The Impact of the Coronavirus Pandemic on the Contribution of Local Green Space and Nature Connection to Mental Health.

BACKGROUND: Exposure to green space and feeling connected to the natural environment have independently been associated with improved mental health outcomes. During the coronavirus pandemic, people experienced restrictions on access to the outdoors, and health data indicated a decline in mental health in the UK general population. METHODS: Data available from two independent surveys conducted prior to and during the pandemic enabled a naturally occurring comparison of mental health and its correlates prior to and during the pandemic. RESULTS: Survey responses from 877 UK residents were included in the analyses. Independent t-tests revealed significant declines in mental health scores during the pandemic. After controlling for age and gender, greater nature connection significantly predicted lower depression and stress and improved well-being. Percentage of green space did not significantly predict any mental health outcomes. Further, time point (pre- or during COVID) and the interaction of time point with green space and nature connection did not significantly predict any of the outcome measures. The findings indicate that nature connection may play an important role in promoting mental health. Strategies to improve mental health and reduce mental illness should consider the role of nature connection and the use of interventions that involve direct interaction with natural environments.

Green spaces for mental disorders.

PURPOSE OF REVIEW: Mental illness is a global challenge, exacerbated by the coronavirus pandemic. Research suggests access to local green spaces is associated with better mental health, yet access is not always equitable. Evaluation of how nature-based interventions protect and support mental health is therefore required. RECENT FINDINGS: Accessible local green spaces are associated with better mental health. They encourage active behaviours and social interaction, reduce loneliness and stress. Green views from the home are associated with increased self-esteem, life satisfaction and happiness and reduced depression, anxiety and loneliness. Nature-based interventions and green social prescriptions effectively target vulnerable groups, resulting in significant reductions in depression, anxiety and anger alongside positive mental health outcomes. SUMMARY: Although existing evidence is encouraging, robust, high-quality research that strengthens the evidence base and informs future clinical practice and policy decision making is needed. Evidence of the long-term effectiveness in individuals with diagnosed mental illness is also required to ascertain the potential social and wider returns on investment. Barriers to use of green social prescriptions like mental health symptoms and geographical accessibility need to be overcome to increase accessibility and uptake of green social prescriptions for the prevention and treatment of mental illness.

The Impact of Therapeutic Community Gardening on the Wellbeing, Loneliness, and Life Satisfaction of Individuals with Mental Illness.

BACKGROUND: literature on the mental health benefits of therapeutic community gardening is not specific to individuals with mental illness and reports short-term outcomes. The impact of the coronavirus pandemic on intervention effectiveness is also unknown. This study examined the impact of therapeutic community gardening prior to and across the pandemic on the wellbeing of individuals referred for support with their mental illness. METHODS: garden members (n = 53; male = 36, female = 17) aged 47.38 ± 13.09 years reported their wellbeing at baseline and four follow-up points (FU1-FU4) across the pandemic. RESULTS: there was significant quadratic growth in wellbeing (-1.248; p < 0.001) that varied between genders (p = 0.021). At baseline, male wellbeing scores were significantly lower (p = 0.020) than the UK population norm, but there were no significant differences at any other follow-up point. Female wellbeing was significantly lower than the UK population norm at baseline (p < 0.001), FU1 (p = 0.012) and FU2 (p < 0.001), but not FU3 and FU4. CONCLUSION: therapeutic community gardening can improve and maintain the wellbeing of individuals with mental illness, even when wellbeing is deteriorating nationally. Future research should further demonstrate the long-term and cost-effectiveness of interventions.

Therapeutic Community Gardening as a Green Social Prescription for Mental Ill-Health: Impact, Barriers, and Facilitators from the Perspective of Multiple Stakeholders.

The UK government has invested £5.77 million in green social prescribing to prevent and tackle mental ill-health. Therapeutic community gardening, one type of green social prescription, provides a range of health outcomes. However, for increased accessibility, a greater understanding of how it impacts mental health and the facilitators and barriers to referral, uptake, and attendance by individuals with mental health problems is required. We conducted and thematically analysed interviews with thirteen stakeholders including social prescribing link workers and garden staff; and focus groups with twenty garden members. The mechanisms by which therapeutic community gardening were suggested to impact mental health were by engaging members with nature and the outdoors, providing hope for the future and facilitating social support and relationships. Factors facilitating referral, uptake, and attendance included a holistic and person-centred approach, which is flexible around health needs. Barriers included awareness of the full offering of therapeutic community gardens and accessibility, in terms of physical location and waiting lists. Given that nature-based interventions have the potential to protect and enhance population health and offer cost savings through reduced reliance on other health services; overcoming these barriers is key to ensuring that therapeutic community gardening is more widely available as an additional mental health treatment.

