Residential greenspace is associated with mental health via intertwined capacity-building and capacity-restoring pathways.

BACKGROUND: Experiences afforded by natural settings promote health by helping people to build new adaptive capacities and to restore existing capacities. The aim of this study was to examine relations among restorative experience, mindfulness, rumination and psychological resilience in pathways linking residential greenspace to anxiety and depression symptoms. METHODS: We sampled 529 university students residing in Plovdiv, Bulgaria. Residential greenspace was measured in terms of the Normalized Difference Vegetation Index (NDVI) and tree cover density for different buffer sizes. Symptoms of anxiety and depression were measured with the Generalized Anxiety Disorder scale (7-item) and Patient Health Questionnaire (9-item), respectively. The following mediators were assessed by self-report: perceived greenspace, restorative quality of the neighborhood, dispositional mindfulness, rumination, and psychological resilience. Structural equation modelling techniques were used to test the theoretically-indicated relations among the variables. RESULTS: Across different buffer sizes, higher greenspace was consistently associated with reduced scores on the anxiety and depression scales. This effect was partially mediated via several pathways. Specifically, higher NDVI 500-m was associated with higher perceived greenspace, and in turn, with higher restorative quality, and then with higher mindfulness, lower rumination, and greater resilience to stress, and consequently, with better mental health. CONCLUSIONS: Our findings affirm the potential of greenspace for building psychological resilience and promoting health by offsetting dysfunctional rumination and facilitating mindfulness as components of intertwined capacity-building and capacity-restoring pathways.

Pathways and contingencies linking road traffic noise to annoyance, noise sensitivity, and mental Ill-Health.

CONTEXT: Traffic noise may contribute to depression and anxiety through higher noise annoyance (NA). However, little is known about noise sensitivity (NS) and mental health status as contextual factors. OBJECTIVE: We tested three hypotheses: (1) Traffic noise is associated with mental ill-health through higher NA; (2) Mental ill-health and NS moderate the association between traffic noise and NA; and (3) NS moderates the indirect effect of traffic noise on mental ill-health. SUBJECTS AND METHODS: We used a convenience sample of 437 undergraduate students from the Medical University in Plovdiv, Bulgaria (mean age 21 years; 35% male). Residential road traffic noise (LAeq; day equivalent noise level) was calculated using a land use regression model. Depression and anxiety symptoms were measured with the Patient Health Questionnaire 9-item (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) scale, respectively. NA was measured using a 5-point verbal scale. The Noise Sensitivity Scale Short Form (NSS-SF) was used to measure NS. To investigate how these variables intertwine, we conducted mediation, moderation and moderated mediation analyses. RESULTS: LAeq was indirectly associated with higher PHQ-9/GAD-7 scores through higher NA, but only in the low NS group. The relationship between LAeq and NA was stronger in students reporting depression/anxiety. While high NS was associated with high NA even at low noise levels, LAeq contributed to NA only in students low on NS. CONCLUSIONS: We found complex conditional relationships between traffic noise, annoyance and mental ill-health. Understanding respective vulnerability profiles within the community could aid noise policy and increase efficacy of interventions.

Psychometric Properties and Contribution to Mental Health of the Bulgarian version of the 4-Factor Ruminative Thought Style Questionnaire.

BACKGROUND: The Ruminative Thought Style Questionnaire (RTSQ) is a multifaceted measure of general trait rumination. However, there is no instrument for measuring rumination in Bulgarian, which limits progress in the field. AIM: We aimed to validate the RTSQ in Bulgarian and examine its psychometric properties and contribution to several mental health outcomes. MATERIALS AND METHODS: We sampled 529 undergraduate students (18 ­ 35 years; 33.6% male; 80.9% Bulgarian) from the Medical University in Plovdiv, Bulgaria. They completed a questionnaire asking about rumination (RTSQ), mental health, and sociodemographic information. The RTSQ was first translated to Bulgarian. Its internal consistency was assessed with Cronbach's alpha. Confirmatory factor analysis was performed on the 4-factor RTSQ, and multi-group CFA examined its measurement invariance. Structural equation modelling was used to test the relations between the RTSQ factors, depression, anxiety, and resilience to stress. RESULTS: The RTSQ had acceptable internal consistency (α ≥ 0.8) and its 4-factor model had good fit to the data. In addition, its measurement invariance was supported across languages and cultures of administration. We observed differential associations with depression, anxiety, and resilience, with some of the RTSQ factors emerging as maladaptive (problem-focused thoughts and repetitive thoughts), while others as neutral (anticipatory thoughts) or potentially supportive of resilience (counterfactual thinking). CONCLUSION: The RTSQ was successfully validated in Bulgarian and represents a reliable measure of trait rumination. It could be useful in gaining further insight into strategies adopted by individuals to cope with stressors and could help develop interventions supporting healthy coping styles. These findings should be replicated in other non-clinical/clinical populations.

