A Cross-Sectional Analysis of Green Space Prevalence and Mental Wellbeing in England

Background With urbanisation increasing, it is important to understand how to design changing environments to promote mental wellbeing. Evidence suggests that local-area proportions of green space may be associated with happiness and life satisfaction; however, the available evidence on such associations with more broadly defined mental wellbeing in still very scarce. This study aimed to establish whether the amount of neighbourhood green space was associated with mental wellbeing. Methods Data were drawn from Understanding Society, a national survey of 30,900 individuals across 11,096 Census Lower-Layer Super Output Areas (LSOAs) in England, over the period 2009–2010. Measures included the multi-dimensional Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) and LSOA proportion of green space, which was derived from the General Land Use Database (GLUD), and were analysed using linear regression, while controlling for individual, household and area-level factors. Results Those living in areas with greater proportions of green space had significantly higher mental wellbeing scores in unadjusted analyses (an expected increase of 0.17 points (95% CI 0.11, 0.23) in the SWEMWBS score for a standard deviation increase of green space). However, after adjustment for confounding by respondent sociodemographic characteristics and urban/rural location, the association was attenuated to the null (regression coefficient B = − 0.01, 95% CI -0.08, 0.05, p = 0.712). Conclusions While the green space in an individual’s local area has been shown through other research to be related to aspects of mental health such as happiness and life satisfaction, the association with multidimensional mental wellbeing is much less clear from our results. While we did not find a statistically significant association between the amount of green space in residents’ local areas and mental wellbeing, further research is needed to understand whether other features of green space, such as accessibility, aesthetics or use, are important for mental wellbeing

Suicide and self-harm in Britain: researching risk and resilience using UK surveys

Aim The main aim of this study was to raise awareness of surveys that could be used to inform self-harm and suicide prevention work. We asked: What UK survey datasets are available for research? What aspects of people’s lives are associated with self-harm and attempted suicide? How do statistical findings resonate with people’s lived experience? What implications do they see? Findings Survey analyses revealed that risk factors for self-harm are wide ranging and include: Mental health Physical health and health behaviours Social relationships Stressful events Employment and financial circumstances Identity and demographics Many different factors are independently associated with self-harm. There is a dose relationship, with more exposure to a factor linked with increased risk. Risks are cumulative that is, exposure to multiple factors is associated with greater risk. Through facilitated consultation, men with lived experience, bereaved family members, and practitioners identified recommendations for responding to suicidal distress in men. These related to the following three main areas: 1. Recognising need: who is ‘ill enough’? Permission - men said that they often did not know they were entitled to help Ask - people who outwardly appear to be functioning may not be Persistence - ask and offer help more than once. 2. Facilitating access: right words, time and place What is available - support is needed with ongoing stress as well as for crises Find the words - men wanted examples of how to ask for help Allow time - employers expect recovery to be swift, some men felt rushed to come off medications or were discharged from services they still needed. 3. Adjusting delivery: equal engagement Power - some were uncomfortable with service dynamics, preferring peer support Every service contact counts - negative contacts had particular impact Safe spaces - may be different for men and women. Methods There were three strands of work: Secondary analysis of nine survey series, spanning more than twenty years Linkage of 144,000 survey participants to information on whether they were alive in 2013 and whether they had taken their own life Facilitated consultation, through depth interviews with people with lived experience

Biochemical reference values in elderly black subjects

Biochemical reference values for the black age group of ≥ 65 years were determined from the black urban population of the Orange Free State. Biochemical investigations performed were those included in the Sequential Multiple Analyser Computer profile because it includes the 20 most requested clinical chemistry investigations. Most of the reference values corresponded to values for the same age groups in the Western world. There was no age-related rise in the alkaline phosphatase values, which suggested absence of occult Paget's disease. Reference values for serum total protein and globulin were found to be higher than values derived from elderly white groups

Weyl asymptotics: From closed to open systems

We present microwave experiments on the symmetry reduced 5-disk billiard studying the transition from a closed to an open system. The measured microwave reflection signal is analyzed by means of the harmonic inversion and the counting function of the resulting resonances is studied. For the closed system this counting function shows the Weyl asymptotic with a leading exponent equal to 2. By opening the system successively this exponent decreases smoothly to an non-integer value. For the open systems the extraction of resonances by the harmonic inversion becomes more challenging and the arising difficulties are discussed. The results can be interpreted as a first experimental indication for the fractal Weyl conjecture for resonances.Comment: 9 pages, 7 figure

