Relationship between Exposure to the Natural Environment and Psychological Well-Being in People Living with CKD

Background: The natural world is beneficial to human health and wellbeing. People with CKD often experience psychological distress which can result in poor health outcomes. We explored the association between exposure to the natural environment and psychological wellbeing in CKD. Methods: 319 participants across CKD stages (188 non-dialysis, 70 kidney transplant recipients, 40 haemodialysis and 21 peritoneal dialysis) from 9 UK NHS hospitals completed an online survey comprising the Distress, Anxiety, Stress Scale (DASS-21), 12-Item Short Form Health Survey (SF-12) and bespoke questions relating to access to and time spent in the natural environment. Data were analysed using frequency analysis, multiple linear regression, and logistic regression. Results: Access to and time spent in the natural environment was similar for the different CKD groups. In the summer, 45% of participants spent more than an hour a day, at least five days a week, in the natural environment, whilst in the winter, this was only 19% of participants. Increased exposure to the natural environment was significantly associated with lower levels of depression (p<0.001), anxiety (P=0.002), and stress (p=0.029), and higher levels of mental health-related quality of life (HRQoL) (P<0.001). Participants reporting greater exposure to the natural environment were less likely to report experiencing stress (OR: 11.118, P=0.002) or depression (OR: 4.109, P<0.001). Conclusion: Greater exposure to the natural environment is associated with better psychological wellbeing and mental HRQoL in people with CKD, suggesting the value of the natural world. Healthcare professionals should support people with CKD to access and engage with the natural environment. This data could inform the development of nature-based interventions for people with CKD to improve HRQoL.