Effect of Greening Vacant Land on Mental Health of Community-Dwelling Adults: A Cluster Randomized Trial

Abstract

Importance: Neighborhood physical conditions have been associated with mental illness and may partially explain persistent socioeconomic disparities in the prevalence of poor mental health.

Objective: To evaluate whether interventions to green vacant urban land can improve self-reported mental health.

Design, setting, and participants: This citywide cluster randomized trial examined 442 community-dwelling sampled adults living in Philadelphia, Pennsylvania, within 110 vacant lot clusters randomly assigned to 3 study groups. Participants were followed up for 18 months preintervention and postintervention. This trial was conducted from October 1, 2011, to November 30, 2014. Data were analyzed from July 1, 2015, to April 16, 2017.

Interventions: The greening intervention involved removing trash, grading the land, planting new grass and a small number of trees, installing a low wooden perimeter fence, and performing regular monthly maintenance. The trash cleanup intervention involved removal of trash, limited grass mowing where possible, and regular monthly maintenance. The control group received no intervention.

Main outcomes and measures: Self-reported mental health measured by the Kessler-6 Psychological Distress Scale and the components of this scale.

Results: A total of 110 clusters containing 541 vacant lots were enrolled in the trial and randomly allocated to the following 1 of 3 study groups: the greening intervention (37 clusters [33.6%]), the trash cleanup intervention (36 clusters [32.7%]), or no intervention (37 clusters [33.6%]). Of the 442 participants, the mean (SD) age was 44.6 (15.1) years, 264 (59.7%) were female, and 194 (43.9%) had a family income less than $25 000. A total of 342 participants (77.4%) had follow-up data and were included in the analysis. Of these, 117 (34.2%) received the greening intervention, 107 (31.3%) the trash cleanup intervention, and 118 (34.5%) no intervention. Intention-to-treat analysis of the greening intervention compared with no intervention demonstrated a significant decrease in participants who were feeling depressed (-41.5%; 95% CI, -63.6% to -5.9%; P = .03) and worthless (-50.9%; 95% CI, -74.7% to -4.7%; P = .04), as well as a nonsignificant reduction in overall self-reported poor mental health (-62.8%; 95% CI, -86.2% to 0.4%; P = .051). For participants living in neighborhoods below the poverty line, the greening intervention demonstrated a significant decrease in feeling depressed (-68.7%; 95% CI, -86.5% to -27.5%; P = .007). Intention-to-treat analysis of those living near the trash cleanup intervention compared with no intervention showed no significant changes in self-reported poor mental health.

Conclusions and relevance: Among community-dwelling adults, self-reported feelings of depression and worthlessness were significantly decreased, and self-reported poor mental health was nonsignificantly reduced for those living near greened vacant land. The treatment of blighted physical environments, particularly in resource-limited urban settings, can be an important treatment for mental health problems alongside other patient-level treatments.

Trial registration: isrctn.org Identifier: ISRCTN92582209.

Figure 1.. Distribution of Study Vacant Lots Across Philadelphia, Pennsylvania

This map shows the distribution of randomly selected study vacant lots across 3 groups of the trial: the greening intervention, the trash cleanup intervention, and no intervention. The distribution of vacant lots shown is representative of those in the study, although for the purposes of confidentiality are not the locations of actual study lots.

Figure 2.. Vacant Lot Main Greening Intervention

Images show blighted preperiod conditions and remediated postperiod restorations. A, The image shows the grass seeding method used to rapidly complete the treatment process. B, The after image shows the low wooden perimeter fence. Vacant lots shown here are representative of those in the study, although for purposes of confidentiality are not actual study lots.

Figure 3.. Flowchart of Vacant Lots and Participants Through Vacant Lot Greening Trial

^aVacant lots were classified as blighted if they (1) had existing violations signaling blight, including illegal dumping, abandoned cars, and/or unmanaged vegetation growth; and (2) had been abandoned, as confirmed through contact with the owner of record who, within a 10-day period, either authorized the intervention or did not reply. Those excluded as having insufficient blight or not confirmed as abandoned did not meet these conditions.