Development of nature-related habits and their relation to mental health outcomes during two years of the COVID-19 pandemic: A population-based study in Sweden
Authors: Klein Yannick , Lindfors Petra , Magnusson Linda Hanson , Stenfors Cecilia Ulrika Dagsdotter 
Published: August 2023

Background: Mental health disorders represent a major part of the global disease burden. The COVID-19 pandemic and associated restrictions posed additional mental health challenges. Spending time in natural environments is linked to mental health benefits and may have been an important resilience factor during the pandemic, but longitudinal studies are limited. Objective: Study aims were thus to investigate the role of different nature-related habits (NRH) and their development during the pandemic (2019-2022) for mental health outcomes (MHO) across this time. Moreover, the buffering potential of NRH on the effects of major life events (MLE) on MHO during the pandemic was investigated. Methods: A sample of respondents from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2020 was followed via online surveys early 2021 (n = 1902) and 2022 (n = 1580), assessing MHO (symptoms of depression, anxiety, loneliness, sleep difficulties), NRH (visiting parks, green playgrounds, forests, blue spaces, other natural areas, own garden use, walking/biking to work/other activity (mobility-related exposure)), and MLE. Descriptive statistics and paired samples t-tests were conducted to assess NRH and MHO changes. Associations between NRH (changes), MHO, and MLE, were analyzed via sequential multiple linear regressions while adjusting for demographic, work-related, and socioeconomic factors. Results: All NRH increased from 2019 to 2022, except for spending time in one’s own garden. While the mean frequency of generally engaging in NRH initially dropped between 2019 and 2020 (t= -2.56**), the mean frequency of forest visits increased (t= 5.57***). During the later pandemic (2020 to 2022), the frequency of mobility-related exposure increased the most (t= 9.24***).Generally engaging in NRH and particularly visiting forests, or using one’s own garden in autumn 2020 was associated with lower symptom levels of depression (general NRH: β = -0.09***, forest: β = -0.11***, garden: β = -0.11***), anxiety (general NRH: β = -0.09***, forest: β = -0.10***, garden: β = -0.12***), loneliness (general NRH: β = -0.07**, forest: β = -0.07**, garden: β = -0.11***), and sleep problems (general NRH: β = -0.05, forest: β = -0.06**, garden: β = -0.06**) in early 2021 (similar results one year later). Changes in general NRH from 2019 to 2020 and 2022 were consistently associated with changes in and better MHO 2021 (depression: β = -0.05*, anxiety: β = -0.03 loneliness: β = -0.05**, sleep problems: β = -0.08***) and 2022 (depression: β = -0.11***, anxiety: β = -0.08*** loneliness: β = -0.04*, sleep problems: β = -0.02). Conclusion: NRH generally increased and were associated with better MHO during the COVID-19 pandemic, in a population-based longitudinal sample in Sweden. This underscores the importance of ensuring green- and blue space accessibility to facilitate outdoor recreation in natural environments and support resilience and sustainable mental health during pandemics.