Advances in Integrative Medicine 2 (2015) 512

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Advances in Integrative Medicine

journal homepage: www.elsevier.com/locate/aimed

Natural environments and mental health

Annemarie Mantler a, Alan C. Logan b,*
a
b

Fiddleheads Health & Nutrition, 25 Bruce Street, Kitchener, ON N2B 1Y4, Canada
CAMNR, 23679 Calabasas Road Suite 542, Calabasas, CA 91302, USA

A R T I C L E I N F O

A B S T R A C T

Article history:
Available online 15 April 2015

Ancestral experiences and evolutionary processes continue to inuence the brain in ways that may
escape conscious awareness by contemporary adults. It is becoming increasingly evident that the 2.2
million years our genus has spent in natural environments are consequential to modern mental health.
This might be especially true in the context of rapid global urbanization, loss of biodiversity and
environmental degradation. Here, we examine some of the emerging research related to natural
environments (and specic elements within them) and mental health. Our synthesis includes research
from various branches of science and medicine, e.g., epidemiology, psychology, physiology,
anthropology, evolutionary biology, and microbiology. Signicant knowledge gaps remain. However,
the accumulating strength of research from multiple disciplines makes it difcult to dismiss the clinical
relevancy of natural environments in 21st century mental health care.
2015 Elsevier Ltd. All rights reserved.

Keywords:
Attention
Delay discounting
Green space
Light at night
Melatonin
Microbiota
Mindfulness
Negative ions
Stress physiology
Urbanization

What is already known about the topic?

 The study of natural environments and mental health is an
expansive topic.
 Experience within natural environments (or with components of
natural environments) produces a differential effect on human
stress physiology vs. similar activity in predominantly built
environments.
 Experience within natural environments (or with components of
natural environments) supports cognitive restoration.

What this paper adds?

 Our review attempts to tie evolutionary aspects of the humannatural environment relationship to modern clinical relevancy.
 Our review attempts to break down the silo-contained research
related to the topic so that the relevancy of compartmentalized
natural environment research areas (e.g. microbiota) can be
viewed through a single lens.

* Corresponding author. Tel.: +1 [3_TD$IF]519 [4_TD$IF]745 [5_TD$IF]7800.

E-mail address: aclnd@cfs-fm.org (A.C. Logan).
http://dx.doi.org/10.1016/j.aimed.2015.03.002
2212-9588/ 2015 Elsevier Ltd. All rights reserved.

1. Introduction
In contemporary lexicon, natural environments are dened as
those that are relatively unchanged or undisturbed by human
culture [1]. These environments are often rich in vegetation and/or
non-human animal life, with varying degrees of trees, shrubs,
rocks, soil, sand and water. Natural environments are inclusive of
atmospheric components such as light, radiation, charged ions,
aromatic chemicals and microbes. Distinct from the purely humanbuilt environment, natural environments are typically not dened
as exclusively wilderness areas; they can include areas that are
designed, manipulated and/or sustained by human interventions.
In the context of urban settings this may include gardens, parks,
forests and waterside areas.
In the context of rapid global urbanization, loss of biodiversity
and environmental degradation, natural environments are increasingly being viewed as an ecosystem service for the
promotion of psychological well-being [2]. This, of course, is not
a new concept. The notion that natural environments can inuence
human health dates back to Hippocrates teachings on Airs, Waters
and Places [3]. Biologist Sir John Arthur Thompson continued this
argument in his 1914 keynote address at the Annual Meeting of the
British Medical Association, maintaining that human evolutionary
connections to natural environments were being eroded by
modernization. In Thompsons view, individuals were contending
with stressors of the urban built environment while missing a layer