Psychological benefits of outdoor physical activity in natural versus urban environments: A systematic review and meta-analysis of experimental studies.

The impact of environmental context on the psychological benefits derived from physical activity has attracted research attention in recent years. Previous reviews have compared effects of indoor versus outdoor exercise. This review compares the effects of physical activity undertaken in outdoor green natural environments versus outdoor urban environments on psychological health outcomes in adult general populations. An electronic literature search identified 24 experimental studies meeting the inclusion criteria. Results were analysed via narrative synthesis (n = 24) and meta-analysis (n = 9) of effect on six outcomes. Narrative synthesis found in favour of the natural environment for anxiety, anger/hostility, energy, affect and positive engagement. Post-intervention effect sizes suggested duration and social context as potential moderators. The meta-analyses revealed large or moderate effects in favour of the natural environment for anxiety, fatigue, positive affect and vigour, and a small effect for depression. Results were subject to high risk of bias and heterogeneity. Physical activity undertaken outdoors in natural environments is more beneficial for a range of psychological outcomes compared with urban environments. The various effect sizes evident in the meta-analyses may be explained by differing mechanisms through which psychological gains are experienced during physical activity in nature.

A cross-sectional study of physical activity behaviour and associations with wellbeing during the UK coronavirus lockdown.

This study assessed physical activity (PA) and wellbeing during lockdown. UK adults reported their PA in the previous week, perception of PA importance (more, less, same) and wellbeing, depression, anxiety and stress. One-way ANOVA compared PA and wellbeing by PA importance. The 'less' importance group did less PA than the 'more' and 'same' (p < 0.05) importance group; and scored worse on all wellbeing measures than the 'same' importance group (p < 0.01). They also had worse wellbeing, depression and anxiety than the 'more' importance group (p < 0.05). Strategies to overcome the impact of the pandemic should aim to increase PA.

Operationalization of One Health Burnout Prevention and Recovery: Participatory Action Research-Design of Nature-Based Health Promotion Interventions for Employees.

Burnout is, besides a global, complex phenomenon, a public health issue with negative consequences on personal, organizational, social, and economic levels. This paper outlines the co-design of a novel Nature-based Burnout Coaching intervention, called NABUCO. Due to the complexity of burnout, we propose a One Health approach in healthcare, educational and governmental pilot organizations, to deliver guidelines and protocols for prevention and recovery of burnout. We advocate the inclusion of the salutogenic and mutual healing capacity of nature connectedness, facilitating a positive impact on mental and environmental health. A transdisciplinary Participative Action Research-design resulted in an iterative adaptive cycle of co-design, implementation, and evaluation of NABUCO.

Modification of the Rosenberg Scale to Assess Self-Esteem in Children.

Rosenberg's scale (RSES) is widely used to assess global self-esteem (SE) in adults and adolescents but is not validated for children <12 years. This study assessed the internal consistency, convergent validity, and factor structure of a modified RSES for schoolchildren (CRSES) aged 7-12 years. A total of 711 children aged 9.0 ± 1.5 years completed the CRSES; a subset (n = 417) also completed a life satisfaction (LS) scale. Data were submitted for confirmatory factor analysis (CFA) and tests of factorial invariance by sex. Two-way ANOVA compared scores by age-group and sex; whilst Pearson's correlations examined the relationship between LS and SE. Following the use of modification indices the fit for the global SE model met the goodness of fit statistic criteria: χ(27, n = 711) = 77.22; χnormed = 2.860 CFI = 0.961; RMSEA = 0.051 with 90% CI = 0.038-0.065; SRMR = 0.037; and displayed respectable internal consistency (α = 0.79). The model was also factorially invariant by sex. SE scores did not vary sex (p > 0.05); but were significantly reduced in children aged 9-10 and 11-12 years compared to children aged 7-8 years. The global SE score was significantly correlated (r = 0.51; P < 0.001) with LS. The current version of the CRSES can reliably examine global SE in children aged 7-12 years; extending the use of the RSES to allow tracking across the life course.

Nature-Based Interventions and Mind-Body Interventions: Saving Public Health Costs Whilst Increasing Life Satisfaction and Happiness.

