Age- and Sex-Specific Association Between Vegetation Cover and Mental Health Disorders: Bayesian Spatial Study

BACKGROUND: Despite growing evidence that reduced vegetation cover could be a putative risk factor for mental health disorders, the age- and the sex-specific association between vegetation and mental health disorder cases in urban areas is poorly understood. However, with rapid urbanization across the globe, there is an urgent need to study this association and understand the potential impact of vegetation loss on the mental well-being of urban residents. OBJECTIVE: This study aims to analyze the spatial association between vegetation cover and the age- and sex-stratified mental health disorder cases in the neighborhoods of Toronto, Canada. METHODS: We used remote sensing to detect urban vegetation and Bayesian spatial hierarchical modeling to analyze the relationship between vegetation cover and mental health disorder cases. Specifically, an Enhanced Vegetation Index was used to detect urban vegetation, and Bayesian Poisson lognormal models were implemented to study the association between vegetation and mental health disorder cases of males and females in the 0-19, 20-44, 45-64, and ≥65 years age groups, after controlling for marginalization and unmeasured (latent) spatial and nonspatial covariates at the neighborhood level. RESULTS: The results suggest that even after adjusting for marginalization, there were significant age- and sex-specific effects of vegetation on the prevalence of mental health disorders in Toronto. Mental health disorders were negatively associated with the vegetation cover for males aged 0-19 years (−7.009; 95% CI −13.130 to −0.980) and for both males (−4.544; 95% CI −8.224 to −0.895) and females (−3.513; 95% CI −6.289 to −0.681) aged 20-44 years. However, for older adults in the 45-64 and ≥65 years age groups, only the marginalization covariates were significantly associated with mental health disorder cases. In addition, a substantial influence of the unmeasured (latent) and spatially structured covariates was detected in each model (relative contributions>0.7), suggesting that the variations in area-specific relative risk were mainly spatial in nature. CONCLUSIONS: As significant and negative associations between vegetation and mental health disorder cases were found for young males and females, investments in urban greenery can help reduce the future burden of mental health disorders in Canada. The findings highlight the urgent need to understand the age-sex dynamics of the interaction between surrounding vegetation and urban dwellers and its subsequent impact on mental well-being.