A. Mantler, A.C. Logan / Advances in Integrative Medicine 2 (2015) 512

of mental health resiliency otherwise provided by mindful

awareness of nature [4].
In this illustrative review we will discuss Thompsons contention from the view of multidisciplinary research. Although
referencing depression and anxiety, we approach our discussion
with mental health being dened as the World Health Organization sees it: the ability of an individual to reach their potential,
cope with normal stressors, work productively, and make
contributions to the community [5]. The absence of a mental
health disorder is not assumed to be synonymous with a state of
good mental health.
Ancestral experience, contemporary implications
For over 2.2 million years, our ancestors in the genus Homo
etched out an existence within natural environments. These
experiences have shaped many aspects of modern brain functioning [5,6]. Human ancestral survival necessities related to sustenance, shelter, and predator avoidance (as well as other threats)
continue to inuence emotion, motivation, learning, and reasoning
in subtle ways. In addition, since the ancestral experience was
often an outdoor one, sleep and mood-regulating circadian
rhythms became coordinated by the cycles of natural light [7].
Detailed discussions of advances within the elds of evolutionary and environmental psychology are available in recent reviews
[8,9]. A sample of recent ndings may help to underscore the subtle
resonance of ancestral experiences that still inuence brain
functionalities today. For example, while processing complex
photographic scenes inclusive of many different objects, humans
display attentional privilege toward animals [10,11]. Children as
young as 9-months of age demonstrate perceptual bias for
threatening reptiles and even the mere sound of an ancestral
threat can elicit a differential physiological response [12,13]. Even
in crowded market environments, humans display enhanced
spatial memory for locations that are purveyors of calorie-dense
foods. Since this nding was independent of taste and personal
food choices, it more likely reects ancestral foraging experiences
[14]. Other researchers have linked human preference for the
shininess of contemporary glossy (versus matte) objects to the
ancestral requirement of sourcing a daily supply of fresh, owing
water [15].
Human preferences for images of nature scenes over those of
the built environment are apparent even when they are presented
for a mere 1/100th of a second [16,17]. Recent functional magnetic
resonance imaging (fMRI) studies have shown that scenes of
natural environments (versus urban built environment) increase
activity in brain regions associated with positive mental outlook,
emotional stability, altruism, empathy and depth of love. On the
other hand, urban built scenes consistently increase activity in the
amygdala, an area well known for processing threat, arousal and
risk assessment [1821]. Moreover, a greater degree of realism in
the display of nature images presented to subjects e.g. 3- vs. 2dimensional alters cerebral oxygen use in ways that support
subjective reports of improved mental functioning [22,23].

inammation [27,28]. In addition, fatigue [29] and cognitive

decits in attention and executive functioning are common
ndings in adults with depression, including individuals who
are subthreshold to major criteria [30,31].
In a vicious cycle, cognitive demands can promote mental
fatigue and hyperactivity of the sympathetic nervous system [32].
Mental fatigue impairs emotion regulation [33], increases the
perception of physical effort, and may diminish the motivation to
engage in physical activity and/or negatively inuence energy
expended during activity [34,35]. Once induced, mental fatigue
further limits the ability to discount distracting information in the
environment [36].
There are many theoretical propositions concerning the
mechanisms that might explain the mental health value of
natural environments. Two complementary and oft-cited theories
include the psycho-evolutionary stress recovery theory (SRT) [37]
and the attention restoration theory (ART) [38]. The former
focuses on the contention that ancestral experiences within
natural environments have resulted in better physiological and
perhaps psychological adaption to natural vs. built or articial
urban environments. The central discussion of SRT is emotion.
Positive emotion as a result of experience in natural settings can in
turn limit the burden of stress physiology. Positive moods offered
advantages to our ancestors [39], and there is every reason to
suspect that (alongside the dangers which may have helped shape
our effective physiological stress response) uplifting experiences,
amusement and awe in natural environments were commonplace.
The ART focuses on directed attention, the effortful cognitive
work that requires non-salient distracters to be largely ignored.
Blocking out distracters during directed attention exacts a
cognitive toll; it ratchets up the requirement for inhibitory energy.
The modern urban environment, and much of the work we do
within it, requires a good degree of directed attention. Mental
fatigue is a primary consequence of sustained directed attention. In
turn, mental fatigue itself, and states associated with mental
fatigue such as sleep deprivation and low-grade inammation
[40,41], impair the ability to direct attention. ART proposes that
natural environments are restorative settings because they do
not require taxing mental effort. The distinction is that such areas
are inherently fascinating; that is, they provide a more automatic
engagement of attention (involuntary attention) and this facilitates a rest and rejuvenation period for the taxed executive
system.
These theories are complementary in that mental fatigue can
promote stress and vice versa. They are by no means the last word
on the mechanistic pathways of natural environments. The
development of social capital, opportunity for physical activity,
and immune function via exposure to benecial microbiota
(described later) are examples of other pathways. However, since
psychological distress and fatigue are interrelated with detrimental lifestyle habits such as unhealthy dietary patterns [42,43] and
sedentary behavior [44], any potential mitigation by way of natural
environments could have a ripple effect in the promotion of mental
health.