Lower Noise Annoyance Associated with GIS-Derived Greenspace: Pathways through Perceived Greenspace and Residential Noise.

Growing amounts of evidence support an association between self-reported greenspace near the home and lower noise annoyance; however, objectively defined greenspace has rarely been considered. In the present study, we tested the association between objective measures of greenspace and noise annoyance, with a focus on underpinning pathways through noise level and perceived greenspace. We sampled 720 students aged 18 to 35 years from the city of Plovdiv, Bulgaria. Objective greenspace was defined by several Geographic Information System (GIS)-derived metrics: Normalized Difference Vegetation Index (NDVI), tree cover density, percentage of green space in circular buffers of 100, 300 and 500 m, and the Euclidean distance to the nearest structured green space. Perceived greenspace was defined by the mean of responses to five items asking about its quantity, accessibility, visibility, usage, and quality. We assessed noise annoyance due to transportation and other neighborhood noise sources and daytime noise level (Lday) at the residence. Tests of the parallel mediation models showed that higher NDVI and percentage of green space in all buffers were associated with lower noise annoyance, whereas for higher tree cover this association was observed only in the 100 m buffer zone. In addition, the effects of NDVI and percentage of green space were mediated by higher perceived greenspace and lower Lday. In the case of tree cover, only perceived greenspace was a mediator. Our findings suggest that the potential for greenspace to reduce noise annoyance extends beyond noise abatement. Applying a combination of GIS-derived and perceptual measures should enable researchers to better tap individuals' experience of residential greenspace and noise.

Pathways linking residential noise and air pollution to mental ill-health in young adults.

BACKGROUND: Recent years have seen growing, but still tentative, evidence of the potential associations of environmental noise and air pollution with mental disorders. In the present study, we aimed to examine the associations between residential noise and air pollution exposures and general mental health in young adults with a focus on underlying processes METHODS: We sampled 720 students (18-35 years) from one university in the city of Plovdiv, Bulgaria. Residential noise (LAeq; day equivalent noise level) and air pollution (NO2) were assessed at participant's residential address by land use regression models. General mental health was measured with a short form of the General Health Questionnaire (GHQ). The following putative mediators were considered: annoyance from environmental pollution, sleep disturbance, restorative quality of the neighborhood, neighborhood social cohesion, and commuting/leisure time physical activity. Structural equation modeling was used to analyze the theoretically-indicated interplay between exposures, mediators, and GHQ. RESULTS: We observed an association between higher LAeq and GHQ, in which environmental annoyance and neighborhood restorative quality emerged as key mediators. First, LAeq was associated with higher annoyance, and through it with lower restorative quality, and then in turn with lower physical activity, and thus with higher GHQ. Simultaneously, higher annoyance was associated with higher sleep disturbance, and thereby with higher GHQ. NO2 had no overall association with GHQ, but it was indirectly associated with it through higher annoyance, lower restorative quality, and lower physical activity working in serial. CONCLUSION: We found evidence that increased residential noise was related to mental ill-health through several indirect pathways. Air pollution was associated with mental health only indirectly.

Multiple pathways link urban green- and bluespace to mental health in young adults.

