Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Source
2.2. Estimation of Exposure to Green Spaces
2.3. Covariates
2.4. Self-Selection Bias
2.5. Dependent Variable
2.6. Statistical Analyses
3. Results
3.1. Exposure to Green Spaces
3.2. Descriptive Statistics and Bivariate Analyses
3.3. Interaction Tests for the Association of Green Space with Antenatal Depression
3.4. Main Analyses for the Association of Green Space with Antenatal Depression for the Entire Cohort
4. Discussion
4.1. Main Findings
4.2. Comparison of Study Results with Previous Studies
4.3. Strengths and Limitations of This Study
4.4. Future Directions
4.5. Comparison between Study Results of Papers Based on the Growing Up in New Zealand Cohort
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
Abbreviations
ArcGIS | Aeronautical Reconnaissance Coverage Geographic Information System |
CAU | Census Area Unit |
CI | Confidence Interval |
EPDS | Edinburgh Postnatal Depression Scale |
GHQ | General Health Questionnaire |
LCDB | Land Cover Database |
NZDep2006 | New Zealand Deprivation Index 2006 |
OR | Odds Ratio |
SD | Standard Deviation |
USA | United States of America |
References
- World Health Organization. Depression. Available online: http://www.who.int/topics/depression/en/ (accessed on 23 November 2016).
- Greenberg, P.E.; Fournier, A.A.; Sisitsky, T.; Pike, C.T.; Kessler, R.C. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J. Clin. Psychiatry 2015, 76, 155–162. [Google Scholar] [CrossRef] [PubMed]
- Bromet, E.; Andrade, L.H.; Hwang, I.; Sampson, N.A.; Alonso, J.; de Girolamo, G.; de Graaf, R.; Demyttenaere, K.; Hu, C.; Iwata, N.; et al. Cross-national epidemiology of DSM-IV major depressive episode. BioMed Cent. Med. 2011, 9, 90. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Andrews, G. Should depression be managed as a chronic disease? BMJ Br. Med. J. 2001, 322, 419–421. [Google Scholar] [CrossRef]
- World Health Organization. Mental Health—A Call for Action by World Health Ministers; World Health Organization: Genava, Switzerland, 2001. [Google Scholar]
- Leigh, B.; Milgrom, J. Risk factors for antenatal depression, postnatal depression and parenting stress. BioMed Cent. Psychiatry 2008, 8, 24. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health. Healthy Beginnings: Developing Perinatal and Infant Mental Health Services in New Zealand; Ministry of Health: Wellington, New Zealand, 2012.
- Accortt, E.E.; Cheadle, A.C.D.; Schetter, C.D. Prenatal depression and adverse birth outcomes: An updated systematic review. Mater. Child Health J. 2015, 19, 1306–1337. [Google Scholar] [CrossRef] [PubMed]
- Goedhart, G.; Snijders, A.C.; Hesselink, A.E.; van Poppel, M.N.; Bonsel, G.J.; Vrijkotte, T.G.M. Maternal depressive symptoms in relation to perinatal mortality and morbidity: Results from a large multiethnic cohort study. Psychosom. Med. 2010, 72, 769–776. [Google Scholar] [CrossRef] [PubMed]
- Chaaya, M.; Campbell, O.M.R.; Kak, F.E.; Shaar, D.; Harb, H.; Kaddour, A. Postpartum depression: prevalence and determinants in Lebanon. Arch. Women Ment. Health 2002, 5, 65–72. [Google Scholar] [CrossRef] [PubMed]
- Milgrom, J.; Gemmill, A.W.; Bilszta, J.L.; Hayes, B.; Barnett, B.; Brooks, J.; Ericksen, J.; Ellwood, D.; Buist, A. Antenatal risk factors for postnatal depression: A large prospective study. J. Affect. Disord. 2008, 108, 147–157. [Google Scholar] [CrossRef] [PubMed]
- Stewart, D.E.; Robertson, E.; Dennis, C.L.; Grace, S.L.; Wallington, T. Postpartum Depression: Literature Review of Risk Factors And Interventions; University Health Network Women’s Health Program: Toronto, ON, USA, 2003. [Google Scholar]
- McEachan, R.R.C.; Prady, S.L.; Smith, G.; Fairley, L.; Cabieses, B.; Gidlow, C.; Wright, J.; Dadvand, P.; van Gent, D.; Nieuwenhuijsen, M.J. The association between green space and depressive symptoms in pregnant women: moderating roles of socioeconomic status and physical activity. J. Epidemiol. Community Health 2016, 70, 253–259. [Google Scholar] [CrossRef] [PubMed]
- United States Environmental Protection Agency. What Is Open Space/Green Space? Available online: http://www.epa.gov/region1/eco/uep/openspace.html (accessed on 1 December 2014).
