A selection from Stockholm University publication database

• Nature visits buffered against loneliness during COVID-19, especially among those working mainly remotely. A population-based study of working adults in Sweden

  Yannick Klein (et al.).

  Article

  Background

  The COVID-19 pandemic and associated restrictions posed challenges to people’s private and work lives. There was a rapid shift from on-site to remote working for many working adults in Sweden and internationally, while opportunities for in-person social and leisure activities indoors were limited. One challenge was thus the risk of increased loneliness and social isolation, especially among those working more remotely. In this context, nature visits may potentially mitigate loneliness. This study thus investigates whether a higher degree of remote work during COVID-19 was related to increased loneliness and whether nature visits mitigated loneliness, especially for those working mainly remotely, for which studies are limited.  

  Methods

  The sample comprised a subsample of respondents to the Swedish Longitudinal Occupational Survey of Health 2020 (n = 984). The effect of remote work, nature-related habits (NRH), and time on loneliness (before – during COVID-19) were analyzed using linear mixed models while controlling for confounders.

  Results

  In general, loneliness levels during COVID-19 were highest and increased the most compared to before the pandemic among the most remotely working individuals. Engaging daily in NRH was associated with lower levels of loneliness, particularly among individuals mostly working remotely. This was observed in a three-way interaction effect between remote work, NRH, and time on loneliness.

  Conclusion

  Daily nature visits may protect against loneliness during and beyond crises like COVID-19, particularly for those working mainly remotely. Policies preserving and facilitating access to natural environments may be crucial for promoting resilience during and beyond crises like COVID-19.

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• More green, less depressed: Residential greenspace is associated with lower antidepressant redemptions in a nationwide population-based study

  2024. Cecilia U. D. Stenfors (et al.). Landscape and Urban Planning 249

  Article

  The objective of the current study was to investigate, for the first time, the association between individual-level residential greenspace and redemption of antidepressant drugs in a longitudinal nationwide population-based sample in Sweden. A nationwide population-based sample of adults residing in Sweden was studied during 2013–2016 (Nindividuals = 108716; Nobservations = 324378). Residential greenspace land cover was assessed via high resolution geographic information systems, at 50, 100, 300, and 500 m buffers around individual residences. Antidepressant redemptions were assessed through the Swedish National Prescribed Drug Register. Greenspace-antidepressant associations were analyzed using generalized estimating equations (GEE), adjusting for demographic, socioeconomic and urban factors. Higher greenspace within 50–500 m residential buffer zones was associated with lower levels of prevalent antidepressant redemptions (50 m, odds ratio [OR] 0.878; 100 m, OR 0.891; 300 m, OR 0.873; 500 m, OR 0.899), while only greenspace in the 50 m buffer was associated with incident antidepressant redemptions (OR 0.853), in covariate-adjusted models. In conclusion, residential greenspace is associated with statistically significantly lower prevalent and incident antidepressant medication redemptions. The association is particularly salient for greenspace in the closest buffer zone around the residence. The results underscore the importance of green infrastructure and greenspace in the immediate residential-surrounding environment for mental health, and further point towards the need for an environmental psychiatry framework, and the importance of integrating health and environmental policies, urban planning and greening.

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• More green, less depressed: Residential greenspace is associated with lower antidepressant redemptions in a nationwide population-based study

