Markevych Iana, Baumbach Clemens, Helbich Marco, Burov Angel, Dimitrova Donka, Nieuwenhuijsen Mark J, Dzhambov Angel M
Institute of Psychology, Jagiellonian University, Krakow, Poland; Health and Quality of Life in a Green and Sustainable Environment Research Group, Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria.
Institute of Psychology, Jagiellonian University, Krakow, Poland; Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany.
Health Place. 2025 Sep;95:103509. doi: 10.1016/j.healthplace.2025.103509. Epub 2025 Jul 10.
Loneliness is prevalent and increases risks of disease and premature death. We aimed to investigate whether greater exposure to nature is associated with less loneliness in urban Bulgarian adults, and whether the association was modified by sociodemographic factors.
The analytic sample comprised 3604 adults from a cross-sectional population-based survey conducted in 2023 in the five largest Bulgarian cities. Loneliness was self-reported with a single item on a seven-point Likert scale. Availability of nature was assessed by several GIS-derived indicators: normalised difference vegetation index (NDVI), tree cover density, urban green space, all in a 300 m buffer around home, and distance to blue space. Self-reported nature indicators included domestic garden, green space and blue space quality, green space and blue space window view, and time spent in green and blue space. Adjusted negative binomial regressions with random intercept for city district were used to assess associations with loneliness. We further checked effect modification by city type, sex, age, relationship, employment status and education.
Residing in areas with more urban green space, higher green space quality, and green space window view and spending more time in green and blue space were associated with lower loneliness scores. Living in low or high compared to medium level NDVI settings or in areas with higher tree cover density was associated with higher loneliness scores. Sociodemographic factors modified some of these associations.
Our findings underscore the importance of extending and improving structured urban green spaces in Bulgarian cities.
孤独现象普遍存在，会增加患病风险和过早死亡的几率。我们旨在调查在保加利亚城市成年人中，更多地接触自然是否与较少的孤独感相关，以及这种关联是否会受到社会人口学因素的影响。
分析样本包括2023年在保加利亚五个最大城市进行的一项基于人群的横断面调查中的3604名成年人。孤独感通过一个七点李克特量表上的单项自我报告。自然环境的可及性通过几个基于地理信息系统得出的指标进行评估：归一化植被指数（NDVI）、树木覆盖密度、城市绿地，均为家周围300米缓冲区内的指标，以及到蓝色空间（如水体）的距离。自我报告的自然指标包括家庭花园、绿地和蓝色空间的质量、绿地和蓝色空间的窗外景观，以及在绿地和蓝色空间中花费的时间。使用带有城市区域随机截距的调整负二项回归来评估与孤独感的关联。我们进一步检查了城市类型、性别、年龄、人际关系、就业状况和教育程度对效应的修饰作用。
居住在城市绿地更多、绿地质量更高、有绿地窗外景观的区域，以及在绿地和蓝色空间中花费更多时间，都与较低的孤独感得分相关。与中等水平的NDVI环境相比，生活在低或高NDVI环境中，或生活在树木覆盖密度较高的区域，与较高的孤独感得分相关。社会人口学因素对其中一些关联有修饰作用。
我们的研究结果强调了在保加利亚城市扩展和改善结构化城市绿地的重要性。
