Residential greenspace and mental health service use in mood and psychotic disorders: a retrospective cohort study

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A growing body of literature shows that exposure to greenspace may have protective effects on mental health, including in individuals with mental, behavioural, or neurological health conditions. For example, greater greenspace exposure is associated with reduced hospital admission rates and a reduction in symptoms in individuals with schizophrenia (Marcham & Ellett, 2024); in children and adolescents, areas with the lowest levels of greenspace have been shown to have an increased prevalence of emergency department visits for mood disorders and substance use disorders (Ryan et al., 2024); and in older adults, higher residential greenness has been prospectively associated with reduced risk of incident dementia over 8 years (Hu et al., 2023). However, there is a lack of large-scale research examining the association between individual residential greenspace exposure (measured using Normalised Difference Vegetation Index, NDVI) and mental health service use (as proxy for illness severity). While a small number of studies have examined impacts on inpatient admissions (e.g., Ye et al., 2025), there is limited insight into community mental health service use. This is an important gap, as many individuals with mental health conditions are managed in the community. Examining both inpatient and community mental health service use can provide greater insight into the broader healthcare burden and potential protective effects of greenspace on population mental health. Moreover, the strength of this relationship is unlikely to be evenly distributed across the population. The effects of greenspace on mental health may be modified by sociodemographic characteristics such as age, gender, ethnicity, and neighbourhood deprivation, as well as by type of diagnosis (Belcher et al., 2024). Associations may also be modified by environmental exposures including air pollution and chronic heat exposure. Using routinely collected electronic health records linked with environmental datasets, this retrospective cohort study will investigate the association between residential greenspace and mental health service use in South London, and examine how this association varies by sociodemographic and environmental characteristics. References: Belcher, R. N., Murray, K. A., Reeves, J. P., & Fecht, D. (2024). Socioeconomic deprivation modifies green space and mental health associations: A within person study. Environment International, 192, 109036. https://doi.org/10.1016/j.envint.2024.109036 Hu, X., Wang, J., Yang, T., Jin, J., Zeng, Q., Aboubakri, O., Feng, X. L., Li, G., & Huang, J. (2023). Role of residential greenspace in the trajectory of major neurological disorders: A longitudinal study in UK Biobank. The Science of the Total Environment, 912, 168967. https://doi.org/10.1016/j.scitotenv.2023.168967 Marcham, L., & Ellett, L. (2024). Exposure to green spaces and schizophrenia: a systematic review. Psychological Medicine, 54(12), 3210–3221. https://doi.org/10.1017/s0033291724001533 Ryan, S. C., Sugg, M. M., Runkle, J. D., & Thapa, B. (2024). Advancing understanding on greenspace and mental health in young people. GeoHealth, 8(3), e2023GH000959. https://doi.org/10.1029/2023gh000959 Ye, T., Huang, W., Xu, Z., Xu, R., Yu, P., Wu, Y., Zhang, Y., Yu, W., Liu, Y., Wen, B., Ju, K., Yang, Z., Zhou, S., Hundessa, S., Hales, S., Lavigne, E., Matus, P., Tantrakarnapa, K., Kim, H., . . . Li, S. (2025). Greenness and hospital admissions for cause specific mental disorders: multicountry time series study. BMJ, 391, e084618. https://doi.org/10.1136/bmj-2025-084618

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