Exposure to residential green and blue space and the natural environment is associated with a lower incidence of psychiatric disorders in middle-aged and older adults: findings from the UK Biobank

Abstract

Background: There is increasing evidence for the role of environmental factors and exposure to the natural environment on a wide range of health outcomes. Whether exposure to green space, blue space, and the natural environment (GBN) is associated with risk of psychiatric disorders in middle-aged and older adults has not been prospectively examined.

Methods: Longitudinal data from the UK biobank was used. At the study baseline (2006-2010), 363,047 participants (women: 53.4%; mean age 56.7 ± 8.1 years) who had not been previously diagnosed with any psychiatric disorder were included. Follow-up was achieved by collecting records from hospitals and death registers. Measurements of green and blue space modeled from land use data and natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazard models with adjustment for potential confounders were used to explore the longitudinal associations between GBN and any psychiatric disorder and then by specific psychiatric disorders (dementia, substance abuse, psychotic disorder, depression, and anxiety) in middle-aged and older adults.

Results: During an average follow-up of 11.5 ± 2.8 years, 49,865 individuals were diagnosed with psychiatric disorders. Compared with the first tertile (lowest) of exposure, blue space at 300 m buffer [hazard ratio (HR): 0.973, 95% confidence interval (CI): 0.952-0.994] and natural environment at 300 m buffer (HR: 0.970, 95% CI: 0.948-0.992) and at 1000 m buffer (HR: 0.975, 95% CI: 0.952-0.999) in the third tertile (highest) were significantly associated with lower risk of incident psychiatric disorders, respectively. The risk of incident dementia was statistically decreased when exposed to the third tertile (highest) of green space and natural environment at 1000 m buffer. The third tertile (highest) of green space at 300 m and 1000 m buffer and natural environment at 300 m and 1000 m buffer was associated with a reduction of 30.0%, 31.8%, 21.7%, and 30.3% in the risk of developing a psychotic disorder, respectively. Subgroup analysis suggested that the elderly, men, and those living with some comorbid conditions may derive greater benefits associated with exposure to GBN.

Conclusions: This study suggests that GBN has significant benefits for lowering the risk of psychiatric disorders in middle-aged and older adults. Future studies are warranted to validate these findings and to understand the potential mechanistic pathways underpinning these novel findings.

Keywords: Blue space; Green space; Natural environment; Psychiatric disorder; UK Biobank.

Fig. 1

The independent associations of green and blue space and natural environment with specific psychiatric disorders (HR, hazard ratio; CI, confidence interval; the estimates were adjusted for age, sex, ethnicity, socioeconomic status; BMI, household income, education group, smoking status, alcohol drinker status, and physical activity, and the references were the first tertile of green and blue space and nature environment, respectively)

Fig. 2

The associations of green and blue space and natural environment at 300 m buffer with any psychiatric disorder by stratified factors (HR, hazard ratio; CI, confidence interval; SES, socioeconomic status; BMI: body mass index, the estimates were adjusted for ethnicity, SES, BMI, household income, education group, smoking status, alcohol drinker status, and physical activity, and relative factors were not included in the models when performing corresponding subgroup analysis)

Fig. 3

The associations of green and blue space and natural environment at 1000 m buffer with any psychiatric disorder by stratified factors (HR, hazard ratio; CI, confidence interval; SES, socioeconomic status; BMI: body mass index, the estimates were adjusted for ethnicity, SES, BMI, household income, education group, smoking status, alcohol drinker status, and physical activity, and relative factors were not included in the models when performing corresponding subgroup analysis)