-Grey Volume Index around participants' homes. Cox proportional hazards regression models were developed to estimate the association of green and grey space exposure and psychiatric conditions and medicine use, adjusted for relevant covariates.
We found beneficial associations of NDVI and the number of trees with antipsychotic and lithium and other mood stabiliser drugs. We also observed detrimental associations between grey volume and lithium and other mood stabilisers and anxiolytic, hypnotic and sedative drugs. Finally, we found a protective association of the NDGG with lithium and other mood stabilisers (HR: 0.977; 95% CI: 0.965-0.990) and anxiolytic, hypnotic and sedative drugs (HR: 0.851; 95% CI: 0.762-0.950). The associations for hospitalisation for psychiatric conditions were less consistent and generally not statistically significant.
Findings suggested that higher greenness areas around residential addresses are associated with reduced use of drugs for psychiatric conditions, while the opposite is true for higher grey space exposure. The study highlights the importance of accurately characterising green and grey spaces, using novel exposure indicators.
现有关于城市绿地与心理健康之间关联的证据主要基于横断面研究，且依赖于二维绿地指标。这项纵向研究旨在调查绿地和灰地的二维与三维指标与一个大型人群队列中与心理健康相关的事件结局之间的关联。
我们的研究使用了来自罗马纵向研究的593894名意大利成年人（≥30岁）的数据。心理健康结局通过药物处方（抗抑郁药、抗精神病药、锂盐及其他情绪稳定剂、抗焦虑药、催眠药和镇静剂）或住院记录（精神分裂症谱系障碍、抑郁症、焦虑症、与压力相关和躯体形式障碍或物质使用障碍）来定义。我们获取了绿地和灰地暴露的二维和三维指标，包括归一化植被指数（NDVI）、绿量、灰量、树木数量以及参与者家周围的归一化绿灰量指数。我们建立了Cox比例风险回归模型，以估计绿地和灰地暴露与精神疾病及药物使用之间的关联，并对相关协变量进行了调整。
我们发现NDVI和树木数量与抗精神病药、锂盐及其他情绪稳定剂药物之间存在有益关联。我们还观察到灰量与锂盐及其他情绪稳定剂以及抗焦虑药、催眠药和镇静剂药物之间存在有害关联。最后，我们发现归一化绿灰量指数与锂盐及其他情绪稳定剂（风险比：0.977；95%置信区间：0.965 - 0.990）以及抗焦虑药、催眠药和镇静剂药物（风险比：0.851；95%置信区间：0.762 - 0.950）之间存在保护关联。精神疾病住院方面的关联不太一致，且一般无统计学意义。
研究结果表明，居住地址周围绿地较多的地区与精神疾病用药减少有关，而灰地暴露较高则情况相反。该研究强调了使用新型暴露指标准确描述绿地和灰地的重要性。