- Sanders, T.; Feng, X.; Fahey, P.P.; Lonsdale, C.; Astell-Burt, T. The influence of neighborhood green space on children’s physical activity and screen time: Findings from the longitudinal study of Australian children. Int. J. Behav. Nutr. Phys. Act. 2015, 12, 126. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cetin, M. Determining the bioclimatic comfort in Kastamonu City. Environ. Monit. Assess. 2015, 187, 640. [Google Scholar] [CrossRef] [PubMed]
- Cetin, M. Using GIS analysis to assess urban green space in terms of accessibility: Case study in Kutahya. Int. J. Sustain. Dev. World Ecol. 2015, 22, 420–424. [Google Scholar] [CrossRef]
- Cetin, M.; Sevik, H. Evaluating the recreation potential of IlgazMountain National Park in Turkey. Environ. Monit. Assess. 2016, 188, 52. [Google Scholar] [CrossRef] [PubMed]
- Dadvand, P.; de Nazelle, A.; Figueras, F.; Basagaña, X.; Su, J.; Amoly, E.; Jerrett, M.; Vrijheid, M.; Sunyer, J.; Nieuwenhuijsen, M.J. Green space, health inequality and pregnancy. Environ. Int. 2012, 40, 110–115. [Google Scholar] [CrossRef] [PubMed]
- Markevych, I.; Fuertes, E.; Tiesler, C.M.T.; Birk, M.; Bauer, C.-P.; Koletzko, S.; von Berg, A.; Berdel, D.; Heinrich, J. Surrounding greenness and birth weight: Results from the GINIplus and LISAplus birth cohorts in Munich. Health Place 2014, 26, 39–46. [Google Scholar] [CrossRef] [PubMed]
- Dadvand, P.; Wright, J.; Martinez, D.; Basagaña, X.; McEachan, R.R.C.; Cirach, M.; Gidlow, C.J.; de Hoogh, K.; Gražulevičienė, R.; Nieuwenhuijsen, M.J. Inequality, green spaces, and pregnant women: Roles of ethnicity and individual and neighborhood socioeconomic status. Environ. Int. 2014, 71, 101–108. [Google Scholar] [CrossRef] [PubMed]
- Dadvand, P.; Sunyer, J.; Basagaña, X.; Ballester, F.; Lertxundi, A.; Fernández-Somoano, A.; Estarlich, M.; García-Esteban, R.; Mendez, M.A.; Nieuwenhuijsen, M.J. Surrounding greenness and pregnancy outcomes in four Spanish birth cohorts. Environ. Health Perspect. 2012, 120, 1481–1487. [Google Scholar] [CrossRef] [PubMed]
- Barton, J.; Pretty, J. What is the Best Dose of nature and green exercise for improving mental health? A multi-study analysis. Environ. Sci. Technol. 2010, 44, 3947–3955. [Google Scholar] [CrossRef] [PubMed]
- Bos, E.H.; van der Meulen, L.; Wichers, M.; Jeronimus, B.F. A Primrose Path? Moderating effects of age and gender in the association between green space and mental health. Int. J. Environ. Res. Public Health 2016, 13, 492. [Google Scholar] [CrossRef] [PubMed]
- De Vries, S.; Verheij, R.A.; Groenewegen, P.P.; Spreeuwenberg, P. Natural environments-healthy environments? An exploratory analysis of the relationship between greenspace and health. Environ. Plan. A 2003, 35, 1717–1731. [Google Scholar] [CrossRef]
- Astell-Burt, T.; Feng, X.; Kolt, G.S. Mental health benefits of neighborhood green space are stronger among physically active adults in middle-to-older age: Evidence from 260,061 Australians. Prev. Med. 2013, 57, 601–606. [Google Scholar] [CrossRef] [PubMed]
- Nutsford, D.; Pearson, A.L.; Kingham, S. An ecological study investigating the association between access to urban green space and mental health. Public Health 2013, 127, 1005–1011. [Google Scholar] [CrossRef] [PubMed]
- Nutsford, D.; Pearson, A.L.; Kingham, S.; Reitsma, F. Residential exposure to visible blue space (but not green space) associated with lower psychological distress in a capital city. Health Place 2016, 39, 70–78. [Google Scholar] [CrossRef] [PubMed]
- Morton, S.M.B.; Atatoa Carr, P.E.; Grant, C.C.; Robinson, E.M.; Bandara, D.K.; Bird, A.; Ivory, V.C.; Kingi, T.K.R.; Liang, R.; Marks, E.J.; et al. Cohort profile: Growing up in New Zealand. Int. J. Epidemiol. 2013, 42, 65–75. [Google Scholar] [CrossRef] [PubMed]
- Statistics, New Zealand. Geographic Definitions. Available online: http://www.stats.govt.nz/Census/about-2006-census/2006-census-definitions-questionnaires/definitions/geographic.aspx (accessed on 1 December 2014).