A number of countries have begun to adopt prevention pays policies and practices to reduce pressure on health and social care systems. Most affluent countries have seen substantial increases in the incidence and costs of non-communicable diseases. The interest in social models for health has led to the growth in use of social prescribing and psychological therapies. At the same time, there has been growth in application of a variety of nature-based and mind-body interventions (NBIs and MBIs) aimed at improving health and longevity. We assess four NBI/MBI programmes (woodland therapy, therapeutic horticulture, ecotherapy/green care, and tai chi) on life satisfaction/happiness and costs of use of public services. These interventions produce rises in life satisfaction/happiness of 1.00 pts to 7.29 (n = 644; p < 0.001) (for courses or participation >50 h). These increases are greater than many positive life events (e.g., marriage or a new child); few countries or cities see +1 pt increases over a decade. The net present economic benefits per person from reduced public service use are £830-£31,520 (after 1 year) and £6450-£11,980 (after 10 years). We conclude that NBIs and MBIs can play a role in helping to reduce the costs on health systems, while increasing the well-being of participants.

Regular Doses of Nature: The Efficacy of Green Exercise Interventions for Mental Wellbeing.

This study investigated the efficacy of medium-term Green Exercise (GE; being physically active within a natural environment) interventions for improving wellbeing, by pooling data collected at the start and end of participants' engagement with a range of GE interventions. Hypotheses were that (i) interventions would show good efficacy for improving wellbeing in the overall sample; (ii) compared to participants reporting 'average to high' wellbeing at the start of their project, participants with 'low' starting wellbeing would report greater improvements post-intervention; and (iii) improvements would significantly differ between age groups. The pooled dataset was categorized in line with UK norms (n = 318) and analyzed using a standardized meta-analysis approach. Effect size was large: g = 0.812 (95% CI [0.599, 1.025]), and differences in wellbeing changes associated with project duration, age or sex were not statistically significant. Compared to those reporting 'average-high' starting wellbeing, participants reporting 'low' starting wellbeing exhibited greater improvements (BCa 95% CI [-31.8, -26.5]), with 60.8% moving into the 'average-high' wellbeing category. GE can play an important role in facilitating wellbeing and can provide alternative pathways for health and social care practice. Public health commissioners should consider integrating such interventions for patients experiencing low wellbeing or associated comorbidities.

Can Simulated Green Exercise Improve Recovery From Acute Mental Stress?

This exploratory study enhances previous research into green exercise and addresses a gap in the research by exploring the contribution of individual and combined senses in the recovery of mood and stress after a psychological stressor, whilst rigorously controlling exercise intensity. The hypotheses were: (i) recovery of mood and stress from a state of psychological stress would be greater following simulated green exercise compared to rest, (ii) green exercise would facilitate better recovery than exercise alone, (iii) these effects would remain 10 min following intervention, and (iv) visual stimuli alone would enhance recovery from a state of psychological stress compared to sound. Fifty participants were randomly assigned to one of five groups: REST, exercise, exercise with nature sounds, exercise with nature visual and exercise with nature sound and visual. An initial visit to obtain predicted peak power output values and to familiarize participants with the equipment being used was followed by a second visit, where participants experienced one test condition. Baseline measures of heart rate, blood pressure, total mood disturbance (TMD), and perceived stress were taken, before participants completed a stressor based on the Trier Social Stress test. Measures of heart rate and blood pressure were recorded in the last 30 s of the stressor to assess efficacy of the stressor. Immediately post stressor, measures of mood and perceived stress were taken followed by the intervention assigned (one of five described above). Measures of mood and perceived stress were taken again immediately post intervention and 10 min post intervention. Results showed that green exercise improved mood and stress scores more than exercise alone or REST. For both TMD and perceived stress, improvements in all simulated nature conditions were significantly improved compared to REST or exercise alone immediately post intervention. There were no significant changes 10 min post intervention in either mood or perceived stress compared to immediately post intervention values in any of the groups. This study suggests that environmental exercise settings including nature sounds, visual or both combined should be considered as important in the use of exercise as a therapeutic activity or recovery from acute psychological stress.

The importance of greenspace for mental health.

There is an urgent global need for accessible and cost-effective pro-mental health infrastructure. Public green spaces were officially designated in the 19th century, informed by a belief that they might provide health benefits. We outline modern research evidence that greenspace can play a pivotal role in population-level mental health.

Green Mind Theory: How Brain-Body-Behaviour Links into Natural and Social Environments for Healthy Habits.

