{
  "abstract": "Abstract Objectives To examine the association between exposure to greenness and hospital admissions for mental disorders, and to estimate greenness related hospital admissions under various greenness intervention scenarios.Design Multicountry time series study.Setting 6842 locations in seven countries (Australia, Brazil, Canada, Chile, New Zealand, South Korea, and Thailand).Participants 11.4 million hospital admissions for mental disorders, 2000-19.Main outcome measures Hospital admissions for all cause mental disorders and for six categories in relation to greenness (measured by the normalised difference vegetation index (NDVI)): psychotic disorders, substance use disorders, mood disorders, behavioural disorders, dementia, and anxiety. Associations were estimated using quasi-Poisson regression models, controlled for weather conditions, air pollutants, socioeconomic indicators, seasonality, and long term trends. Models were stratified by sex, age, urbanisation, and season. Hospital admissions were estimated under different greenness intervention scenarios.Results During 2000-19, of hospital admissions related to mental health disorders, 30.8% (3 522 749 patients) were for psychotic disorders, 24.7% (2 821 860) for substance use disorders, 11.6% (1 325 305) for mood disorders, 7.4% (845 561) for behavioural disorders, 3.0% (348 149) for dementia, and 2.5% (283 914) for anxiety. A 0.1 increase in NDVI was associated with a 7% reduction in the risk of hospital admissions for all cause mental disorders (relative risk 0.93, 95% confidence interval (CI) 0.89 to 0.98) in pooled analyses. However, associations varied across countries and disorder types. Brazil, Chile, and Thailand showed consistent protective associations across most disorder categories, while modest adverse (ie, harmful) associations were observed in Australia and Canada for hospital admissions for all cause mental disorders and for several specific disorder categories. Exposure-response analyses showed a generally monotonic and approximately linear relation without clear thresholds. When limited to urban settings where associations were generally more consistent, an estimated 7712 (95% CI 6701 to 8726) hospital admissions for mental health disorders annually in urban areas were statistically attributable to observed greenness levels. Analysis by greenness intervention scenarios in urban areas suggested that a 10% increase in greenness was associated with reductions in hospital admissions for mental disorders ranging from ~1 per 100 000 in South Korea to ~1000 per 100 000 in New Zealand.Conclusions Greenness was statistically associated with lower risks of hospital admissions for mental disorders in several countries, particularly in urban settings. Some adverse associations were, however, observed, and findings were heterogeneous across contexts.",
  "authors": [
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Tingting Ye"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Wenzhong Huang"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Zhihu Xu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia",
        "Chongqing Emergency Medical Centre, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China"
      ],
      "name": "Rongbin Xu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Pei Yu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Yao Wu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Yiwen Zhang"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Wenhua Yu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Yanming Liu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Bo Wen"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Ke Ju"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Zhengyu Yang"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Shuang Zhou"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Samuel Hundessa"
    },
    {
      "affiliations": [
        "Department of Public Health, University of Otago, Wellington, New Zealand"
      ],
      "name": "Simon Hales"
    },
    {
      "affiliations": [
        "School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada",
        "Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada"
      ],
      "name": "Eric Lavigne"
    },
    {
      "affiliations": [
        "School of Medicine, University of the Andes (Chile), Las Condes, Región Metropolitana, Chile"
      ],
      "name": "Patricia Matus"
    },
    {
      "affiliations": [
        "Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Krung Thep Maha Nakhon, Thailand"
      ],
      "name": "Kraichat Tantrakarnapa"
    },
    {
      "affiliations": [
        "Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea"
      ],
      "name": "Ho Kim"
    },
    {
      "affiliations": [
        "Laboratory of Environmental and Environmental Pathology LIM05, Department of Pathology, University of São Paulo School of Medicine, São Paulo, SP, Brazil"
      ],
      "name": "Micheline de Sousa Zanotti Stagliorio Coelho"
    },
    {
      "affiliations": [
        "Laboratory of Environmental and Environmental Pathology LIM05, Department of Pathology, University of São Paulo School of Medicine, São Paulo, SP, Brazil"
      ],
      "name": "Paulo Saldiva"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Yuming Guo"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Shanshan Li"
    }
  ],
  "title": "Greenness and hospital admissions for cause specific mental disorders: multicountry time series study",
  "uid": "e5f19711-ac63-5dce-96cf-d857bf9fb3e0"
}