- Richardson, E.A.; Pearce, J.; Mitchell, R.; Kingham, S. Role of physical activity in the relationship between urban green space and health. Public Health 2013, 127, 318–324. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Richardson, E.; Pearce, J.; Mitchell, R.; Day, P.; Kingham, S. The association between green space and cause-specific mortality in urban New Zealand: An ecological analysis of green space utility. BioMed Cent. Public Health 2010, 10, 240. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nichani, V.; Dirks, K.; Burns, B.; Bird, A.; Morton, S.; Grant, C. Green space and physical activity in pregnant women: Evidence from the growing up in New Zealand study. J. Phys. Act. Health 2016, 13, 1341–1350. [Google Scholar] [CrossRef] [PubMed]
- Auckland Council Park Extent. Available online: http://aucklandopendata.aucklandcouncil.opendata.arcgis.com/datasets/b73e1d6e2fae4515b517db8c975f85c7_0 (accessed on 1 September 2016).
- Land Cover Database (LCDB). The New Zealand Land Cover Database (LCDB), 3.3 ed.; Land Cover Database (LCDB): Wellington, New Zealand, 2013.
- Salmond, C.; Crampton, P.; Atkinson, J. NZDep2006 Index of Deprivation; University of Otago: Dunedin, New Zealand, 2007. [Google Scholar]
- Witten, K.; Hiscock, R.; Pearce, J.; Blakely, T. Neighborhood access to open spaces and the physical activity of residents: A national study. Prev. Med. 2008, 47, 299–303. [Google Scholar] [CrossRef] [PubMed]
- McCormack, G.R.; Shiell, A. In search of causality: A systematic review of the relationship between the built environment and physical activity among adults. Int. J. Behav. Nutr. Phys. Act. 2011, 8, 125. [Google Scholar] [CrossRef] [PubMed]
- Mokhtarian, P.L.; Cao, X. Examining the impacts of residential self-selection on travel behavior: A focus on methodologies. Transp. Res. Part B Methodol. 2008, 42, 204–228. [Google Scholar] [CrossRef]
- Beyer, K.; Kaltenbach, A.; Szabo, A.; Bogar, S.; Nieto, F.; Malecki, K. Exposure to neighborhood green space and mental health: Evidence from the survey of the health of Wisconsin. Int. J. Environ. Res. Public Health 2014, 11, 3453–3472. [Google Scholar] [CrossRef] [PubMed]
- Zhang, Y.; van Dijk, T.; Tang, J.; van den Berg, A.E. Green Space Attachment and Health: A comparative study in two urban neighborhoods. Int. J. Environ. Res. Public Health 2015, 12, 14342–14363. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Alcock, I.; White, M.P.; Wheeler, B.W.; Fleming, L.E.; Depledge, M.H. Longitudinal effects on mental health of moving to greener and less green urban areas. Environ. Sci. Technol. 2014, 48, 1247–1255. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Morton, S.; Atatoa Carr, P.E.; Bandara, D.; Grant, C.; Ivory, V.C.; Kingi, T.K.R.; Liang, R.; Perese, L.M.; Pryor, J.E.; Reese, E.; et al. Growing up in New Zealand. In A Longitudinal Study of New Zealand Children and Their Families. Report 1: Before We Are Born; Growing Up In New Zealand: Auckland, New Zealand, 2010; Available online: http://www.growingup.co.nz/en.html (accessed on 1 December 2016).
