Mehta Unnati V, Wilt Grete E, Roscoe Charlotte, Okereke O I, Coull B A, James Peter, Laden Francine, Iyer Hari S, Yanosky Jeff D, Kaufman Joel, Fiffer Melissa R, DeVille Nicole V, Holland Isabel, Hart Jaime E
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts, USA.
Environ Health Perspect. 2025 Jun;133(6):67008. doi: 10.1289/EHP14458. Epub 2025 Jun 11.
BACKGROUND: Emerging evidence has implicated built and natural environmental exposures in the etiology and exacerbation of anxiety symptoms. OBJECTIVES: Our objective was to assess individual and joint associations between neighborhood socioeconomic status (nSES), walkability, greenness, fine particulate matter (), nitrogen dioxide (), and temperature and generalized anxiety disorder (GAD) symptoms. METHODS: We included 81,897 participants of the Nurses' Health Study II. GAD symptoms were measured in 2013 and 2017 using the seven-item Generalized Anxiety Disorder scale (GAD-7). Walkability and nSES -scores were calculated at the census tract level. Summer and annual average greenness were measured using Normalized Difference Vegetation Index (NDVI) at 270 m and 1,230 m buffer sizes. 1-, 3-, and 12-month averages of particulate matter with an aerodynamic diameter of (), nitrogen dioxide (), and temperature were predicted using spatiotemporal models. Exposures were measured at the residential level. Longitudinal logistic and generalized estimating equations (GEE) models estimated odds ratios (OR) and 95% confidence intervals (CIs) for clinically relevant GAD symptoms (GAD-7 points). We assessed effect modification by nSES, summer NDVI (), and select covariates. We employed quantile g-computation to assess the association between environmental exposure mixtures and GAD symptoms more directly. RESULTS: In single-exposure models, summer NDVI (e.g., for , ; 95% CI: 0.94, 0.98), (e.g., for 12-month average , ; 95% CI: 1.01, 1.04), 12-month average temperature (; 95% CI: 1.03, 1.07), and walkability (; 95% CI: 1.01, 1.03) were associated with GAD symptoms. In the joint-exposure model, nSES (; 95% CI: 0.95, 0.98) and summer NDVI were associated (; 95% CI: 0.88, 0.96); all other associations were attenuated. Associations with summer NDVI (), temperature, and were modified by nSES, with stronger associations in socioeconomically deprived areas. DISCUSSION: In this population, higher levels of summer greenness and nSES may be protectively associated with GAD symptoms, whereas medium- and long-term exposure, long-term temperature, and walkability are adversely associated with GAD symptoms. Socioeconomically deprived areas may bear additional risks. The results of the quantile g-computation analysis suggest that environmental exposures may act antagonistically with one another in relation to GAD symptoms. https://doi.org/10.1289/EHP14458.
背景：新出现的证据表明，人造环境和自然环境暴露与焦虑症状的病因及加重有关。 目的：我们的目的是评估邻里社会经济地位（nSES）、步行便利性、绿化程度、细颗粒物（）、二氧化氮（）和温度与广泛性焦虑障碍（GAD）症状之间的个体关联和联合关联。 方法：我们纳入了护士健康研究II的81,897名参与者。2013年和2017年使用七项广泛性焦虑障碍量表（GAD-7）测量GAD症状。在人口普查区层面计算步行便利性和nSES得分。使用归一化植被指数（NDVI）在270米和1230米缓冲范围内测量夏季和年平均绿化程度。使用时空模型预测空气动力学直径为（）、二氧化氮（）和温度的1个月、3个月和12个月平均值。在居住层面测量暴露情况。纵向逻辑回归和广义估计方程（GEE）模型估计临床相关GAD症状（GAD-7分）的比值比（OR）和95%置信区间（CI）。我们评估了nSES、夏季NDVI（）和选定协变量的效应修正。我们采用分位数g计算更直接地评估环境暴露混合物与GAD症状之间的关联。 结果：在单暴露模型中，夏季NDVI（例如，对于，；95%CI：0.94，0.98）、（例如，对于12个月平均值，；95%CI：1.01，1.04）、12个月平均温度（；95%CI：1.03，1.07）和步行便利性（；95%CI：1.01，1.03）与GAD症状相关。在联合暴露模型中，nSES（；95%CI：0.95，0.98）和夏季NDVI相关（；95%CI：0.88，0.96）；所有其他关联均减弱。与夏季NDVI（）、温度和的关联因nSES而改变，在社会经济贫困地区关联更强。 讨论：在该人群中，较高的夏季绿化程度和nSES水平可能与GAD症状呈保护性关联，而中长期暴露、长期温度和步行便利性与GAD症状呈不利关联。社会经济贫困地区可能承担额外风险。分位数g计算分析结果表明，环境暴露在GAD症状方面可能相互拮抗。https://doi.org/10.1289/EHP14458
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