دانلود رایگان مقاله انگلیسی قرار گرفتن در معرض دوران کودکی در فضای سبز - مکانیسم کاهش خطر ابتلا به اسکیزوفرنی؟ - الزویر 2018

abstract

Schizophrenia risk has been linked to urbanization, but the underlying mechanism remains unknown. Green space is hypothesized to positively influence mental health and might mediate risk of schizophrenia by mitigating noise and particle pollution exposure, stress relief, or other unknown mechanisms. The objectives for this study were to determine if green space are associated with schizophrenia risk, and if different measures of green space associate differently with risk. We used satellite data from the Landsat program to quantify green space in a new data set for Denmark at 30 × 30 m resolution for the years 1985–2013. The effect of green space at different ages and within different distances from each person's place of residence on schizophrenia risk was estimated using Cox regression on a very large longitudinal population-based sample of the Danish population (943,027 persons). Living at the lowest amount of green space was associated with a 1.52-fold increased risk of developing schizophrenia compared to persons living at the highest level of green space. This association remained after adjusting for known risk factors for schizophrenia: urbanization, age, sex, and socioeconomic status. The strongest protective association was observed during the earliest childhood years and closest to place of residence. This is the first nationwide population-based study to demonstrate a protective association between green space during childhood and schizophrenia risk; suggesting limited green space as a novel environmental risk factor for schizophrenia. This study supports findings from other studies highlighting positive effects of exposure to natural environments for human health.

4. Discussion

This is the first nationwide population-based study to investigate the potential effect of green space on schizophrenia risk. We demonstrated a dose-response association between the magnitude of greenspace during childhood and the risk of later developing schizophrenia. This finding was invariant to adjustment for urbanization and sex. Our analysis shows that exposure to more green space during childhood is negatively associated with the risk of schizophrenia, whereas green space heterogeneity, measured as the standard deviation, had no consistent association with the risk of schizophrenia. We found a tendency towards a stronger protective association of green space within the closest distance to a person's residence and results that might indicate that exposure during the earliest years are most strongly associated with the risk of schizophrenia.

We found the effect of green space to be largely independent of urbanization and also robust to controlling for a range of potential confounding factors. This may indicate that green space is a novel environmental risk-reducing factor for schizophrenia development. The potential mechanism behind this association remains unknown, but results from other studies points towards several plausible hypotheses. Air pollution has previously been linked to schizophrenia risk (Attademo et al., 2017; Oudin et al., 2016; Pedersen et al., 2004) and could be moderated by green space. Air pollution is often higher in urban areas, but can be reduced by trees and shrubs (Nowak et al., 2006), which may improve air quality under the right conditions (Escobedo et al., 2011), hence possibly decrease schizophrenia risk. Contact with nature is also thought to enhance immune functioning (Kuo, 2015), which may decrease infections during pregnancy, another proposed risk factor for schizophrenia (Mortensen, 2000).