Display options
Cite
Tomita A, Vandormael AM, Cuadros D, et al. Green environment and incident depression in South Africa: a geospatial analysis and mental health implications in a resource-limited setting. Lancet Planet Health. 2017;1(4):e152-e162doi: 10.1016/S2542-5196(17)30063-3.
Tomita, A., Vandormael, A. M., Cuadros, D., Di Minin, E., Heikinheimo, V., Tanser, F., Slotow, R., & Burns, J. K. (2017). Green environment and incident depression in South Africa: a geospatial analysis and mental health implications in a resource-limited setting. The Lancet. Planetary health, 1(4), e152-e162. https://doi.org/10.1016/S2542-5196(17)30063-3
Tomita, Andrew, et al. "Green environment and incident depression in South Africa: a geospatial analysis and mental health implications in a resource-limited setting." The Lancet. Planetary health vol. 1,4 (2017): e152-e162. doi: https://doi.org/10.1016/S2542-5196(17)30063-3
Tomita A, Vandormael AM, Cuadros D, Di Minin E, Heikinheimo V, Tanser F, Slotow R, Burns JK. Green environment and incident depression in South Africa: a geospatial analysis and mental health implications in a resource-limited setting. Lancet Planet Health. 2017 Jul;1(4):e152-e162. doi: 10.1016/S2542-5196(17)30063-3. PMID: 28890948; PMCID: PMC5589195.
Copy Download .nbib Format: NLM
Share it on

Lancet Planet Health. 2017 Jul;1(4):e152-e162. doi: 10.1016/S2542-5196(17)30063-3.

Green environment and incident depression in South Africa: a geospatial analysis and mental health implications in a resource-limited setting.

The Lancet. Planetary health

Andrew Tomita, Alain M Vandormael, Diego Cuadros, Enrico Di Minin, Vuokko Heikinheimo, Frank Tanser, Rob Slotow, Jonathan K Burns

Affiliations

  1. College of Health Sciences (A Tomita PhD, A M Vandormael PhD), Africa Health Research Institute (A Tomita, A M Vandormael, Prof F Tanser PhD), School of Life Sciences (E Di Minin PhD, Prof R Slotow PhD), School of Nursing and Public Health (Prof F Tanser), and Department of Psychiatry (Prof J K Burns PhD), University of KwaZulu-Natal, Durban, South Africa; Department of Geography, University of Cincinnati, Cincinnati, OH, USA (D Cuadros PhD); Department of Geosciences and Geography, University of Helsinki, Helsinki, Finland (E Di Minin, V Heikinheimo MSc); Department of Genetics, Evolution and Environment, University College London, London, UK (Prof R Slotow); and Institute for Health Research, University of Exeter, Exeter, UK (Prof J K Burns).

PMID: 28890948 PMCID: PMC5589195 DOI: 10.1016/S2542-5196(17)30063-3

Abstract

BACKGROUND: Unprecedented levels of habitat transformation and rapid urbanisation are changing the way individuals interrelate with the natural environment in developing countries with high economic disparities. Although the potential benefit of green environments for mental health has been recognised, population-level evidence to this effect is scarce. We investigated the effect of green living environment in potentially countering incident depression in a nationally representative survey in South Africa.

METHODS: We used panel data from the South African National Income Dynamics Study (SA-NIDS). Our study used SA-NIDS data from three waves: wave 1 (2008), wave 2 (2010), and wave 3 (2012). Households were sampled on the basis of a stratified two-stage cluster design. In the first stage, 400 primary sampling units were selected for inclusion. In the second stage, two clusters of 12 dwelling units each were drawn from within each primary sampling unit (or 24 dwelling units per unit). Household and individual adult questionnaires were administered to participants. The main outcome, incident depression (ie, incident cohort of 11 156 study participants without significant depression symptoms at their first entry into SA-NIDS), was assessed in the adult survey via a ten item version of the Center for Epidemiologic Studies Depression Scale; a total score of ten or higher was used as a cutoff to indicate significant depressive symptoms. Each participant was assigned a value for green living space via a satellite-derived normalised difference vegetation index (NDVI) based on the GPS coordinates of their household location.