BACKGROUND: A growing body of scientific literature indicates that urban green- and bluespace support mental health; however, little research has attempted to address the complexities in likely interrelations among the pathways through which benefits plausibly are realized. OBJECTIVES: The present study examines how different plausible pathways between green/bluespace and mental health can work together. Both objective and perceived measures of green- and bluespace are used in these models. METHODS: We sampled 720 students from the city of Plovdiv, Bulgaria. Residential greenspace was measured in terms of the Normalized Difference Vegetation Index (NDVI), tree cover density, percentage of green areas, and Euclidean distance to the nearest green space. Bluespace was measured in terms of its presence in the neighborhood and the Euclidean distance to the nearest bluespace. Mental health was measured with the 12-item form of the General Health Questionnaire (GHQ-12). The following mediators were considered: perceived neighborhood green/bluespace, restorative quality of the neighborhood, social cohesion, physical activity, noise and air pollution, and environmental annoyance. Structural equation modelling techniques were used to analyze the data. RESULTS: Higher NDVI within a 300 m buffer around the residence was associated with better mental health through higher perceived greenspace; through higher perceived greenspace, leading to increased restorative quality, and subsequently to increased physical activity (i.e., serial mediation); through lower noise exposure, which in turn was associated with lower annoyance; and through higher perceived greenspace, which was associated with lower annoyance. Presence of bluespace within a 300 m buffer did not have a straightforward association with mental health owing to competitive indirect paths: one supporting mental health through higher perceived bluespace, restorative quality, and physical activity; and another engendering mental ill-health through higher noise exposure and annoyance. CONCLUSIONS: We found evidence that having more greenspace near the residence supported mental health through several indirect pathways with serial components. Conversely, bluespace was not clearly associated with mental health.

Urban residential greenspace and mental health in youth: Different approaches to testing multiple pathways yield different conclusions.

BACKGROUND: Urban greenspace can benefit mental health through multiple mechanisms. They may work together, but previous studies have treated them as independent. OBJECTIVES: We aimed to compare single and parallel mediation models, which estimate the independent contributions of different paths, to several models that posit serial mediation components in the pathway from greenspace to mental health. METHODS: We collected cross-sectional survey data from 399 participants (15-25 years of age) in the city of Plovdiv, Bulgaria. Objective "exposure" to urban residential greenspace was defined by the Normalized Difference Vegetation Index (NDVI), Soil Adjusted Vegetation Index, tree cover density within the 500-m buffer, and Euclidean distance to the nearest urban greenspace. Self-reported measures of availability, access, quality, and usage of greenspace were also used. Mental health was measured with the General Health Questionnaire. The following potential mediators were considered in single and parallel mediation models: restorative quality of the neighborhood, neighborhood social cohesion, commuting and leisure time physical activity, road traffic noise annoyance, and perceived air pollution. Four models were tested with the following serial mediation components: (1) restorative quality → social cohesion; (2) restorative quality → physical activity; (3) perceived traffic pollution → restorative quality; (4) and noise annoyance → physical activity. RESULTS: There was no direct association between objectively-measured greenspace and mental health. For the 500-m buffer, the tests of the single mediator models suggested that restorative quality mediated the relationship between NDVI and mental health. Tests of parallel mediation models did not find any significant indirect effects. In line with theory, tests of the serial mediation models showed that higher restorative quality was associated with more physical activity and more social cohesion, and in turn with better mental health. As for self-reported greenspace measures, single mediation through restorative quality was significant only for time in greenspace, and there was no mediation though restorative quality in the parallel mediation models; however, serial mediation through restorative quality and social cohesion/physical activity was indicated for all self-reported measures except for greenspace quality. CONCLUSIONS: Statistical models should adequately address the theoretically indicated interdependencies between mechanisms underlying association between greenspace and mental health. If such causal relationships hold, testing mediators alone or in parallel may lead to incorrect inferences about the relative contribution of specific paths, and thus to inappropriate intervention strategies.

Residential road traffic noise and general mental health in youth: The role of noise annoyance, neighborhood restorative quality, physical activity, and social cohesion as potential mediators.

