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Schizophr Res. 2019 Nov 4. pii: S0920-9964(19)30443-8. doi: 10.1016/j.schres.2019.10.012. [Epub ahead of print]

Natural surroundings in childhood are associated with lower schizophrenia rates.

Author information

1
Section for Ecoinformatics & Biodiversity, Department of Bioscience, Aarhus University, 8000, Aarhus C, Denmark; Center for Biodiversity Dynamics in a Changing World (BIOCHANGE), Aarhus University, 8000, Aarhus C, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, 8210, Aarhus V, Denmark; Big Data Centre for Environment and Health, Aarhus University, 8210, Aarhus V, Denmark. Electronic address: engemann@bios.au.dk.
2
Section for Ecoinformatics & Biodiversity, Department of Bioscience, Aarhus University, 8000, Aarhus C, Denmark; Center for Biodiversity Dynamics in a Changing World (BIOCHANGE), Aarhus University, 8000, Aarhus C, Denmark. Electronic address: svenning@bios.au.dk.
3
Center for Massive Data Algorithmics, MADALGO, Aarhus University, Department of Computer Science, Aarhus University, 8200, Aarhus N, Denmark. Electronic address: large@cs.au.dk.
4
Section for Atmospheric Modelling, Department of Environmental Science, Aarhus University, 4000, Roskilde, Denmark. Electronic address: jbr@envs.au.dk.
5
Section for Atmospheric Modelling, Department of Environmental Science, Aarhus University, 4000, Roskilde, Denmark. Electronic address: cag@envs.au.dk.
6
Centre for Integrated Register-based Research, CIRRAU, Aarhus University, 8210, Aarhus V, Denmark; National Centre for Register-based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210, Aarhus V, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210, Aarhus V, Denmark. Electronic address: pbm@econ.au.dk.
7
National Centre for Register-based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210, Aarhus V, Denmark. Electronic address: opr@econ.au.dk.
8
Center for Massive Data Algorithmics, MADALGO, Aarhus University, Department of Computer Science, Aarhus University, 8200, Aarhus N, Denmark. Electronic address: tsirogiannis.c@gmail.com.
9
Centre for Integrated Register-based Research, CIRRAU, Aarhus University, 8210, Aarhus V, Denmark; Big Data Centre for Environment and Health, Aarhus University, 8210, Aarhus V, Denmark; National Centre for Register-based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, 8210, Aarhus V, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, 8210, Aarhus V, Denmark. Electronic address: cbp@econ.au.dk.

Abstract

High exposure to green space and natural environments has previously been associated with lower schizophrenia rates possibly through low air pollution and improved psychological restoration. Exposure to natural environments could explain the negative urban-rural gradient of schizophrenia, but it is unclear if all natural environments are associated with schizophrenia rates. We investigated the association between schizophrenia and growing up surrounded by environments classified as mainly urban, agricultural, near-natural green space, and blue space. Vegetation density and air pollution were assessed as potential pathways. We used the Danish population (943 027 people) and remotely-sensed environmental data to determine land cover exposure and vegetation density around each individual's residence. Effect sizes were estimated using Cox regression and adjusted for air pollution, socioeconomic status, and urbanization. Our results show that growing up surrounded by non-urban environments is associated with lower schizophrenia rates. Firstly, growing up surrounded by non-built-up areas (agricultural areas, near-natural green and blue space) is associated with lower schizophrenia rates compared to urban areas. Secondly, rates decrease with vegetation density in a dose-response relationship for urban and agricultural areas. Air pollution mitigation more strongly explained the protective association in near-natural green spaces, implying that restorative pathways together with air pollution mitigation may explain lower rates in natural environments. This study suggests that ensuring access to natural environments during childhood may be important for schizophrenia prevention, whilst being the first study to show that natural environments may influence schizophrenia rates through multiple pathways.

KEYWORDS:

Environment; Green space; Mental health; Psychiatric risk; Psychological ecosystem services; Remote sensing

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