FINDINGS: Overall, we found uneven benefit of NDVI on incident depression among our study participants. Although the green living environment showed limited benefit across the study population as a whole, our final analysis based on logistic regression models showed that higher NDVI was a predictor of lower incident depression among middle-income compared with low-income participants (adjusted odds ratio [aOR] 0·98, 0·97-0·99, p<0·0001), although when this analysis was broken down by race, its positive effect was particularly evident amongst African individuals. Living in rural areas was linked to lower odds of incident depression (aOR 0·71, 0·55-0·92, p=0·011) compared with study participants residing in urban informal areas that often lack formal planning.

INTERPRETATION: Our results imply the importance of green environments for mental wellbeing in sub-Saharan African settings experiencing rapid urbanisation, economic and epidemiological transition, reaffirming the need to incorporate environmental services and benefits for sustainable socioeconomic development.

FUNDING: South African Medical Research Council, National Institutes of Health, and Academy of Finland.

Conflict of interest statement

Declaration of interests We declare no competing interests.

References

  1. Am J Prev Med. 2016 Jul;51(1):78-89 - PubMed
  2. Lancet. 2012 Dec 15;380(9859):2163-96 - PubMed
  3. Int J Environ Res Public Health. 2013 Sep 02;10(9):4086-103 - PubMed
  4. Health Place. 2015 May;33:48-56 - PubMed
  5. Psychol Assess. 2004 Dec;16(4):360-72 - PubMed
  6. S Afr Med J. 2009 May;99(5 Pt 2):339-44 - PubMed
  7. Assessment. 2013 Aug;20(4):429-36 - PubMed
  8. Soc Psychiatry Psychiatr Epidemiol. 2016 Nov;51(11):1525-1537 - PubMed
  9. J Epidemiol Community Health. 2014 Jun;68(6):578-83 - PubMed
  10. Proc Natl Acad Sci U S A. 2012 Oct 2;109(40):16083-8 - PubMed
  11. Environ Int. 2014 Oct;71:101-8 - PubMed
  12. Trends Ecol Evol. 2005 Sep;20(9):503-10 - PubMed
  13. Health Place. 2012 Mar;18(2):385-90 - PubMed
  14. Environ Int. 2016 Jan;86:60-7 - PubMed
  15. Science. 2010 May 28;328(5982):1164-8 - PubMed
  16. Science. 2013 Feb 22;339(6122):961-5 - PubMed
  17. Sci Rep. 2016 Jun 23;6:28551 - PubMed
  18. Am J Prev Med. 1994 Mar-Apr;10(2):77-84 - PubMed
  19. Environ Health Perspect. 2016 Sep;124(9):1344-52 - PubMed
  20. Front Psychiatry. 2015 May 08;6:68 - PubMed
  21. Psychol Sci. 2013 Jun;24(6):920-8 - PubMed
  22. Environ Health. 2013 Jun 19;12:49 - PubMed
  23. Conserv Biol. 2013 Aug;27(4):808-20 - PubMed
  24. J Ment Health Policy Econ. 2006 Jun;9(2):87-98 - PubMed
  25. AIDS Patient Care STDS. 2008 Feb;22(2):147-58 - PubMed
  26. Int J Environ Res Public Health. 2015 Apr 22;12(4):4354-79 - PubMed
  27. BMC Public Health. 2012 May 08;12:337 - PubMed
  28. Science. 1985 Jan 25;227(4685):369-75 - PubMed
  29. Environ Sci Technol. 2014 Jan 21;48(2):1247-55 - PubMed
  30. J Clin Psychiatry. 2015 Feb;76(2):155-62 - PubMed
  31. J Epidemiol Community Health. 2008 May;62(5):e9 - PubMed
  32. Sci Total Environ. 2016 Jan 15;542(Pt A):750-6 - PubMed
  33. Curr Epidemiol Rep. 2015 Jun;2(2):131-142 - PubMed
  34. Soc Sci Med. 2010 Apr;70(8):1203-10 - PubMed
  35. PLoS Med. 2013 Nov;10(11):e1001547 - PubMed
  36. J Epidemiol Community Health. 2008 Jun;62(6):538-44 - PubMed
  37. Tydskr Stud Ekon Ekon. 2010 Jan 1;34(3):69-85 - PubMed
  38. PLoS One. 2011;6(8):e23777 - PubMed
  39. Environ Monit Assess. 2003 Jul-Aug;86(1-2):29-45 - PubMed
  40. Environ Int. 2015 Apr;77:35-41 - PubMed
  41. J Epidemiol Community Health. 2016 Mar;70(3):253-9 - PubMed

Publication Types

Grant support