- Cox, J.L.; Holden, M.; Sagovsky, R. Detection of postnatal depression development of the 10-item Edinburgh Postnatal Depression Scale. Br. J. Psychiatry 1987, 150, 782–786. [Google Scholar] [CrossRef] [PubMed]
- Matthey, S.; Barnett, B.; White, T. The Edinburgh Postnatal Depression Scale. Br. J. Psychiatry 2003, 182, 368. [Google Scholar] [CrossRef] [PubMed]
- Waldie, K.E.; Peterson, E.R.; D’Souza, S.; Underwood, L.; Pryor, J.E.; Carr, P.A.; Grant, C.; Morton, S.M.B. Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand. J. Affect. Disord. 2015, 186, 66–73. [Google Scholar] [CrossRef] [PubMed]
- Tsai, A.C.; Scott, J.A.; Hung, K.J.; Zhu, J.Q.; Matthews, L.T.; Psaros, C.; Tomlinson, M. Reliability and Validity of Instruments for Assessing Perinatal Depression in African Settings: Systematic Review and Meta-Analysis. PLoS ONE 2013, 8, e82521. [Google Scholar] [CrossRef] [PubMed]
- Kheirabadi, G.R.; Maracy, M.R.; Akbaripour, S.; Masaeli, N. Psychometric properties and diagnostic accuracy of the Edinburgh Postnatal Depression Scale in a sample of Iranian women. Iran. J. Med. Sci. 2012, 37, 32–38. [Google Scholar] [PubMed]
- Ekeroma, A.J.; Ikenasio-Thorpe, B.; Weeks, S.; Kokaua, J.; Puniani, K.; Stone, P.; Foliaki, S.A. Validation of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for postnatal depression in Samoan and Tongan women living in New Zealand. N. Z. Med. J. 2012, 125, 41–49. [Google Scholar] [PubMed]
- Diez Roux, A.V. A glossary for multilevel analysis. J. Epidemiol. Community Health 2002, 56, 588–594. [Google Scholar] [CrossRef] [PubMed]
- The American College of Obstetricians and Gynecologists (ACOG). The ACOG committee opinion No. 267: Exercise during pregnancy and the postpartum period. Obstet. Gynecol. 2002, 99, 171–173. [Google Scholar]
- Dekrout, A.S.; Clarkson, B.D.; Parsons, S. Temporal and spatial distribution and habitat associations of an urban population of New Zealand long-tailed bats (Chalinolobus tuberculatus). N. Z. J. Zool. 2014, 41, 285–297. [Google Scholar] [CrossRef]
- Freeman, C.; Buck, O. Development of an ecological mapping methodology for urban areas in New Zealand. Landsc. Urban Plan. 2003, 63, 161–173. [Google Scholar] [CrossRef]
- Annerstedt, M.; Östergren, P.O.; Björk, J.; Grahn, P.; Skärbäck, E.; Währborg, P. Green qualities in the neighborhood and mental health—Results from a longitudinal cohort study in Southern Sweden. BioMed Cent. Public Health 2012, 12, 337. [Google Scholar] [CrossRef] [PubMed]
- Astell-Burt, T.; Mitchell, R.; Hartig, T. The association between green space and mental health varies across the lifecourse. A longitudinal study. J. Epidemiol. Community Health 2014, 68, 578–583. [Google Scholar] [CrossRef] [PubMed]
- Van den Berg, M.; van Poppel, M.; van Kamp, I.; Andrusaityte, S.; Balseviciene, B.; Cirach, M.; Danileviciute, A.; Ellis, N.; Hurst, G.; Masterson, D.; et al. Visiting green space is associated with mental health and vitality: A cross-sectional study in four European cities. Health Place 2016, 38, 8–15. [Google Scholar] [CrossRef] [PubMed]
- McCormack, G.R.; Rock, M.; Toohey, A.M.; Hignell, D. Characteristics of urban parks associated with park use and physical activity: A review of qualitative research. Health Place 2010, 16, 712–726. [Google Scholar] [CrossRef] [PubMed]
- Nichani, V.; Dirks, K.; Burns, B.; Bird, A.; Morton, S.; Cameron, G. Green space and pregnancy outcomes: Evidence from the growing up in New Zealand study. Health Place 2017, 46, 21–28. [Google Scholar] [CrossRef] [PubMed]
Variables (n = 6772) * | Descriptives n (%) or Mean (SD) | Bivariate Analyses Test Statistic (p-Value for Chi-Square or F Test) |
---|---|---|
Demographics | ||
Age (years), n (%) | ||
<20 | 325 (5) | 147.31 (<0.001) |
20–24 | 992 (15) | |
25–29 | 1651 (24) | |
30–34 | 2108 (31) | |
35–39 | 1411 (21) | |
≥40 | 285 (4) | |
Education, n (%) | ||