We propose a Green Mind Theory (GMT) to link the human mind with the brain and body, and connect the body into natural and social environments. The processes are reciprocal: environments shape bodies, brains, and minds; minds change body behaviours that shape the external environment. GMT offers routes to improved individual well-being whilst building towards greener economies. It builds upon research on green exercise and nature-based therapies, and draws on understanding derived from neuroscience and brain plasticity, spiritual and wisdom traditions, the lifeways of original cultures, and material consumption behaviours. We set out a simple metaphor for brain function: a bottom brain stem that is fast-acting, involuntary, impulsive, and the driver of fight and flight behaviours; a top brain cortex that is slower, voluntary, the centre for learning, and the driver of rest and digest. The bottom brain reacts before thought and directs the sympathetic nervous system. The top brain is calming, directing the parasympathetic nervous system. Here, we call the top brain blue and the bottom brain red; too much red brain is bad for health. In modern high-consumption economies, life has often come to be lived on red alert. An over-active red mode impacts the gastrointestinal, immune, cardiovascular, and endocrine systems. We develop our knowledge of nature-based interventions, and suggest a framework for the blue brain-red brain-green mind. We show how activities involving immersive-attention quieten internal chatter, how habits affect behaviours across the lifecourse, how long habits take to be formed and hard-wired into daily practice, the role of place making, and finally how green minds could foster prosocial and greener economies. We conclude with observations on twelve research priorities and health interventions, and ten calls to action.

Influences of Green Outdoors versus Indoors Environmental Settings on Psychological and Social Outcomes of Controlled Exercise.

This study addressed a methodological gap by comparing psychological and social outcomes of exercise in green outdoors versus built indoors settings, whilst rigorously controlling exercise mode and intensity. The hypotheses were that greater improvements or more desirable values for directed attention, mood, perceived exertion, social interaction time, intention for future exercise behaviour and enjoyment would be associated with outdoors compared to indoors exercise. Following a baseline session, paired participants completed two conditions of 15 min of cycling on an ergometer placed outside in a natural environment and inside in a laboratory setting in a randomized, counter-balanced order. At pre- and post-exercise, directed attention was measured with the digit span backwards task, and mood was assessed with the Profile of Mood States. During the exercise session, visual and verbal interactions were recorded by means of experimenter observations. After each exercise session, participants provided self-reports of their enjoyment of the exercise, perceived exertion and intention for future exercise in the same environment. Social interaction time was significantly greater during outdoors exercise versus indoors; on average, participants engaged in three minutes more social interaction during exercise outdoors compared to indoors. Social interaction time significantly predicted intention for future exercise in the outdoors condition, but did not in the indoor condition. There was a significant time by condition interaction for directed attention. Scores worsened in the indoors condition, but improved in the outdoors condition. There was no statistically-significant time by condition interaction for mood and no significant difference between conditions for either perceived exertion or intention. Taken together, these findings show that exercise in a natural environment may promote directed attention and social interactions, which may positively influence future exercise intentions.

Occlusion of sight, sound and smell during Green Exercise influences mood, perceived exertion and heart rate.

This study's aim was to identify the relative contribution of sight, sound and smell to the Green Exercise effect. It was hypothesised that visual occlusion while exercising in a natural environment would have the greatest diminishing effect on perceived exertion and mood compared to auditory and olfactory occlusion. Twenty-nine healthy participants were randomly assigned to one of the three groups: visual (n = 10), auditory (n = 9) and olfactory occlusion (n = 10). Each performed six, 5-min bouts of exercise alternating between full sensory and occlusion. Rate of perceived exertion (RPE), heart rate (HR) and mood were recorded at the end of each bout. Sensory-occlusion increased mood, RPE and HR; effects were strongest when sounds were blocked but virtually absent when vision was blocked. During sensory occlusion, mood changes were characterised by increased Fatigue and Confusion, and reduced Vigour. Reductions in Tension and Vigour and increases in Fatigue were found during full sensory exercise, consistent with previous research findings.

Improving health and well-being independently of GDP: dividends of greener and prosocial economies.

Increases in gross domestic product (GDP) beyond a threshold of basic needs do not lead to further increases in well-being. An explanation is that material consumption (MC) also results in negative health externalities. We assess how these externalities influence six factors critical for well-being: (i) healthy food; (ii) active body; (iii) healthy mind; (iv) community links; (v) contact with nature; and (vi) attachment to possessions. If environmentally sustainable consumption (ESC) were increasingly substituted for MC, thus improving well-being and stocks of natural and social capital, and sustainable behaviours involving non-material consumption (SBs-NMC) became more prevalent, then well-being would increase regardless of levels of GDP. In the UK, the individualised annual health costs of negative consumption externalities (NCEs) currently amount to £62 billion for the National Health Service, and £184 billion for the economy (for mental ill-health, dementia, obesity, physical inactivity, diabetes, loneliness and cardiovascular disease). A dividend is available if substitution by ESC and SBs-NMC could limit the prevalence of these conditions.

A comparison of four typical green exercise environments and prediction of psychological health outcomes.

