Perceptions of green spaces and their associations with mental health in Germany

Abstract Background Green space is linked to mental health in previous research. The impact of perceived quality of green spaces at different spatial levels remains to be explored. This study investigates associations between perceived quality of green spaces and mental health outcomes (depression, anxiety). Methods We analysed cross-sectional data from a population-based study of adults (aged 18+) in northwestern Germany (12/2022-07/2023). We assessed depression (PHQ-9) and anxiety (GAD-7). Participants rated the perceived distance to next larger green space, perceived quality of green space (view from window, street, neighbourhood, city/town). Linear regression models were conducted for combined spatial levels and adjusted for age, gender, marital status, education, equivalized income, and urban/rural residence. Sensitivity analyses were performed by spatial level and urban/rural subgroups. Results The sample (n = 354, mean age=52.32, SD = 17.7, range: 19-89; female: 66.4%, n = 235, male: 33.6%, n = 119) was rural (76.8%, n = 272) and urban (23.2%, n = 82). Greater distance to green space was significantly associated with higher anxiety (B = 0.452, 95% CI: 0.001; 0.902). Higher perceived quality of green spaces (across all spatial levels) was significantly associated with lower depression (B=-1.236, 95% CI: -1.782; -0.689) and lower anxiety (B=-1.188, 95% CI: -1.648, -0.728). Separate analysis by spatial level showed consistent associations. No significant associations were found in the urban subgroup. Conclusions Distance to green space is associated with anxiety. Perceived quality of green spaces is associated with lower depression and anxiety, and higher wellbeing. Future analyses will compare perceived quality with Normalized Difference Vegetation Index-based greenness (NDVI) to inform health-promoting urban and rural design planning and interventions.