No secondary school | 485 (7) | 123.47 (<0.001) |
Secondary school | 1610 (24) | |
Diploma | 2068 (30) | |
Bachelor’s degree | 1532 (23) | |
Higher degree | 1058 (16) | |
Employment status, n (%) | ||
Employed | 3636 (54) | 93.83 (<0.001) |
Unemployed | 543 (8) | |
Student | 455 (7) | |
Not in workforce | 1822 (27) | |
Self-identified ethnicity, n (%) | ||
European | 3576 (53) | 202.76 (<0.001) |
Māori | 933 (14) | |
Pacific | 1001 (15) | |
Asian | 1002 (15) | |
Middle Eastern/Latin-American/African | 145 (2) | |
Other or New Zealander | 96 (1) | |
Relationship status, n (%) | ||
No relationship | 125 (2) | 115.04 (<0.001) |
Dating, not cohabiting | 278 (4) | |
Cohabiting | 2312 (34) | |
Married or civil union | 4038 (60) | |
Parity, n (%) | ||
First born | 2833 (42) | 0.68 (0.41) |
Subsequent | 3932 (58) | |
Health behaviors and health | ||
Smoking, n (%) | ||
No | 5473 (81) | 101.53 (<0.001) |
Yes | 656 (10) | |
Alcohol consumption, n (%) | ||
No drinking during pregnancy | 4851 (72) | 9.12 (0.003) |
Any drinking during pregnancy | 1904 (28) | |
Physical activity during the first trimester of pregnancy, n (%) | ||
No | 4243 (63) | 2.91 (0.088) |
Yes | 1890 (28) | |
Physical activity after the first trimester of pregnancy, n (%) | ||
No | 4700 (69) | 0.64 (0.42) |
Yes | 1433 (21) | |
General health status, n (%) | ||
Poor or fair | 698 (10) | 168.79 (<0.001) |
Good | 2306 (34) | |
Very good | 2382 (35) | |
Excellent | 1372 (20) | |
Antenatal depression, n (%) | ||
No | 5141 (76) | - |
Yes | 992 (15) | |
Household characteristics | ||
Area deprivation (NZDep2006), n (%) | ||
≤3: low | 1684 (25) | 90.83 (<0.001) |
4–7: medium | 2471 (36) | |
8–10: high | 2615 (39) | |
Length of stay at current residence, mean (SD) | ||
Length of stay (years) | 4 (6) | 1.00 (0.50) |
Residential rurality, n (%) | ||
Urban | 6325 (93) | 3.52 (0.06) |
Rural | 447 (7) | |
District health board region, n (%) | ||
Auckland | 2421 (36) | 53.70 (<0.001) |
Manukau | 2526 (37) | |
Waikato | 1825 (27) | |
Green space percentage in census area units | ||
Green space percentage, n (%) | ||
Low (0–<12%) | 1672 (25) | 6.87 (0.08) |
Medium (12–<21%) | 1652 (24) | |
High (21–<38%) | 1764 (26) | |
Very High (38–100%) | 1684 (25) |
Association between Maternal Exposure to Green Space and Antenatal Depression (n = 6772) | ||||
---|---|---|---|---|
Green Space Percentage | Model 1 a | Model 2 b | Model 3 c | Model 4 d |
OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
Low | 1.00 | 1.00 | 1.00 | 1.00 |
Medium | 1.11 (0.91–1.36) | 1.13 (0.92–1.39) | 1.12 (0.91–1.37) | 1.10 (0.90–1.35) |
High | 1.12 (0.92–1.36) | 1.13 (0.93–1.39) | 1.13 (0.92–1.39) | 1.12 (0.92–1.38) |
Very High | 0.95 (0.77–1.17) | 1.20 (0.97–1.49) | 1.20 (0.96–1.48) | 1.22 (0.98–1.51) |
Green space percentage | Model 5 e | Model 6 f | Model 7 g | |
OR (95% CI) | OR (95% CI) | OR (95% CI) | ||
Low | 1.00 | 1.00 | 1.00 | |
Medium | 1.11 (0.90–1.36) | 1.10 (0.90–1.36) | 1.10 (0.89–1.35) | |
High | 1.14 (0.93–1.40) | 1.14 (0.93–1.40) | 1.15 (0.94–1.41) | |
Very High | 1.22 (0.98–1.51) | 1.20 (0.97–1.49) | 1.21 (0.96–1.52) |
© 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Nichani, V.; Dirks, K.; Burns, B.; Bird, A.; Grant, C. Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study. Int. J. Environ. Res. Public Health 2017, 14, 1083. https://doi.org/10.3390/ijerph14091083
Nichani V, Dirks K, Burns B, Bird A, Grant C. Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study. International Journal of Environmental Research and Public Health. 2017; 14(9):1083. https://doi.org/10.3390/ijerph14091083
Chicago/Turabian StyleNichani, Vikram, Kim Dirks, Bruce Burns, Amy Bird, and Cameron Grant. 2017. "Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study" International Journal of Environmental Research and Public Health 14, no. 9: 1083. https://doi.org/10.3390/ijerph14091083