Aim: The COVID-19 pandemic and associated restrictions posed challenges to people’s private and work lives. This included a rapid shift from on-site to remote work for many working adults in Sweden and internationally, and limited opportunities for indoor social and leisure activities. This involved risks for increased loneliness and social isolation, particularly among those mainly working remotely. In this context, nature visits may mitigate loneliness. This study adds to existing research in investigating whether a higher degree of remote work during COVID-19 was related to increased loneliness and whether nature visits mitigated loneliness, especially for those who mainly worked remotely. Subject and methods: The sample comprised a subsample of respondents to the Swedish Longitudinal Occupational Survey of Health 2020 (n = 984). Nature-related habits (NRH) were measured using self-reported frequency of visits to various natural environments. The effect of remote work, NRH, and time on loneliness (before – during COVID-19) was analyzed using linear mixed models while controlling for confounders. Results: Loneliness levels during COVID-19 were highest and increased the most compared to before the pandemic among individuals with the greatest degree of working remotely. Engaging daily in NRH was associated with lower loneliness levels, 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 mainly working remotely. Policies preserving and facilitating access to nature may promote resilience during and beyond crises like COVID-19.

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.

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.

Background: Human health and environmental sustainability constitute major local and global challenges which are also closely interconnected. Mental health and sleeping problems are e.g. public health concerns that are costly for society and for individuals.Exposure to natural environments such as green (vegetation) and blue (water) space are associated with a range of human health benefits, and are also central in biodiversity conservation and climate change mitigation. However, population-based studies investigating high-resolution, individual-level residential greenspace are yet limited, as population-based studies have mainly assessed greenspace at more crude aggregated levels. Objective & methods: Thus, in a set of large-scale population-based longitudinal studies, on nationwide cohorts in Sweden, objective high-resolution individual-level residential greenspace land cover assessments were made, including availability and access to different greenspace qualities (incl. of high biodiversity). The role of different residential greenspace qualities was investigated longitudinally for: 1) objective prescription medication purchase for common mental health problems, and 2) self-reported symptoms. Furthermore behaviour-related use and exposure to different types of natural environments were assessed in a sub-cohort, and their significance for multiple health indicators.Results & discussion: Results across studies show that more residential greenspace especially in the immediate residential surrounding (50m and 100m buffer zones around home) is associated with lower insomnia, antidepressant and anxiolytic prescription medication purchases, and less symptoms. Furthermore, spending time in nature especially in the home environment and forests were important for several aspects of mental health and health behaviours.Results highlight the role of greenspace in the immediate residential surroundings, as well as access to high quality greenspaces (i.e. larger coherent green areas conferring higher biodiversity) for mental health and health related behaviours. The multiple pathways through which different greenspace qualities can affect human health, while also contributing to biodiversity conservation and climate change mitigation and resilience are discussed.

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.

Olika typer av psykisk ohälsa och besvär är ett stort folkhälsoproblem, både globalt och i Sverige. Psykisk ohälsa är förenat med individuellt lidande och med långtidssjukskrivning, rehabiliteringskostnader, förtida utträde ur arbetslivet samt med andra produktivitetsförluster. Covid-19-pandemin, med dess tillhörande restriktioner, medförde utmaningar för individers privata och arbetsrelaterade situation. I takt med ökad urbanisering har naturmiljöers roll för att främja psykisk hälsa och hållbar stadsutveckling uppmärksammats alltmer. Att tillbringa tid i naturliga miljöer har kopplats till psykisk hälsa, även under Covid-19-pandemin, och kan utgöra en viktig faktor för motståndskraft. Få populationsbaserade studier har dock undersökt grönyta (dvs vegetation) runt individers bostad i relation till olika aspekter av psykisk hälsa med hjälp av högkvalitativa exponeringsmått. Longitudinella studier av samband mellan naturbesök och psykisk hälsa, samt studier som undersöker betydelsen av naturbesök för att motverka ensamhet i den arbetande befolkningen över tid under COVID-19, saknas också. Det övergripande syftet med studierna i denna avhandling var därför att undersöka betydelsen av olika typer av naturexponeringar för psykisk hälsa i olika situationer och tidsperioder innan respektive under COVID-19 pandemin genom tre kvantitativa studier på befolkningsbaserade urval. 

I Studie I undersöktes betydelsen av individuell grönyta (dvs vegetation) runt individers bostad för psykisk hälsa i ett populationsbaserat urval av vuxna bosatta i urbaniserade områden i Sverige, med hjälp av högupplösta geografiska marktäckedata. Resultaten visade att en högre andel av grönyta och grön-blå yta runt en individs bostad var förenat med bättre psykisk hälsa, särskilt lägre symptom på depression och utbrändhet bland icke-arbetande individer, samt högre livstillfredsställelse i hela urvalsgruppen. Genomgående var grönyta och grön-blå yta i den omedelbara bostadsmiljön (50 m) tydligast relaterat till psykisk hälsa. 

I Studie II undersöktes utvecklingen av vanor avseende olika typer av naturbesök före och under två år av covid-19-pandemin (2019–2022), samt deras samband med psykisk hälsa över tid, i ett befolkningsbaserat urval i Sverige. Det visade sig att de flesta typer av naturbesök ökade över tid (2019–2022), och att skogsbesök också ökade betydligt på kort sikt (2019–2020). Frekventa naturbesök, särskilt trädgårds- och skogsbesök, var relaterade till lägre nivåer av depression, ångest, ensamhet och sömnproblem i början av 2021 och 2022. Att bibehålla och öka frekvensen av naturbesök över tid var förenat med bättre psykisk hälsa eller skyddade mot sämre psykisk hälsa i samband med minskad frekvens av naturbesök över tid.

I Studie III undersöktes om distansarbete under covid-19 var förenat med högre nivåer av ensamhet i ett befolkningsbaserat urval av yrkesverksamma vuxna i Sverige och om naturbesök buffrade mot ensamhet över tid bland dem som huvudsakligen arbetade på distans. Det framkom att ensamhetsnivåerna under pandemin var högst och ökade mest jämfört med tidigare bland individer som huvudsakligen distansarbetade. Dagliga naturbesök mildrade det negativa sambandet mellan distansarbete och ensamhet över tid.

Sammantaget visar resultaten från studierna i avhandlingen att de olika typerna av naturexponeringar som undersöktes konsekvent var förenade med bättre psykisk hälsa i olika situationer och tidsperioder. Det belyser vikten av att bevara och utveckla naturmiljöer i stadsområden för att främja psykisk hälsa, i linje med FN:s mål för hållbar utveckling.

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.

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.

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.