  2024. Cecilia U. D. Stenfors (et al.). Landscape and Urban Planning 249

  Article

  The objective of the current study was to investigate, for the first time, the association between individual-level residential greenspace and redemption of antidepressant drugs in a longitudinal nationwide population-based sample in Sweden. A nationwide population-based sample of adults residing in Sweden was studied during 2013–2016 (Nindividuals = 108716; Nobservations = 324378). Residential greenspace land cover was assessed via high resolution geographic information systems, at 50, 100, 300, and 500 m buffers around individual residences. Antidepressant redemptions were assessed through the Swedish National Prescribed Drug Register. Greenspace-antidepressant associations were analyzed using generalized estimating equations (GEE), adjusting for demographic, socioeconomic and urban factors. Higher greenspace within 50–500 m residential buffer zones was associated with lower levels of prevalent antidepressant redemptions (50 m, odds ratio [OR] 0.878; 100 m, OR 0.891; 300 m, OR 0.873; 500 m, OR 0.899), while only greenspace in the 50 m buffer was associated with incident antidepressant redemptions (OR 0.853), in covariate-adjusted models. In conclusion, residential greenspace is associated with statistically significantly lower prevalent and incident antidepressant medication redemptions. The association is particularly salient for greenspace in the closest buffer zone around the residence. The results underscore the importance of green infrastructure and greenspace in the immediate residential-surrounding environment for mental health, and further point towards the need for an environmental psychiatry framework, and the importance of integrating health and environmental policies, urban planning and greening.

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• The role of nature exposure for mental health outcomes: Population-based studies of adults in Sweden, before and during the COVID-19 pandemic

  2024. Yannick Klein.

  Thesis (Doc)

  Poor mental health is a major public health concern, globally and in Sweden. It is linked to individual suffering and systematic issues such as long-term sick leave, rehabilitation costs, early work exit, or productivity loss. The COVID-19 pandemic and associated restrictions emerged as a crisis involving challenges to individuals’ private and work situations. With increasing urbanization, the role of natural environments in promoting mental health has gained recognition. Exposure to natural environments has been linked to mental health benefits, also during the COVID-19 pandemic when this may have been an important resilience factor. However, few population-based studies have investigated individual-level residential greenspace (RGS) and mental health-related outcomes (MHO) using high-quality exposure measures. Also, longitudinal studies of nature visits and MHO, and the role of nature visits for loneliness in the working population, over time during COVID-19, are scarce. Thus, the overall aim of this thesis was to fill these gaps by examining the role of various types of nature exposure for MHO across different situations and time frames before and during COVID-19 in three quantitative studies. 

  Study I examined the role of individual RGS on MHO in a population-based sample of adults residing in urban areas in Sweden, using high-resolution geographic land-cover data. Results showed that higher levels of residential green and green-blue space cover were associated with better MHO, specifically lower symptoms of depression and burnout among non-working individuals, and higher life satisfaction in the whole sample, after adjustment for demographic and socioeconomic variables. Consistently, green and green-blue space in the immediate residential surroundings (50 m) showed the most robust associations with MHO. 

  Study II investigated the development of nature-related habits (NRH) from before and during two years of the COVID-19 pandemic (2019–2022), and their relationship with MHO over time, in a population-based sample in Sweden. It was found that most nature visits increased over time (2019–2022), with forest visits also increasing significantly in the short term (2019–2020). Frequent NRH, particularly garden time and forest visits, were related to lower levels of depression, anxiety, loneliness, and sleep problems in early 2021 and 2022. Maintaining and increasing NRH frequency over time was related to better MHO or protected against worse MHO in association with decreasing NRH over time.

  Study III investigated whether working mainly remotely during COVID-19 was associated with higher levels of loneliness in a population-based sample of working adults in Sweden and whether nature visits buffered against loneliness over time among those working mainly remotely. It was found that loneliness levels during the pandemic were highest and increased the most compared to before among individuals working mainly remotely. Engaging daily in NRH mitigated the detrimental association between remote work and loneliness over time.

  Overall, the results across the three studies showed that the various types of nature exposure investigated were consistently associated with better MHO across various situations and time frames. This underscores the importance of preserving and developing natural environments in urban areas to promote mental health, in alignment with the UN Sustainable Development Goals.

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• Development of nature-related habits and their relation to mental health outcomes during two years of the COVID-19 pandemic: a population-based study in Sweden

  2024. Yannick Klein (et al.). Journal of Public Health

  Article

  Aims Spending time in natural environments has been linked to mental health benefits, and may have been an important resilience factor during the COVID-19 pandemic, but longitudinal studies are limited. This longitudinal study aimed to investigate the development of nature-related habits and their relationship to different mental health outcomes before and during early and later phases of COVID-19 (2019–2022). Furthermore, the buffering potential of nature-related habits on effects of major life events on mental health outcomes was investigated.

