Greenness linked to fewer hospital stays for mental health conditions

Study provides broader understanding of the mental health benefits of green space

BMJ Group

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Higher levels of greenness are associated with lower risks of hospital admissions for mental disorders, finds an analysis of data from seven countries over two decades, published in The BMJ’s climate issue today.

The results suggest that this protective effect increases with greater exposure to greenness, with no clear threshold - evidence that can inform urban design and health policy to better protect mental health, say the researchers.

Mental wellbeing remains a global challenge. It’s estimated that 1.1 billion people had mental disorders in 2021, contributing to 14% of the global disease burden with associated economic and societal costs.

Growing evidence suggests that exposure to greenness might reduce the risk of mental disorders, but most previous studies are limited to single countries, short term exposures, or specific mental health outcomes.

To address these gaps, researchers analysed 11.4 million hospital admissions for mental disorders from 6,842 locations in seven countries (Australia, Brazil, Canada, Chile, New Zealand, South Korea, and Thailand) from 2000 to 2019.

They included all cause mental disorders and six specific categories (psychotic disorders, substance use disorders, mood disorders, behavioural disorders, dementia, and anxiety).

Greenness was measured by the normalised difference vegetation index (NDVI), a widely used and reliable satellite derived metric for assessing vegetation levels in a given area.

Factors including population levels, weather conditions, air pollutants, socioeconomic indicators and seasonality were taken into account and models were stratified by sex, age, urbanisation, and season.

The results show that local greenness was associated with a 7% reduction in hospital admissions for all cause mental disorders, with stronger associations for substance use disorders (9%), psychotic disorders (7%), and dementia (6%).

However, associations varied across countries and disorders. For example, Brazil, Chile, and Thailand showed consistent protective associations across most disorders, while in Australia and Canada, greenness was associated with modestly increased risks for all cause mental disorders and for several specific disorders.

Overall, protective associations were strongest in urban areas, where an estimated 7,712 hospital admissions for mental disorders annually were potentially preventable through greater exposure to greenness.

Seasonal patterns were also found in urban areas, suggesting that climate and weather conditions play a crucial role in how green spaces are used and perceived, say the authors.

Further analysis in urban areas suggested that a 10% increase in greenness was associated with fewer hospital admissions for mental disorders ranging from around 1 per 100,000 in South Korea to approximately 1,000 per 100,000 in New Zealand.

This is an observational study so no firm conclusions can be drawn about cause and effect and the authors acknowledge the uncertainties of using hospital admission data from multiple countries. They also point out that their results only capture severe disorders requiring inpatient care so underestimate the full burden of mental health.

Nevertheless, they say this study suggests “a considerable proportion or rate of hospital admissions for mental disorders may be associated with exposure to greenness and could potentially be reduced through greening interventions under realistic scenarios.”

“These mental health benefits may also bring broader economic and social advantages, including reduced healthcare costs, less strain on health systems, improved workplace productivity, and enhanced community wellbeing.”

Future research should aim to explore the differential effects of various types of green spaces, such as parks or forests, on mental health outcomes, and focus on assessing the quality and accessibility of green spaces, they add.

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Journal

The BMJ

DOI

10.1136/bmj-2025-084618 

Method of Research

Observational study

Subject of Research

People

Article Title

Greenness and hospital admissions for cause specific mental disorders: multicountry time series study

Article Publication Date

5-Nov-2025

COI Statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Australian Research Council and Australian National Health and Medical Research Council; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work

 

High risk of suicide after involuntary psychiatric care

Karolinska Institutet

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People who have been treated in psychiatric care against their will are at increased risk of taking their own lives after hospital discharge. This is shown by a new study from Karolinska Institutet published in the journal The Lancet Regional Health – Europe. The results highlight a need for follow-up care after discharge.

Every year, more than 10,000 people in Sweden receive involuntary inpatient psychiatric care. This compulsory care is provided in cases of serious mental disorder where there is an urgent need for inpatient care, but the person refuses care. A new study now shows that the risk of suicide is particularly high during the period after patients are discharged from hospital following such care.