A spatial analysis of proximate greenspace and mental wellbeing in London

While local-area greenspace is associated with reduced symptoms of mental distress and greater life satisfaction, most previous research has measured the amount of local-area greenspace within administrative boundaries, and found mixed results for associations between greenspace and multidimensional mental wellbeing. The study was designed to examine whether the amount of greenspace within a radius of individuals’ homes was associated with mental wellbeing, testing the government guideline that greenspace should be available within 300 m of homes. Individual and Household-level data were drawn from the Annual Population Survey at postcode level (APS, Pooled Dataset 2012–2015), which includes 3 mental wellbeing measures, covering aspects of life satisfaction, sense of worth, and happiness, as well as a range of socio-demographic variables. Greenspace data were obtained Greenspace Information for Greater London Group (GiGL), and was used to calculated the amount of greenspace within a 300 m radius of individuals. Linear regression models revealed positive and statistically significant associations between the amount of greenspace and indicators of life satisfaction and worth. Moran's I, an indicator of spatial autocorrelation, revealed statistically significant clustering of the residuals of these models, so Geographically Weighted Regression (GWR) models were calculated, in order to adjust for underlying spatial processes within the data and investigate the geographic variation in the association between local greenspace and mental wellbeing. The global GWR model revealed that an increase in 1 ha of greenspace within 300 m of residents was associated with a statistically significant 0.803 increase in life satisfaction, 0.740 and 0.521 for worth and happiness, respectively. This therefore provides some support for the inclusion of greenspace within 300 m of homes. Local GWR coefficients revealed slight variation in the strength of these associations across the study space. Therefore, further analyses are required to investigate whether the walking (network distance), absolute size, or type of each greenspace are able to explain this spatial variation

Does nature make us happier? A spatial error model of greenspace types and mental wellbeing

Exposure to nature is thought to benefit mental health and wellbeing. However, many studies consider greenspace as a single entity, which overlooks the potential significance of the various forms of greenspace, and natural greenspaces in particular. This study was designed to investigate the association between different types of greenspace and mental wellbeing. Drawing wellbeing and socioeconomic data from the Annual Population Survey (2012–2015), and shapefiles from the Greenspace Information for Greater London group, the amount of greenspace accessible within a 300 m walk of individual’s postcodes was calculated, and categorised according to type. Spatial Error Models were used to account for spatial patterns in the data. Natural greenspace was significantly associated with improved life satisfaction (B = 0.028, p < 0.001) and happiness (B = 0.023, p = 0.019) scores. The spatial autoregressive parameter ( ) was small but significant (p < 0.001), implying slight second-order spatial variation in the model. These results imply that natural areas may be more important for hedonic mental wellbeing than other greenspaces. Future research is needed on exploring causal relationships between exposure to greenspace and mental wellbeing outcomes

Psychosocial stressors and depression at a Swedish primary health care centre. A gender perspective study

<p>Abstract</p> <p>Background</p> <p>Psychosocial stress may account for the higher prevalence of depression in women and in individuals with a low educational background. The aim of this study was to analyse the association between depression and socio-demographic data, psychosocial stressors and lifestyle circumstances from a gender perspective in a relatively affluent primary care setting.</p> <p>Methods</p> <p>Patients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI). The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score <10, 187 men and 93 women. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CI) as being depressed were calculated for the psychosocial stressors and lifestyle circumstances, separately for men and women. Multiple logistic regression analyses were used to determine the age-adjusted main effect models for men and women.</p> <p>Results</p> <p>The same three psychosocial stressors: feeling very stressed, perceived poor physical health and being dissatisfied with one's family situation were associated with depression equally in men and women. The negative predictive values of the main effect models in men and women were 90.7% and 76.5%, respectively. Being dissatisfied with one's work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only.</p> <p>Conclusions</p> <p>Three questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.</p

Readmission after discharge from acute mental healthcare among 231 988 people in England: cohort study exploring predictors of readmission including availability of acute day units in local areas

Background: In the UK, acute mental healthcare is provided by in-patient wards and crisis resolution teams. Readmission to acute care following discharge is common. Acute day units (ADUs) are also provided in some areas. Aims: To assess predictors of readmission to acute mental healthcare following discharge in England, including availability of ADUs. Method: We enrolled a national cohort of adults discharged from acute mental healthcare in the English National Health Service (NHS) between 2013 and 2015, determined the risk of readmission to either in-patient or crisis teams, and used multivariable, multilevel logistic models to evaluate predictors of readmission. Results: Of a total of 231 998 eligible individuals discharged from acute mental healthcare, 49 547 (21.4%) were readmitted within 6 months, with a median time to readmission of 34 days (interquartile range 10–88 days). Most variation in readmission (98%) was attributable to individual patient-level rather than provider (trust)-level effects (2.0%). Risk of readmission was not associated with local availability of ADUs (adjusted odds ratio 0.96, 95% CI 0.80–1.15). Statistically significant elevated risks were identified for participants who were female, older, single, from Black or mixed ethnic groups, or from more deprived areas. Clinical predictors included shorter index admission, psychosis and being an in-patient at baseline. Conclusions: Relapse and readmission to acute mental healthcare are common following discharge and occur early. Readmission was not influenced significantly by trust-level variables including availability of ADUs. More support for relapse prevention and symptom management may be required following discharge from acute mental healthcare

A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England.

BACKGROUND: For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone. AIMS: We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs. METHOD: We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick-Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale). RESULTS: We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54-1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4-3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4-2.1, P = 0.004), and lower depression scores (-1.7, 95% CI -2.7 to -0.8, P < 0.001), than CRT participants. CONCLUSIONS: Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed