Place-Based Differences in the Association Between Greenspace and Suicide-Related Outcomes Among Young People

This study investigated place-based differences in the association between greenspace and suicide-related outcomes (SROs) among young people, guided by the following two objectives: (1) Contextualize place-based differences in the association between greenspace and SRO prevalence among young people at the community level in five different urbanities (urban, suburban, micropolitan, small towns, and rural/isolated communities) and (2) identify which greenspace metrics (quantity, quality, or accessibility) are most protective for SROs at the community level.

Publicly available greenspace datasets were used to derive greenspace quantity, quality, and accessibility metrics. SRO emergency department visits for young people were identified from 2016-2019 in North Carolina, USA. Generalized linear models investigated the association between greenspace metrics and community-level drivers of SRO prevalence. Shapely additive explanations confirmed the most important greenspace variables in accurately predicting community-level SRO prevalence.

The prevalence of SROs was highest in communities with the least amount of public greenspace; this association was most pronounced in suburban communities, with SROs 27% higher in suburban communities with low quantities of greenspace (PRR_Urban: 1.11, confidence interval [CI]: 1.08-1.13; PRR_Suburban: 1.27, CI: 1.10-1.46; PRR_SmallTowns: 1.21, CI: 1.05-1.39), and in communities with the worst greenspace accessibility (i.e., furthest distance to nearest greenspace) (PRR_Urban: 1.07, CI: 1.04-1.10; PRR_{Rural&Isolated}: 1.95, CI: 1.54-2.49).

Our analysis provides place-based, community-specific findings to guide targeted greenspace interventions aimed at addressing the rising prevalence of SROs among young people. Our findings suggest that greenspace quantity interventions may be most effective in urban, suburban, and small-town communities, and greenspace accessibility interventions may be most useful in urban and rural/isolated communities.