“We saw that the risk of suicide was highest during the first month after discharge, and that it remained elevated for several years,” says Leoni Grossmann, doctoral student at the Department of Clinical Neuroscience, Karolinska Institutet.

The researchers followed more than 72,000 people who were involuntarily hospitalised in Sweden between 2010 and 2020. A total of 2,104 people died by suicide, corresponding to 2.9 percent, during an average follow-up period of just over four years.

During the five-year follow-up period, the risk of suicide was 1.6 times higher compared to all psychiatric inpatients and almost four times higher than in psychiatric outpatients. Compared to the general population, the risk of suicide after compulsory psychiatric care was 56 times higher.

“Considering that these are the most severely ill patients in psychiatry, it is no surprise that the risk of suicide was higher than for those receiving voluntary care,” says Leoni Grossmann.

Among compulsory care patients, some had a higher risk than others, such as young men and those being single. Patients diagnosed with personality disorders or substance abuse also had a higher risk. Previous experience of involuntary treatment or a history of self-harm was also associated with a higher risk of suicide after discharge.

"Among other things, the results also show that involuntary treatment is a risk marker for suicide. The findings should be useful to identify specific risk groups, but it is important to point out that our observational study cannot be interpreted as meaning that involuntary treatment causes suicide. However, it is important that healthcare providers follow these patients with the right support after discharge. We now want to investigate whether the differences in risk can be used to support discharge decisions and tailored follow-up after compulsory treatment," says John Wallert, assistant professor and associate professor at the same institution and principal investigator.

The study used data from several national registries and was conducted in collaboration with, among others, the University of Oxford (UK) and Indiana University (USA). It was funded by the Swedish Research Council, ALF, CIMED, FORTE, and the Söderström-Königska Foundation. See the study for any conflicts of interest.

Publication: “Suicide after involuntary psychiatric care: a nationwide cohort study in Sweden,” Leoni Grossmann, Fred Johansson, Seena Fazel, Ralf Kuja-Halkola, Björn Bråstad, David Mataix-Cols, Lorena Fernández de la Cruz, Bo Runeson, Paul Lichtenstein, Zheng Chang, Henrik Larsson, Isabell Brikell, Brian D’Onofrio, Ronnie Pingel, Christian Rück, John Wallert, The Lancet Regional Health – Europe, online November 4, 2025, doi: 10.1016/j.lanepe.2025.101504

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Journal

The Lancet Regional Health - Europe

DOI

10.1016/j.lanepe.2025.101504 

Method of Research

Observational study

Subject of Research

People

Article Title

Suicide after involuntary psychiatric care: a nationwide cohort study in Sweden

Article Publication Date

4-Nov-2025

 

Study finds gaps exist in quality of cancer care for incarcerated people

Yale University

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New Haven, Conn. — In the United States, the incarcerated population is aging. About 15% of incarcerated adults, or approximately 175,000 people, are now 55 years or older.

As the incarcerated population ages, cancer has become one of the greatest threats to their health. And despite the growing prevalence, cancer outcomes among those incarcerated are worse than for those with no history of incarceration. 

In a new study, Yale researchers investigated the quality of cancer care received by people diagnosed with cancer during and immediately after incarceration — and whether differences in access to care might explain some of the mortality gaps. They found that people who had a cancer diagnosed during a period of incarceration, or shortly after their release, were less likely to receive prompt, guideline-recommended cancer care.

The findings are published in the journal JAMA Network Open. 

“Incarceration is associated with higher cancer-related mortality,” said Cary Gross, professor of medicine (general medicine) and of epidemiology (chronic diseases) at Yale School of Medicine (YSM) and senior author of the new study. “Because people who are incarcerated have a constitutional right to care, it is particularly important to understand cancer care that patients are receiving.”

While incarceration has been associated with worse cancer outcomes in previous research, little has been known about quality of cancer care among people with a history of incarceration, the researchers say. 

