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. 2024 Feb 1;21(2):168.
doi: 10.3390/ijerph21020168.

Nature and Mental Health in Urban Texas: A NatureScore-Based Study

Omar M Makram  1 , Alan Pan  2 , Jay E Maddock  1   3 , Bita A Kash  1
Affiliations

Nature and Mental Health in Urban Texas: A NatureScore-Based Study

Omar M Makram et al. Int J Environ Res Public Health. .

Abstract

In this cross-sectional study, we examined the impact of access to nature on mental health utilization in urban neighborhoods using Texas outpatient encounters data merged with NatureScoreTM (0-100; low to high nature levels) and US census data (household income, education, employment, poverty, and insurance coverage) at the zipcode level. Our sample size included 61 million outpatient encounters across 1169 zipcodes, with 63% women and 30% elderly. A total of 369,344 mental health encounters were identified, with anxiety/stress and depression encounters representing 68.3% and 23.6%, respectively. We found that neighborhoods with a NatureScore of 60+ had lower overall mental health utilization than those below 40 (RR 0.51, 95%CI 0.38-0.69). This relationship persisted for depression, bipolar disorder, and anxiety/stress and in neighborhoods with a NatureScore above 80 (p < 0.001). Compared to neighborhoods with a NatureScore below 40, those above 80 had significantly lower depression (aRR 0.68, 95%CI 0.49-0.95) and bipolar (aRR 0.59, 95%CI 0.36-0.99) health encounters after adjusting for demographic and socioeconomic factors. This novel approach, utilizing NatureScore as a proxy for urban greenness, demonstrates the correlation between a higher NatureScore and reduced mental health utilization. Our findings highlight the importance of integrating nature into our healthcare strategies to promote well-being and mental health.

Keywords: NatureScore; depression; mental health; nature; stress; urban design.

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Conflict of interest statement

The authors declare no conflicts of interest. NatureQuant provided the data to our research group. They played no role in the design and execution of the study. NatureQuant did not exert any influence on the design or interpretation of the results.

Figures

Figure 1
Figure 1
Flowchart depicting the inclusion process for the population in the final analysis.
Figure 2
Figure 2
Bar chart illustrating differences in mental health encounters across different NatureScore neighborhoods.
Figure 3
Figure 3
Forest plot of multivariable regression results for different mental health encounters, sorted by factors influencing mental health outcomes from lowest to highest.
See this image and copyright information in PMC

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