Is rurality, area deprivation, access to outside space and green space associated with mental health during the Covid-19 pandemic? A cross sectional study from the Covid-19 Health and Adherence Research in Scotland (CHARIS) project

ObjectivesTo determine if rurality, area deprivation, access to outside space (Study 1) and frequency of visiting and duration in green space (Study 2) are associated with mental health during the Covid-19 pandemic.DesignSerial, weekly, nationally representative, cross-sectional, observational study of randomly selected adults in Scotland during June and July 2020.MethodsIf available, validated instruments were used to measure psychological distress, individual demographics and illness beliefs and the following environments: rurality, area deprivation, access to residential outside space, frequency of visiting, and duration in green space. Simple linear regressions followed by examination of moderation effect.Results2969 participants in Study 1, of which, 1765 (59.6%) female, 349 (11.9%) in the shielding category, median age 54 years. 502 participants in Study 2, of which, 295 (58.60%) female, 58 (11.6%) in shielding category, median age 53 years. Direct effects show that psychological distress was worse if: younger, female, in shielding category (demographics), worse illness (Covid-19) representations and greater threat perception (illness beliefs), if urban, in a deprived area, no access to or sharing residential outside space, and fewer visits to green space (environment). Moderation analyses show that environment amplify the direct effects of the individual factors on psychological distress.ConclusionsEnvironment is important for mental health during pandemics and this study offers pointers for public health and for environmental planning, design and management, including housing design and public open space provision and regulation.