“Most specialized cancer care for people who are incarcerated takes place in outside of correctional health care settings,” said Ilana Richman, an assistant professor at YSM and one of the first authors of the study. “So, it's important that clinicians and health systems who are providing care to people who are incarcerated recognize and address barriers to high quality, timely care.”

The outsourcing of highly specialized care, including oncologic care, may have complex effects on quality of care. On the one hand, patients could be treated at comprehensive cancer centers and academic centers, which usually have access to newer treatments and have been shown to have better outcomes than other cancer treatment facilities. On the other hand, outsourcing care can come with barriers to delivering high-quality care, from the logistics of scheduling appointments to arranging transport to outside providers. Additionally, because carceral health care is financed by the government, limited budgets could constrain contracts with outside facilities and shape the quality of care in other ways.  

For the new study, the researchers evaluated the quality of cancer care received by people diagnosed with cancer during and immediately after incarceration. 

Specifically, they examined data from the statewide cancer registry in Connecticut, the Connecticut Tumor Registry, and rosters from the Connecticut Department of Correction (DOC). Within this combined dataset, they identified individuals diagnosed with invasive cancer in the state from 2005 through 2016. They then compared the quality of cancer care received within three distinct groups: individuals diagnosed with cancer while incarcerated, those diagnosed within 12 months after release, and those who had never been incarcerated. They analyzed the sample, which included 690 individuals, between March 2024 and January 2025.

The researchers examined indicators of quality of care, including the amount of time to initiate treatment — including surgery, chemotherapy, and radiation therapy — and receipt of recommended cancer care. They also examined whether treatment was initiated within 60 days following the cancer diagnosis. 

Through this work, the researchers discovered that patients diagnosed with cancer during incarceration were less likely to initiate treatment within 60 days or receive recommended treatment-related care. 

People diagnosed immediately following release were also less likely to receive recommended treatment-related care in a timely manner compared with those with no incarceration history.

“Many of our community members know someone who has a history of criminal justice involvement,” Gross said. “This is a good opportunity to not only advocate for improving health of these individuals but also to consider the health impact of mass incarceration. As we strive to develop new cancer screening tests or treatments, it’s also critical to ensure that we are removing barriers to accessing these breakthroughs.”

The findings, researchers say, suggest that gaps in quality of care may contribute to observed disparities in cancer outcomes among people with a history of incarceration. The team is currently conducting an interview study, asking people who have been diagnosed with cancer while incarcerated about their experiences.

Gross is also the founder and director of YSM’s Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center. Richman is also a COPPER affiliate. 

Other YSM-affiliated authors include Lisa Puglisi, associate professor of medicine (general medicine); Rajni Mehta, director of the Rapid Case Ascertainment (RCA) Shared Resource Core of the Yale Cancer Center; Emily Wang, professor of medicine (general medicine) and of public health (social and behavioral sciences) at Yale School of Public Health; Jenerius Aminawung, a project manager and data analyst at COPPER; and M.D. student Jason Weinstein. 

The study was supported by a grant from the National Institutes of Health.  

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2025.37400 

Article Title

Incarceration and Quality of Cancer Care

 

Parents' attachment style may be linked with risk of parental burnout, especially when associated with difficulty in understanding and identifying their emotions

PLOS

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image: 

Parents' attachment style may be linked with risk of parental burnout.

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Credit: Vitaly Gariev, Unsplash, CC0 (https://creativecommons.org/publicdomain/zero/1.0/)

Parents' attachment style may be linked with risk of parental burnout, especially when associated with difficulty in understanding and identifying their emotions

Article URL: http://plos.io/3Lv62sL

Article title: Alexithymia and attachment dimensions in relation to parental burnout: A structural equation modelling approach

Author countries: Poland

Funding: The author(s) received no specific funding for this work.

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Journal

PLOS One

DOI

10.1371/journal.pone.0334647 

Article Title

Alexithymia and attachment dimensions in relation to parental burnout: A structural equation modelling approach

Article Publication Date

5-Nov-2025