Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysis

Muhammad Mainuddin Patwary; Mondira Bardhan; Asma Safia Disha; Angel M Dzhambov; Colby Parkinson; Matthew H E M Browning; S M Labib; Lincoln R Larson; Md Zahidul Haque; Md Atiqur Rahman; Md Ashraful Alam; Md Faysal Tareq; Faysal Kabir Shuvo

doi:10.1016/j.envpol.2024.124284

Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysis

Environ Pollut. 2024 Sep 1:356:124284. doi: 10.1016/j.envpol.2024.124284. Epub 2024 May 30.

Affiliations

¹ Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh. Electronic address: [email protected].
² Environment and Sustainability Research Initiative, Khulna, Bangladesh; Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA.
³ Environment and Sustainability Research Initiative, Khulna, Bangladesh; Department of Environmental Science and Management, North South University, Bashundhara, Dhaka, 1229, Bangladesh.
⁴ Research Group "Health and Quality of Life in a Green and Sustainable Environment", Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria.
⁵ Department of Recreation, Park, and Tourism Management, Pennsylvania State University, University Park, PA, USA.
⁶ Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA.
⁷ Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Vening Meineszgebouw A, Princetonlaan 8a, 3584 CB, Utrecht, the Netherlands.
⁸ Department of Parks, Recreation & Tourism Management, North Carolina State University, Raleigh, NC, USA.
⁹ Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh.
¹⁰ Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
¹¹ Environment and Sustainability Research Initiative, Khulna, Bangladesh; Institute of Environmental Sciences (CML), Leiden University, Netherlands.
¹² Swinburne University of Technology, Hawthorn, VIC, Australia.

PMID: 38821342
DOI: 10.1016/j.envpol.2024.124284

Abstract

Prior reviews have highlighted that nature exposure was a valuable coping strategy enhancing mental health during the COVID-19 pandemic. However, no existing reviews have determined the quality of evidence and risk of bias of the empirical studies supporting this claim. To address this gap, we employed a Navigation Guide systematic review and meta-analysis approach to investigate associations between nature exposure and mental health during the pandemic. Searches in PubMed, Web of Science, Scopus, CINAHL, and PsycInfo retrieved relevant articles published between January 1, 2020, and March 4, 2024. We used the Navigation Guide methodology to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessments to evaluate the overall quality of evidence. Our search retrieved 113 studies that met the inclusion criteria and reported diverse types of exposure, including nature availability, nature visit frequency, green space accessibility, and green space type, alongside associations with 12 mental health outcomes. Meta-analyses found access to gardens was associated with lower odds of depression [(Pooled odds ratio [OR] = 0.71, 95%CI = 0.61, 0.82), I² = 0%, n = 3] and anxiety [(Pooled OR = 0.73, 95%CI = 0.63, 0.84), I² = 0%, n = 3]. Increased time in green spaces was associated with lower level of stress [(Pooled Corr = -0.11, 95%CI = -0.17, -0.05), I² = 0%, n = 2]. Higher frequency of visits to nature was associated with improved mental well-being [(Pooled standardized beta = 0.10, 95%CI = 0.07, 0.14), I² = 0%, n = 2] and general mental health [(Pooled standardized beta = 0.11, 95%CI = 0.03-0.38), I² = 82%, n = 2]. However, the number of pooled studies was small and the overall quality of evidence was "very low" for all outcomes, and high levels of bias were observed (26% of studies had high, 71% probably high). Nonetheless, given the trends in the results, nature-based solutions emphasizing exposure to gardens and green spaces near the home may have promoted psychological resilience during this public health crisis.

Keywords: Anxiety; Gardens; Green space; Meta-analysis; Nature-based solutions; Pandemic.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Anxiety / epidemiology
COVID-19* / epidemiology
COVID-19* / psychology
Depression / epidemiology
Gardens
Humans
Mental Health*
Nature
Pandemics
SARS-CoV-2