Suicide mortality and natural environments
Authors: Bence Mátyás
Journal: The Lancet Planetary Health (2019)

Marco Helbich and colleagues' important Article1Helbich M Beurs DD Kwan MP O'Connor RC Groenewegen PP Natural environments and suicide mortality in the Netherlands: a cross-sectional, ecological study.Lancet Planet Health. 2018; 2: e134-e139Summary Full Text Full Text PDF PubMed Scopus (55) Google Scholar investigated the correlation between suicide mortality and natural outdoor environments, such as green (grass, forests, and parks) and blue (visible bodies of lakes, rivers, and seas) spaces. One of their findings contradicted their hypothesis, which stated that coastal proximity is negatively associated with suicide mortality. When discussing their study, the authors found that blue space visibility did not necessarily correlate with mental health. Then, however, they add that they believe their study is the first of its kind, so they are not sure whether their findings are specific to their case study. This study is very valuable and comprehensive. Nevertheless, it should be mentioned that there was a retrospective study published 2 years earlier by Nutsford and colleagues2Nutsford D Pearson AL Kingham S Reitsma F Residential exposure to visible blue space (but not green space) associated with lower psychological distress in a capital city.Health Place. 2016; 39: 70-78Crossref PubMed Scopus (195) Google Scholar who found that a higher visibility of blue space is associated with lower psychological distress. Helbich and colleagues' analyses were based on the officially registered suicide deaths per municipality for the period 2005–14 in the Netherlands. Considering that suicide mortality was studied in Helbich and colleagues' study, and not other factors that correlate with psychological wellbeing (such as percieved self-efficacy, autonomy, competence, intergenerational dependence, and self-actualisation)3WHOThe world health report 2001. Mental health: new understanding, new hope. World Health Organization, Geneva2001Google Scholar, the authors' statement should be refined to something like “Our finding is that blue space is not necessarily associated with suicide mortality”. With this minor correction, the apparent contradiction could be dispelled because suicide mortality was the only factor analysed, and other factors contributing to overall wellbeing (such as those previously mentioned) were not analysed. Conversely, modelling of data is one of the most important means of drawing conclusions from analyses. Helbich and colleagues' analyses is a well-structured and seemingly reliable. Furthermore, to aid the reader's understanding of the present study's findings, it is important to draw attention to positive findings from other (previously published) studies that have explored a similar hypothesis. I declare no competing interests. Natural environments and suicide mortality in the Netherlands: a cross-sectional, ecological studyOur findings support the notion that exposure to natural environments, particularly to greenery, might have a role in reducing suicide mortality. If confirmed by future studies on an individual level, the consideration of environmental exposures might enrich suicide prevention programmes. Full-Text PDF Open AccessSuicide mortality and natural environments – Authors' replyWe welcome the comments from Bence Mátyás concerning our Article about the associations between suicide mortality and green and blue space.1 Here, we would like to respond to his two observations. Full-Text PDF Open Access