A population-based retrospective study of the modifying effect of urban blue space on the impact of socioeconomic deprivation on mental health, 2009–2018

Abstract

The incidence of mental health disorders in urban areas is increasing and there is a growing interest in using urban blue spaces (urban waterways, canals, lakes, ponds, coasts, etc.) as a tool to manage and mitigate mental health inequalities in the population. However, there is a dearth of longitudinal evidence of the mechanisms and impact of blue spaces on clinical markers of mental health to support and inform such interventions. We conducted a 10-year retrospective study, following STROBE guidelines, using routinely collected population primary care health data within the National Health Service (NHS) administrative area of Greater Glasgow and Clyde for the North of Glasgow city area. We explored whether living near blue space modifies the negative effect of socio-economic deprivation on mental health during the regeneration of an urban blue space (canal) from complete dereliction and closure. A total of 132,788 people (65,351 female) fulfilling the inclusion criteria were entered in the analysis. We established a base model estimating the effect of deprivation on the risk of mental health disorders using a Cox proportional hazards model, adjusted for age, sex and pre-existing comorbidities. We then investigated the modifying effect of living near blue space by computing a second model which included distance to blue space as an additional predicting variable and compared the results to the base model. Living near blue space modified the risk of mental health disorders deriving from socio-economic deprivation by 6% (hazard ratio 2.48, 95% confidence interval 2.39–2.57) for those living in the most deprived tertile (T1) and by 4% (hazard ratio 1.66, 95% confidence interval 1.60–1.72) for those in the medium deprivation tertile (T2). Our findings support the notion that living near blue space could play an important role in reducing the burden of mental health inequalities in urban populations.

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

“…In line with previous evidence from observational studies [ 16 , 19 , 48 , 49 ], this study also showed that blue space coverage was statistically associated with decreased risk of any psychiatric disorder consistent with findings from a systematic review [ 50 ]. Although a few studies have reported the benefits of blue space coverage with specific psychiatric disorders, for example depression [ 12 , 13 , 18 ] and anxiety [ 12 , 14 , 19 ], the findings were controversial and had visible heterogeneity.…”

Urban Blue Spaces as Therapeutic Landscapes: “A Slice of Nature in the City”

“…Research on the health-promoting capacities of local urban canals is emerging. Retrospective longitudinal studies of the canals, looking at a macro-geographical level, found that the regeneration of Glasgow’s canals was associated with a 3% decrease in mortality rate [ 22 ], 10–15% decrease in risk of chronic diseases [ 23 ] and 6% decrease in the effect of deprivation on the risk of mental health issues [ 24 ]. Qualitative research explored locals’ experiences of the Niasarm Canal in Isfahan, Iran, concluding that it is an active space that promoted feelings of relaxation and concentration and was also seen to foster identity among users and shaped the canal as a therapeutic landscape [ 25 ].…”