Issue 7: Nov 2013


By Dr Jenny Roe

Last month, a survey by the Office of National Statistics indicated 39% of Scottish people (aged 16 and over) have reported ‘high’ or ’ very high’ levels of anxiety – and across the UK mixed anxiety and depression is the UK’s most common mental disorder presenting a major challenge for the future in health, economic and social terms. The cost of mental illness to the UK economy was recently reported to cost some £80 million annually.

Whilst Cognitive Behaviour Therapy (CBT) is a tried and trusted method of treating mental health problems - and National Institute for Heath and Care Excellence (NICE) approved – there are long waiting lists and the NHS only provide six sessions per patient. So there is an urgent need to find other less expensive, simple solutions that can help on a daily basis. 

Anxiety UK recommends exercise – an activity that could be further enhanced by walking in an attractive local park or nearby woodland.  These natural environments not only make a place more pleasant in which to walk, they offer recuperation from fatigue and stress because they hold our attention with little effort – what’s called by Kaplan and Kaplan ‘soft fascination’. This mental health benefit of green space is called ‘psychological restoration’ and has mostly been studied using subjective measures of stress and wellbeing.  But now there is new evidence from a study carried out in Scotland which has used an objective, physiological measure of stress to show the potential importance of green space for people under stress in areas of urban deprivation.

…there is an urgent need to find, simple solutions for anxiety that can help on a daily basis.

Our team, led by the OPENspace research centre at the Universities of Edinburgh and Heriot-Watt, working in collaboration with the Universities of Glasgow and Westminster, Biomathematics and Statistics Scotland and the James Hutton Institute, measured the concentrations of cortisol - the stress hormone - found in human saliva, in adults who were unemployed (or otherwise not in work for some other reason), aged between 35 – 55 and living in socially disadvantaged city areas.

Cortisol acts as a stress biomarker but has rarely been used before as part of methods to explore how the different attributes of our built environment may act to exacerbate, or relieve, stress for those going about their everyday lives in urban environments.

Our data – rigorously measured and analysed statistically controlling for confounders such as income deprivation – illustrates that green space appears to help buffer stress for those living in poverty in deprived cities.  The effect appears to be stronger for women, whose diurnal patterns of cortisol showed greater hypocortisolemia (i.e. unusually low, constant levels of cortisol), indicative of chronic stress and exhaustion, for those living in areas with little green space when compared to those living with higher levels of green space, whose diurnal cortisol patterns indicated better stress regulation. This is an important result because dysregulation of the daily pattern of cortisol secretion, part of our circadian rhythms, is associated with an array of negative health outcomes including major depressive disorders.

It is interesting that the patterns we found in cortisol were also reflected in our data on perceived levels of stress, with both men and women reporting lower perceived stress in areas with more green space, and women reporting higher perceived stress in areas with low levels of green space.  

“These results are important in understanding how neighbourhood green space might contribute to public health improvement. Stress is known to impact on cardiovascular health, alongside other risk factors such as genetics, age, diet and physical activity, but little is known about the contributions of environmental factors.“ Jenny Roe

So what might explain these effects?  As well as the intrinsic ‘soft fascination’ of nature, it is speculated that we are ‘hard-wired’ to need connection with nature - it’s part of our evolution - and theoretically linked to a concept called biophilia.  Biophilia is a term popularized by American biologist and conservationist E.O. Wilson (1993) to describe the emotional affiliation of humans to nature and living things. This idea is now being harnessed in America and applied to urban design to build greener, more sustainable and resilient cities.

We are not suggesting green space can solve the problems of major life stressors - redundancy bereavement, divorce – but, at a time when both our own and international health and welfare services are evaluating new approaches to the wellbeing of our growing populations, we believe our study is an important indication of the potential positive emotional impact of providing access to green space. 

Dr Jenny Roe is at University of York and is writing as part of a research team that includes: Catharine Ward Thompson, Peter A. Aspinall, Mark J. Brewer, Elizabeth I. Duff, David Miller, Richard Mitchell and Angela Clow. Her web page can be found here: Jenny Roe

By Dr Jenny Roe

Issue 7: Nov 2013

Issue 7: Nov 2013


Re-energising the move towards integrated care

Scotland's move to integrated care can learn from elsewhere by focussing on two key differentiators between successful partnerships and those paying lip service to integrated working: Shared outcomes and common language is one, the other is demonstrating mutual investments and mutual benefits.


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