AIMS: 'Green exercise' (GE) is physical activity while simultaneously being exposed to nature. GE comprises three physical components: the individual, the exercise and the environment, and one processes component encompassing a range of psychological and physiological processes. Previous research has consistently shown affective benefits of GE compared to equivalent non-GE. Investigating the possibility of optimum GE environments may help maximise health benefits. The aim of this study was to compare affective outcomes of GE participation between four different typical GE environments (beach, grasslands, riverside, heritage), and further examine influences of several physical component-related variables and one processes component-related variable, on these outcomes. METHOD: Participants (N = 331) completed questionnaires before and after a 5km run, at one of four parkrun event locations. RESULTS: Self-esteem (Δ = 1.61, 95% confidence interval (CI) = (1.30, 1.93)), stress (Δ = -2.36, 95% CI = (-3.01, -1.71)) and mood (Δ = -5.25, 95% CI = (-7.45, -3.05)) all significantly improved from pre- to post-run (p < .05). Improvements in these measures were not significantly different between environments. Several component-related variables significantly predicted these improvements, accounting for 9% of self-esteem improvement, 1.6% of perceived stress improvement, and 9.5% of mood improvement. CONCLUSION: GE offers accessible provision for improving acute psychological wellbeing. Although nature-based exercise environments can facilitate affective outcomes, the overall type of nature may be less critical. Other characteristics of the individual, exercise and environment can significantly influence attainment of psychological GE benefits. However, the results support a greater importance of the processes component in attaining previously reported affective outcomes.

Effects of the Visual Exercise Environments on Cognitive Directed Attention, Energy Expenditure and Perceived Exertion.

Green exercise research often reports psychological health outcomes without rigorously controlling exercise. This study examines effects of visual exercise environments on directed attention, perceived exertion and time to exhaustion, whilst measuring and controlling the exercise component. Participants completed three experimental conditions in a randomized counterbalanced order. Conditions varied by video content viewed (nature; built; control) during two consistently-ordered exercise bouts (Exercise 1: 60% VO2peakInt for 15-mins; Exercise 2: 85% VO2peakInt to voluntary exhaustion). In each condition, participants completed modified Backwards Digit Span tests (a measure of directed attention) pre- and post-Exercise 1. Energy expenditure, respiratory exchange ratio and perceived exertion were measured during both exercise bouts. Time to exhaustion in Exercise 2 was also recorded. There was a significant time by condition interaction for Backwards Digit Span scores (F2,22 = 6.267, p = 0.007). Scores significantly improved in the nature condition (p < 0.001) but did not in the built or control conditions. There were no significant differences between conditions for either perceived exertion or physiological measures during either Exercise 1 or Exercise 2, or for time to exhaustion in Exercise 2. This was the first study to demonstrate effects of controlled exercise conducted in different visual environments on post-exercise directed attention. Via psychological mechanisms alone, visual nature facilitates attention restoration during moderate-intensity exercise.

The effect of playground- and nature-based playtime interventions on physical activity and self-esteem in UK school children.

School playtime provides opportunities for children to engage in physical activity (PA). Playground playtime interventions designed to increase PA have produced differing results. However, nature can also promote PA, through the provision of large open spaces for activity. The purpose of this study is to determine which playtime interventions are most effective at increasing moderate-to-vigorous physical activity (MVPA) and if this varies by school location. Fifty-two children from an urban and rural school participated in a playground sports (PS) and nature-based orienteering intervention during playtime for one week. MVPA was assessed the day before and on the final day of the interventions using accelerometers. Intervention type (p < 0.05) and school location (p < 0.001) significantly influenced MVPA; with PS increasing MVPA more than nature-based orienteering. Urban children seemed to respond to the interventions more positively; however, differences in baseline MVPA might influence these changes. There was a positive correlation for fitness and MVPA during PS (r = 0.32; p < 0.05), but not nature-based orienteering (p > 0.05). The provision of PS influences PA the most; however, a variety of interventions are required to engage less fit children in PA.

Innovations in Practice: Adapting a specialized ADHD parenting programme for use with 'hard to reach' and 'difficult to treat' preschool children.

BACKGROUND: Effective implementation of parent training programmes for preschool Attention-Deficit/Hyperactivity Disorder type is constrained by barriers limiting take-up and effective engagement by 'hard to reach' and 'difficult to treat' families. METHOD: We describe an evidence-driven adaptation and piloting of an existing empirically supported preschool ADHD parenting programme to address these problems. RESULTS: The New Forest Parenting programme was changed substantially in terms of length; content and delivery on the basis of information gathered from the literature, from parents and practitioners, further modifications were made after the pilot study. CONCLUSIONS: The adapted-NFPP is currently being assessed for efficacy in a large multicentre randomized controlled trial.