White, Mathew P.Elliott, Lewis R.Grellier, JamesEconomou, TheoBell, SimonBratman, Gregory N.Cirach, MartaGascon Merlos, Mireia, 1984-Lima, Maria L.Lõhmus, MareNieuwenhuijsen, Mark J.Ojala, AnnRoiko, AnneSchultz, P. Wesleyvan den Bosch, Matilda A.Fleming, Lora E.2022-06-022022-06-022021White MP, Elliott LR, Grellier J, Economou T, Bell S, Bratman GN, Cirach M, Gascon M, Lima ML, Lõhmus M, Nieuwenhuijsen M, Ojala A, Roiko A, Schultz PW, van den Bosch M, Fleming LE. Associations between green/blue spaces and mental health across 18 countries. Sci Rep. 2021 Apr 26;11(1):8903. DOI: 10.1038/s41598-021-87675-02045-2322http://hdl.handle.net/10230/53357Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastal-blue spaces); and (b) nature connectedness, across season and country. People who lived in greener/coastal neighbourhoods reported higher positive well-being, but this association largely disappeared when recreational visits were controlled for. Frequency of recreational visits to green, inland-blue, and coastal-blue spaces in the last 4 weeks were all positively associated with positive well-being and negatively associated with mental distress. Associations with green space visits were relatively consistent across seasons and countries but associations with blue space visits showed greater heterogeneity. Nature connectedness was also positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. By contrast inland-blue space visits were associated with a greater likelihood of using anxiety medication. Results highlight the benefits of multi-exposure, multi-response, multi-country studies in exploring complexity in nature-health associations.application/pdfeng© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1038/s41598-021-87675-0Environmental social sciencesPsychologyinfo:eu-repo/semantics/openAccess