Abstract
Background: The COVID-19 pandemic has profoundly affected population mental health, with mounting evidence that access to neighborhood green spaces may buffer against psychological distress. However, longitudinal studies examining how green space access influences well-being trajectories across the pandemic remain scarce. This study investigates the association between baseline green space access and changes in psychological well-being over three waves of the pandemic. Methods: A prospective cohort study was conducted with 1,842 adults in three mid-sized cities (Montreal, Delhi, and Tokyo) from April 2020 to June 2022. Green space access was measured using a validated composite index (proximity to parks, perceived quality, and normalized difference vegetation index within 500 m of residence). Psychological well-being was assessed with the WHO-5 Well-Being Index at three time points (wave 1: lockdown, wave 2: reopening, wave 3: post-vaccination). Linear mixed models with random intercepts and slopes were used to estimate trajectories. Results: Participants in the highest quartile of green space access reported significantly higher baseline well-being (mean difference = 4.8 points, 95% CI: 3.2–6.4) and less steep declines over time compared to the lowest quartile. After adjustment for sociodemographic confounders, the interaction between time and high green space access remained significant (β = 0.72, p=0.003). Subgroup analyses revealed stronger protective effects among older adults and those living alone. Conclusions: Greater neighborhood green space access was associated with more favorable psychological well-being trajectories during the COVID-19 pandemic. Urban planning policies that enhance equitable access to green space may serve as a population-level mental health resilience strategy.
Keywords
green space, psychological well-being, COVID-19, longitudinal study, urban health, nature exposure, mental health trajectories, resilience