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dc.contributor.authorGeary, RS
dc.contributor.authorThompson, DA
dc.contributor.authorGarrett, JK
dc.contributor.authorMizen, A
dc.contributor.authorRowney, FM
dc.contributor.authorSong, J
dc.contributor.authorWhite, MP
dc.contributor.authorLovell, R
dc.contributor.authorWatkins, A
dc.contributor.authorLyons, RA
dc.contributor.authorWilliams, S
dc.contributor.authorStratton, G
dc.contributor.authorAkbari, A
dc.contributor.authorParker, SC
dc.contributor.authorNieuwenhuijsen, MJ
dc.contributor.authorWhite, J
dc.contributor.authorWheeler, BW
dc.contributor.authorFry, R
dc.contributor.authorTsimpida, D
dc.contributor.authorRodgers, SE
dc.date.accessioned2023-11-09T11:06:00Z
dc.date.issued2023-10-30
dc.date.updated2023-11-09T09:53:40Z
dc.description.abstractBackground Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited. Objectives To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use. Design A retrospective, dynamic longitudinal panel study. Setting Wales, UK. Participants An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008–2019). A 5312-strong ‘National Survey for Wales (NSW) subgroup’ was surveyed on well-being and visits to green and blue spaces. Main outcome measures Common mental health disorders, general practice records; subjective well-being, Warwick–Edinburgh Mental Well-being Scale. Data sources Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank. Methods Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders. Results and conclusions Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick–Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) –10.15, 95% CI –17.13 to −3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick–Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta −0.06, 95% CI −0.11 to −0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick–Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation −0.18, 95% CI −0.33 to −0.04) although well-being remained generally lower. Limitations Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets. Future work Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties.en_GB
dc.description.sponsorshipNational Institute for Health and Care Research (NIHR)en_GB
dc.format.extent1-176
dc.identifier.citationVol. 11 (10)en_GB
dc.identifier.doihttps://doi.org/10.3310/lqpt9410
dc.identifier.urihttp://hdl.handle.net/10871/134476
dc.identifierORCID: 0000-0003-0512-876X (Garrett, Joanne K)
dc.identifierORCID: 0000-0002-6962-0350 (Lovell, Rebecca)
dc.identifierORCID: 0000-0001-9404-5936 (Wheeler, Benedict W)
dc.identifierScopusID: 7102860699 (Wheeler, Benedict W)
dc.language.isoenen_GB
dc.publisherNIHR Journals Libraryen_GB
dc.rights© 2023 Geary et al. This work was produced by Geary et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.en_GB
dc.titleGreen–blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey dataen_GB
dc.typeArticleen_GB
dc.date.available2023-11-09T11:06:00Z
dc.identifier.issn2050-4381
dc.descriptionThis is the final version. Available on open access from NIHR Journals Library via the DOI in this recorden_GB
dc.identifier.eissn2050-439X
dc.identifier.journalPublic Health Researchen_GB
dc.relation.ispartofPublic Health Research
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_GB
dcterms.dateAccepted2022
rioxxterms.versionVoRen_GB
rioxxterms.licenseref.startdate2023-10-30
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2023-11-09T11:03:06Z
refterms.versionFCDVoR
refterms.dateFOA2023-11-09T11:06:01Z
refterms.panelAen_GB
refterms.dateFirstOnline2023-10-30


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© 2023 Geary et al. This work was produced by Geary et al. under the terms of a commissioning contract issued by 
the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative 
Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium 
and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the 
title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.
Except where otherwise noted, this item's licence is described as © 2023 Geary et al. This work was produced by Geary et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.