Exploring "equigenesis" in the association between the natural outdoor environment, mental health and death by suicide before and during the COVID-19 pandemic: a population-based cohort study of more than 2 million records in Northern Ireland.

Authors

Ruoyu Wang, Zhiqiang Feng, Jamie Pearce, Rich Fry, Aideen Maguire, Ruth F Hunter

Published in

Environmental research. Pages 126054. Oct 29, 2026. Epub Oct 29, 2026.

Abstract

Recent evidence suggests that the natural outdoor environment (NOE) may mitigate socioeconomic inequalities in mental health, but it remains unclear how such associations vary between the pandemic and the non-pandemic period. Therefore, this study focused on the association between NOE and inequalities in mental health before and during the pandemic. We used a population-based cohort of individuals in Northern Ireland (NI), including more than 2 million General Practice participants from 2017 to 2022. NOE was assessed using the proportion of blue space and green space within the administrative neighbourhoods, respectively. Mental health outcomes included death by suicide, mental health-related hospital admissions and prescriptions. We applied multilevel Cox proportional hazards and logistic regressions. Further, we stratified the analysis by area-level deprivation index. The analyses were performed for the pre-pandemic (2017-2019) and during the pandemic (2020-2022), respectively. People living in neighbourhoods with a higher proportion of NOE (e.g., 4^th quintile of blue space) had lower odds of being in receipt of mental-health-related prescriptions (e.g., pre-pandemic: OR=0.835, 95% CI=0.796-0.874; intra-pandemic: OR=0.802, 95% CI=0.763-0.844) and a lower risk of dying by suicide (e.g., pre-pandemic: HR=0.634, 95% CI=0.451-0.890; intra-pandemic: HR=0.684, 95% CI=0.469-0.998). However, there is no evidence that NOE is related to a lower risk of having a mental health-related hospital admission (e.g., pre-pandemic: OR=1.053, 95% CI=0.794-1.396; intra-pandemic: OR=1.044, 95% CI=0.778-1.401). The association between NOE and mental health-related hospital admissions, as well as the association between NOE and prescriptions, was more pronounced in socioeconomically disadvantaged neighbourhoods, especially during the pandemic. However, such "equigenesis" was only observed for death by suicide before the pandemic. Therefore, NOE may mitigate socioeconomic inequalities in mental health, especially during the pandemic. Our findings demonstrate the importance of sufficient NOE to support better and more equal mental health and preparedness for future pandemics.

PMID:
42957027
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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