Given the ubiquitous nature of both noise pollution and mental disorders, their alleged association has not escaped the spotlight of public health research. The effect of traffic noise on mental health is probably mediated by other factors, which have not been elucidated sufficiently. Herein, we aimed to disentangle the pathways linking road traffic noise to general mental health in Bulgarian youth, with a focus on several candidate mediators - noise annoyance, perceived restorative quality of the living environment, physical activity, and neighborhood social cohesion. A cross-sectional sample was collected in October - December 2016 in the city of Plovdiv, Bulgaria. It consisted of 399 students aged 15-25years, recruited from two high schools and three universities. Road traffic noise exposure (Lden) was derived from the strategic noise map of Plovdiv. Mental health was measured with the 12-item form of the General Health Questionnaire (GHQ-12). Noise annoyance, perceived restorative quality of the living environment, commuting and leisure time physical activity, and neighborhood social cohesion were assessed using validated questionnaires. Analyses were based on linear regression mediation models and a structural equation modeling (SEM) to account for the hypothesized interdependencies between candidate mediators. Results showed that higher noise exposure was associated with worse mental health only indirectly. More specifically, tests of the single and parallel mediation models indicated independent indirect paths through noise annoyance, social cohesion, and physical activity. In addition, the SEM revealed that more noise annoyance was associated with less social cohesion, and in turn with worse mental health; noise annoyance was also associated with lower neighborhood restorative quality, thereby with less social cohesion and physical activity, and in turn with worse mental health. However, causality could not be established. Further research is warranted to expand our still limited understanding of these person-environment interactions.

Study of the relationship between aggression and chronic diseases (diabetes and hypertension).

INTRODUCTION: This study focused on the widely examined psychosomatic diseases - diabetes mellitus and arterial hypertension as chronic conditions. The Buss-Perry validated questionnaire was used in it to measure aggression in Bulgarian conditions. AIM: To study aggression as a predictor and a connection of the chronic diseases diabetes and hypertension. MATERIAL AND METHODS: The number of the studied people was 142: 54 (38%) men and 88 (62%) women. Thirty-six of them had musculoskeletal disorders (77.8% women and 22.2% men), 54 had diabetes mellitus (29% women and 25% men) and 52 had hypertension (31% women and 21% men). RESULTS: During the statistical analysis of the data, the results from the Buss-Perry questionnaire were compared in the group of patients with hypertension and diabetes mellitus with chronic diseases, related to musculoskeletal disorders. CONCLUSION: The study revealed that there was a statistically significant difference in 95% of the cases between anger, hostility in patients with diabetes, hypertension and musculoskeletal disorders. The highest levels of physical aggression were observed in patients with arterial hypertension, M = 17.32 ± 0.86. The highest average levels of verbal aggression were observed in patients with diabetes, M = 15.24 ± 0.64. The highest levels of anger were observed with patients with hypertension, M = 17.96 ± 0.90, and hostility - in patients with hypertension, M = 19.15 ± 0.86. The comparison between the four Aggression Questionnaire scales showed statistically significant differences between the patients with musculoskeletal disorders and the ones with hypertension and diabetes.

Cross-cultural validation of the revised temperament and character inventory in the Bulgarian language.

RATIONALE, AIMS AND OBJECTIVES: Health-care professions have long been considered prone to work-related stress, yet recent research in Bulgaria indicates alarmingly high levels of burnout. Cloninger's inventory is used to analyse and evaluate correlation between personality characteristics and degree of burnout syndrome manifestation among the risk categories of health-care professionals. The primary goal of this study was to test the conceptual validity and cross-cultural applicability of the revised TCI (TCI-R), developed in the United States, in a culturally, socially and economically diverse setting. METHODS: Linguistic validation, test-retest studies, statistical and expert analyses were performed to assess cross-cultural applicability of the revised Cloninger's temperament and character inventory in Bulgarian, its reliability and internal consistency and construct validity. RESULTS: The overall internal consistency of TCI-R and its scales as well as the interscale and test-retest correlations prove that the translated version of the questionnaire is acceptable and cross-culturally applicable for the purposes of studying organizational stress and burnout risk in health-care professionals. CONCLUSIONS: In general the cross-cultural adaptation process, even if carried out in a rigorous way, does not always lead to the best target version and suggests it would be useful to develop new scales specific to each culture and, at the same time, to think about the trans-cultural adaptation.