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. 2025 Jan 21;23(1):31.
doi: 10.1186/s12916-025-03864-y.

Green sanctuaries: residential green and garden space and the natural environment mitigate mental disorders risk of diabetic patients

Erxu Xue #  1   2   3 , Jianhui Zhao #  4 , Jingyu Ye  5 , Jingjie Wu  1 , Dandan Chen  1 , Jing Shao  6   3 , Xue Li  7 , Zhihong Ye  8
Affiliations

Green sanctuaries: residential green and garden space and the natural environment mitigate mental disorders risk of diabetic patients

Erxu Xue et al. BMC Med. .

Abstract

Background: The co-occurrence of diabetes and mental disorders is an exceedingly common comorbidity with poor prognosis. We aim to investigate the impact of green space, garden space, and the natural environment on the risk of mental disorders among the population living with diabetes.

Methods: We performed a longitudinal analysis based on 39,397 participants with diabetes from the UK Biobank. Residential green and garden space modeled from land use data and the natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazards model was used to analyze the associations between nature exposures and mental disorders of diabetes. Casual mediation analysis was used to quantify indirect effect of air pollution.

Results: During a mean follow-up of 7.55 years, 4513 incident mental disorders cases were identified, including 2952 depressive disorders and 1209 anxiety disorders. Participants with natural environment at 300 m buffer in the second and third tertiles had 7% (HR = 0.93, 95%CI: 0.86-0.99) and 12% (HR = 0.88, 95%CI: 0.82-0.94) lower risks of incident mental disorders compared with those in the first tertile, respectively. The risk of mental disorders incidence among diabetes patients will decrease by 13% when exposed to the third tertile of garden space at 300 m buffer. The natural environment and garden space individually prevented 6.65% and 10.18% of mental disorders incidents among diabetes patients. The risk of incident mental disorders was statistically decreased when exposed to the third tertile of green space at 1000 m buffer (HR = 0.84, 95% CI: 0.78-0.90). Protective effects of three nature exposures against depressive and anxiety disorders in diabetes patients were also observed. Air pollution, particularly nitrogen dioxide, nitrogen oxides, and fine particulate matter, significantly contributed to the associations between nature exposures and mental disorders, mediating 48.3%, 29.2%, and 62.4% of the associations, respectively.

Conclusions: Residential green and garden space and the natural environment could mitigate mental disorders risk in diabetes patients, with air pollution playing a vital mediator. This highlights the potential for local governments to enhance the sustainability of such interventions, grounded in public health and urban planning, through strategic planning initiatives.

Keywords: Anxiety disorders; Depression disorders; Diabetes; Garden space; Green space; Mental disorders; Natural environment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was granted by the UK Biobank by the North West-Haydock Research Ethics Committee (REC reference: 16/NW/0274). All participants gave written informed consent before enrolment in the study, which was conducted following the principles of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Associations of exposure to green and garden space and natural environment at 300 and 1000 m buffer with incident depression (A and B) and anxiety disorders (C and D) among people with diabetes
Fig. 2
Fig. 2
Exposure–response curves between green and garden space and natural environment with incident mental disorders
See this image and copyright information in PMC

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