Natural environments and suicide mortality in the Netherlands: a cross-sectional, ecological study.
Natural environments and suicide mortality in the Netherlands: a cross-sectional, ecological study.
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DOI：
10.1016/s2542-5196(18)30033-0
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发表时间：
2018-03
期刊：
影响因子：
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通讯作者：
Groenewegen PP
中科院分区：
文献类型：
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作者：
Helbich M;de Beurs D;Kwan MP;O'Connor RC;Groenewegen PP
自然的户外环境，例如绿色空间（即草地、森林或公园）、蓝色空间（即可见的淡水或咸水体）以及邻近沿海地区，已越来越多地被证明可以促进心理健康。然而，人们对这些自然环境如何以及在多大程度上与自杀死亡率相关却知之甚少。我们的目的是调查人们的生活环境中以及沿海地区的绿色空间和蓝色空间的可用性是否可以预防自杀死亡率。在这项横断面生态研究中，我们分析了 2005 年至 2014 年间荷兰各市官方确认的自杀死亡人数。我们使用地理信息系统计算了衡量每个城市的绿色空间和蓝色空间比例以及每个城市的沿海邻近程度的指数。我们采用贝叶斯分层泊松回归来评估自杀风险、绿地、蓝色空间和沿海邻近度之间的关联，并根据风险和保护因素进行调整。与绿地面积较少的城市相比，拥有较大比例绿地（相对风险 0·879，95% 可信区间 0·779–0·991）或中等比例绿地（0·919、0·846–0·998）的城市自杀风险较低。绿色空间与自杀的关系并没有因城市化程度而异。蓝色空间和靠近沿海地区都与自杀风险无关。残余相对自杀风险的地理差异很大，荷兰南部的风险较高。我们的研究结果支持这样的观点：接触自然环境，特别是绿色植物，可能有助于降低自杀死亡率。如果未来的个人研究证实，对环境暴露的考虑可能会丰富自杀预防计划。欧洲研究理事会（拨款协议编号 714993）。
Natural outdoor environments, such as green spaces (ie, grass, forests, or parks), blue spaces (ie, visible bodies of fresh or salt water), and coastal proximity, have been increasingly shown to promote mental health. However, little is known about how and the extent to which these natural environments are associated with suicide mortality. Our aim was to investigate whether the availability of green space and blue space within people's living environments and living next to the coast are protective against suicide mortality. In this cross-sectional, ecological study, we analysed officially confirmed deaths by suicide between 2005 and 2014 per municipality in the Netherlands. We calculated indexes to measure the proportion of green space and blue space per municipality and the coastal proximity of each municipality using a geographical information system. We fitted Bayesian hierarchical Poisson regressions to assess associations between suicide risk, green space, blue space, and coastal proximity, adjusted for risk and protective factors. Municipalities with a large proportion of green space (relative risk 0·879, 95% credibility interval 0·779–0·991) or a moderate proportion of green space (0·919, 0·846–0·998) showed a reduced suicide risk compared with municipalities with less green space. Green space did not differ according to urbanicity in relation to suicide. Neither blue space nor coastal proximity was associated with suicide risk. The geographical variation in the residual relative suicide risk was substantial and the south of the Netherlands was at high risk. Our findings support the notion that exposure to natural environments, particularly to greenery, might have a role in reducing suicide mortality. If confirmed by future studies on an individual level, the consideration of environmental exposures might enrich suicide prevention programmes. European Research Council (grant agreement number 714993).