Results from an 18 country cross-sectional study examining experiences of nature for people with common mental health disorders

Abstract

Exposure to natural environments is associated with a lower risk of common mental health disorders (CMDs), such as depression and anxiety, but we know little about nature-related motivations, practices and experiences of those already experiencing CMDs. We used data from an 18-country survey to explore these issues (n = 18,838), taking self-reported doctor-prescribed medication for depression and/or anxiety as an indicator of a CMD (n = 2698, 14%). Intrinsic motivation for visiting nature was high for all, though slightly lower for those with CMDs. Most individuals with a CMD reported visiting nature ≥ once a week. Although perceived social pressure to visit nature was associated with higher visit likelihood, it was also associated with lower intrinsic motivation, lower visit happiness and higher visit anxiety. Individuals with CMDs seem to be using nature for self-management, but ‘green prescription’ programmes need to be sensitive, and avoid undermining intrinsic motivation and nature-based experiences.

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References:

  1. Bratman, G. N. et al. Nature and mental health: an ecosystem service perspective. Sci. Adv. 5, 7 (2019)
  2. Baxter, D. E. & Pelletier, L. G. Is nature relatedness a basic human psychological need? A critical examination of the extant literature. Can. Psychol. 60(1), 21 (2019).
  3. Cleary, A. et al. Exploring potential mechanisms involved in the relationship between eudaimonic wellbeing and nature connection. Landsc. Urban Plan. 158, 119–128 (2017).
  4. Ryan, R. M. & Deci, E. L. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am. Psychol. 55(1), 68 (2000).
  5. McMahan, E. A. & Estes, D. The effect of contact with natural environments on positive and negative affect: a meta-analysis. J. Positive Psychol. 10(6), 507–519 (2015).
  6. Bragg, R. & Atkins, G. A review of nature-based interventions for mental health care. Nat. Engl. Commission. Rep. 204, 1 (2016).
  7. Van den Berg, A. E. From green space to green prescriptions: challenges and opportunities for research and practice. Front. Psychol. 8, 268 (2017).
  8. Annerstedt, M. & Währborg, P. Nature-assisted therapy: systematic review of controlled and observational studies. Scand. J. Public Health 39(4), 371–388 (2011).
  9. Depression, W. H. O. Other common mental disorders: global health estimates 1–24 (World Health Organization, Geneva, 2017).
  10. Baldwin, D. S. et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J. Psychopharmacol. 19(6), 567–596 (2005).
  11. Kazdin, A. E. & Blase, S. L. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect. Psychol. Sci. 6(1), 21–37 (2011).
  12. White, M. P. et al. Would you be happier living in a greener urban area? a fixed-effects analysis of panel data. Psychol. Sci. 24(6), 920–928 (2013).
  13. Helbich, M. et al. More green space is related to less antidepressant prescription rates in the Netherlands: a Bayesian geoadditive quantile regression approach. Environ. Res. 166, 290–297 (2018).
  14. Berman, M. G. et al. Interacting with nature improves cognition and affect for individuals with depression. J. Affect. Disord. 140(3), 300–305 (2012).
  15. Roe, J. & Aspinall, P. The restorative benefits of walking in urban and rural settings in adults with good and poor mental health. Health Place 17(1), 103–113 (2011).
  16. Britton, E. et al. Blue care: a systematic review of blue space interventions for health and wellbeing. Health Promot. Int. 35(1), 50–69 (2020).
  17. Robinson, J. M. & Breed, M. F. Green prescriptions and their co-benefits: Integrative strategies for public and environmental health. Challenges 10, 9 (2019).
  18. Smith, B. Depression and motivation. Phenomenol. Cogn. Sci. 12(4), 615–635 (2013).
  19. Cribb, G., Moulds, M. L. & Carter, S. Rumination and experiential avoidance in depression. Behav. Change 23(3), 165 (2006).
  20. Krämer, L. V. et al. Correlates of reduced exercise behaviour in depression: the role of motivational and volitional deficits. Psychol. Health 29(10), 1206–1225 (2014).
  21. Deci, E. L., Koestner, R. & Ryan, R. M. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol. Bull. 125(6), 627 (1999).
  22. Dejonckheere, E. et al. Perceiving social pressure not to feel negative predicts depressive symptoms in daily life. Depress. Anxiety 34(9), 836–844 (2017).
  23. Sebire, S. J., Standage, M. & Vansteenkiste, M. Examining intrinsic versus extrinsic exercise goals: cognitive, affective, and behavioral outcomes. J. Sport Exerc. Psychol. 31(2), 189–210 (2009).
  24. Grellier, J. et al. BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe’s blue spaces. BMJ Open 7, 6 (2017).
  25. Steel, Z. et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int. J. Epidemiol. 43(2), 476–493 (2014).
  26. Schipperijn, J. et al. Factors influencing the use of green space: results from a Danish national representative survey. Landsc. Urban Plan. 95(3), 130–137 (2010).
  27. Korpela, K. M. et al. Environmental strategies of affect regulation and their associations with subjective well-being. Front. Psychol. 9, 562 (2018).
  28. Wüstemann, H., Kalisch, D. & Kolbe, J. Access to urban green space and environmental inequalities in Germany. Landsc. Urban Plan. 164, 124–131 (2017).
  29. Wyles, K. J. et al. Are some natural environments more psychologically beneficial than others? The importance of type and quality on connectedness to nature and psychological restoration. Environ. Behav. 51(2), 111–143 (2019).
  30. Allen, J., & Balfour, R. Natural Solutions for Tackling Health Inequalities. (UCL Institute of Health Equity, London, 2014). https://www.instituteofhealthequity.org/resources-reports/natural-solutions-to-tackling-health-inequalities/natural-solutions-to-tackling-health-inequalities.pdf.
  31. Feng, C. et al. The pursuit of social acceptance: aberrant conformity in social anxiety disorder. Soc. Cogn. Affect. Neurosci. 13(8), 809–817 (2018).
  32. Zimmerman, M., Morgan, T. A. & Stanton, K. The severity of psychiatric disorders. World Psychiatry 17(3), 258–275 (2018).
  33. Eurostat. European Health Interview Survey (EHIS wave 2) Methodological Manual. Publications Office of the European Union (2013). https://ec.europa.eu/eurostat/documents/3859598/5926729/KS-RA-13-018-EN.PDF/26c7ea80-01d8-420e-bdc6-e9d5f6578e7c.
  34. Sahlin, E. et al. How do participants in nature-based therapy experience and evaluate their rehabilitation?. J. Ther. Hortic. 22(1), 8–23 (2012).
  35. Ferrer-i-Carbonell, A. & Frijters, P. How important is methodology for the estimates of the determinants of happiness?. Econ. J. 114(497), 641–659 (2004).
  36. Marker, I. & Norton, P. J. The efficacy of incorporating motivational interviewing to cognitive behavior therapy for anxiety disorders: a review and meta-analysis. Clin. Psychol. Rev. 62, 1–10 (2018).
  37. Elliott, L. R. & White, M. P. BlueHealth International Survey Methodology and Technical Report. https://doi.org/10.17605/OSF.IO/7AZU2. (2020).
  38. Markland, D. & Tobin, V. A modification to the behavioural regulation in exercise questionnaire to include an assessment of amotivation. J. Sport Exerc. Psychol. 26(2), 191–196 (2004).
  39. Shanahan, D. F. et al. Health benefits from nature experiences depend on dose. Sci. Rep. 6, 28551 (2016).
  40. Organisation for Economic Cooperation and Development (OECD). How’s life? 2020: Measuring wellbeing. (2020). https://www.oecd-ilibrary.org/docserver/9870c393-en.pdf?expires=1585930901&id=id&accname=guest&checksum=A5F581FE337E43D1FAD78E0F5A831588.
  41. Faresjö, T. & Faresjö, Å. To match or not to match in epidemiological studies—same outcome but less power. Int. J. Environ. Res. Public Health 7(1), 325–332 (2010).
  42. Garrett, J. K. et al. Coastal proximity and mental health among urban adults in England: the moderating effect of household income. Health Place 59, 102200 (2019).
  43. 43. White, M. P. et al. Feelings of restoration from recent nature visits. J. Environ. Psychol. 35, 40–51 (2013).