Green psychiatry: natural environments, developmental trauma and anxiety

Abstract

Green space is an important element of public health systems and appears to have a positive influence on mental health, reducing levels of depression and anxiety.1–3 Accessible and good-quality green space helps to tackle social and cultural inequalities with consequent benefits for health.4,5 Emotional vulnerability may confer a greater vulnerability to the harmful health effects of pollution.6 Air pollution is linked to more demand for treatment of psychiatric illnesses. The evidence of green-space benefits for well-being and physical illnesses (such as asthma and hypertension) is limited and inconsistent, and if there is an effect it is likely to be moderated by age, gender, and realistic opportunities and time to use green space.7–11 The mechanisms are theorised, and seemingly involve a shift in attention, promoting curiosity and interest, access to social networks, group cooperation and physical activity.3,6 The Parliamentary Office of Science and Technology concludes green space is associated with better mental health and that the design and maintenance of green space is an important determinant of health, mediated by physical activity, and improved health is associated with less financial and social cost and reduced cardiovascular mortality.12 A World Health Organization report on green space recommends better metrics of exposure and that the numerous public health benefits emerge through diverse pathways such as psychological relaxation and stress reduction, enhanced physical activity and mitigation of harmful effects of air pollution, excessive heat and noise, as well as other harms in the urban environment.13 Even urban green space has health benefits, especially for economically deprived communities, children, pregnant women and senior citizens. Child soldiers are psychologically vulnerable, damaged by their actions and they can inflict violence and harms on their society, families and friends, perhaps mediated through mental illnesses.14–19 Preventing and treating mental illnesses in war zones raises numerous ethical and moral dilemmas, not to mention the challenge of reintegration of child soldiers back into society.15–19 Traumatic experiences are associated with poor health generally, including anxiety, depression, post-traumatic stress and emotional dysregulation.20 Emotional dysregulation may be a suitable treatment target for those experiencing early life maltreatment, and people receiving diagnoses of borderline personality and major depression (Dittrich et al, pp. 412–418). PLoS One 2016; 11: e0168931. 7 Oudin A, Braback L, Oudin Astrom D, Forsberg B. Air pollution and dispensed medications for asthma, and possible effect modifiers related to mental health and socio-economy: a longitudinal cohort study of Swedish children and adolescents.