  Subject and methods A subsample of the Swedish Longitudinal Occupational Survey of Health (SLOSH) was studied during 2018–2022, including follow-ups in early 2021 (n  = 1902) and 2022 (n = 1580). Visits to various types of nature, mental health outcomes (symptoms of depression, anxiety, loneliness, sleep difficulties), and major life events were analyzed across the study period while controlling for confounders.

  Results Greater overall engagement in nature visits, particularly visiting forests or using one’s garden, was associated with lower levels of depression, anxiety, loneliness, and sleep problems in early 2021 and 2022.

  Importantly, changes in nature visits were consistently negatively associated with investigated mental health outcomes across the study period. All nature visits, except for garden time, increased in the long term (2019–2022). Visiting forests also increased in the short term, while overall nature visits initially decreased (2019–2020).

  Conclusion Generally, nature visits increased longitudinally and were associated with better mental health outcomes during the COVID-19 pandemic. This underscores the importance of green- and blue-space accessibility for facilitating outdoor recreation in natural environments, to support resilience and public health during pandemics.

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• Nature-related habits and their development and relation to mental health outcomes during the covid-19 pandemic: a population-based study in Sweden

  2023. Yannick Klein (et al.). International Journal of Behavioral Medicine, 136

  Conference

  Background: Mental health disorders represent a major public health concern, and significantly contribute to the global burden of disease. The Covid-19 pandemic posed additional challenges for mental health. Spending time in natural environments has been linked to numerous health benefits.

  Purpose: Therefore, the present study investigated the role of different types of nature-related habits for symptoms of depression, anxiety, and loneliness, and their development during the pandemic 2019–2022, in Sweden. Further, we investigated whether nature habits could buffer negative effects of major life events on mental health outcomes (MHO).

  Method: Different types of nature-related habits, symptoms of depression, anxiety, loneliness, major life events, and control variables were assessed via self-report measures, in a sub-sample of respondents to the Swedish Occupational Survey of Health, in 2021 (n = 1 896), and 2022 (n = 1 579). Sequential linear regressions were conducted to analyze relationships between nature-related habits and MHO, while controlling for demographics, SES, relationship status, and pre-pandemic MHO.

  Results: Spending time in nature was consistently associated with fewer symptoms of depression, anxiety, and loneliness during the pandemic after adjusting for control variables. Especially spending time in forest and garden environments were associated with better mental health. Spending time in garden environments buffered effects of major life events on symptoms of depression and anxiety, but not loneliness. Increased nature habits during the pandemic related to improved MHO.

  Conclusions: Spending time in natural environments during the Covid-19 pandemic led to better MHO, with implications for urban development and public health promotion.

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• Residential Greenspace Is Associated with Lower Levels of Depressive and Burnout Symptoms, and Higher Levels of Life Satisfaction: A Nationwide Population-Based Study in Sweden

  2022. Yannick Klein (et al.). International Journal of Environmental Research and Public Health 19 (9)

  Article

  Population-based studies of individual-level residential greenspace and mental health outcomes are still limited. Thus, the present study investigates greenspace–mental health associations—including depressive symptoms, burnout symptoms, and life satisfaction—in a population-based sample of adults, the Swedish Longitudinal Occupational Survey of Health, in 2016 (n = 14,641). High-resolution land cover of greenspace and green–blue-space was assessed at 50, 100, 300 and 500 m buffers around residential addresses. Higher residential greenspace and green–blue-space were associated with lower levels of depressive and burnout symptoms among non-working individuals and with higher life satisfaction in the whole study population, after controlling for age, sex, individual income, and neighborhood socioeconomics. The immediate residential-surrounding environment (50 m) consistently showed the strongest associations with the outcomes. Having a partner was associated with better mental health outcomes and with having more residential greenspace, and adjusting for this rendered greenspace–health associations mostly statistically non-significant. In conclusion, higher levels of greenspace and green–blue-space in the immediate residential-surrounding environment were associated with better mental health outcomes in the present study, which contributes additional nuances to prior studies. The importance of residential greenspace for public health, urban planning, and development is discussed.

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