Theoretical constructs, primary mechanisms

Psychological connection to nature
In order to contextualize the specic value of natural
environments to mental health, it may be helpful to briey
underscore known links between psychological distress and
cognitive load in relation to depression and anxiety. The
accumulation of stressful life events, ranging from daily hassles
to more signicant negative events, have been associated with a
trajectory toward compromised mental health [2426]. Over time,
this may take its toll in the form of damaging physiological
consequences, most notably captured by markers of low-grade

Several validated instruments are now used to assess the extent

to which an individual is connected to the natural world. A recent
meta-analysis found that a higher level of nature connectedness
(also called nature connectivity, nature relatedness) is positively
associated with vitality, positive affect and life satisfaction [45].
Other studies published post-analysis have shown that higher
scores are negatively correlated with lower anxiety and anger
[46,47].

A. Mantler, A.C. Logan / Advances in Integrative Medicine 2 (2015) 512

While more research is required, there are indications that

nature relatedness can be cultivated [48,49]. Mindfulness (awareness of the present moment and its associated thoughts, emotions
and sensations), contentiousness, and the ability to perceive
natures beauty appear to be prerequisites for achieving maximal
health benets associated with natural environments [5054]. In
other words, images of nature, views to nature, and even time
spent in nature may not fulll its full clinical promise if the
individual is distracted from mindful awareness.
Residential proximity to natural environments
A variety of international studies have examined relationships
between residential proximity to natural environments and
mental health. For example, studies found increasing residential
distance from areas high in green space, or low levels of green
space surrounding the home, were associated with increases in
self-reported stress as well as poor scores on measurements of
general health, vitality, overall mental health and bodily pain [55
60]. Research on residential proximity to bodies of water, or socalled blue space, also report positive impact on general health
and well-being [61]. Even self-reports on the perceived degree of
greenness of urban neighborhoods correlate positively with
individual life satisfaction and mental health among residents
[62,63].
Of particular interest is a Dutch study that found residents of
areas with a low degree of green space had a greater risk of
depression and anxiety disorders vs. residents with the highest
concentration of green space in proximity to the home. Those
residing in areas with small amounts of green space (10% within
1 km of home) had a 25% greater risk of depression and a 30%
greater risk of anxiety disorders versus those with the highest area
of green space (90%) near the home [55]. Similarly, a study in New
Zealand found every 1% increase in the proportion of useable or
total urban green space in proximity to the home was associated
with a 4% lower rate of anxiety/mood disorder treatment [64].
Furthermore, individuals who moved into areas with a higher
degree of green space (vs. previous residence) experienced
improved mental health, a benet that continued to endure over
three years of study [65]. Some research suggests that the mental
health benets of green space can remain after controlling for
urbanization, gender, physical activity, socioeconomic status [66][6_TD$IF],
and[1_TD$IF] specically in depression, they are also evident after
controlling for genetics [67].
Residential proximity to natural environments may be of
relevance in the developmental origins of health and disease
(DOHaD) construct. DOHaD is based on volumes of evidence that
link perinatal and early life experiences with long-term health
outcomes [68]. Low birth weight has been associated with
subsequent depression and difculties in cognition, academic
achievement, motor skills, and social adaptive functioning later in
life [6971]. The ripple of unchecked psychological stress and a
sedentary lifestyle during pregnancy [72,73] may even extend
from generation to generation [74].
Several studies have linked residential greenness with healthy
term pregnancies [7578]. A recent study of over 64,000 birth
outcomes in Vancouver, Canada, showed that greenness within
100 meters of residence is associated with higher term birth
weight and reduced likelihood of preterm births. Importantly,
these associations in were independent of air pollution, noise,
walkability, and distance to the nearest park [78]. This suggests
that stress reduction, perceptions of the neighborhood, or other
undened biological interaction with natural environments during
pregnancy may inuence birth outcomes. Moreover, taking these
ndings together underscores the notion that the benets of
natural environments may begin even before birth.

Stress physiology
The epidemiological studies are supported by intriguing
experimental studies. A popular research design is to employ
measurements of physiology and/or validated instruments of
neuropsychological relevance before and after experimental
exposure to actual natural environments, elements of nature
(e.g. sounds, aromatic chemicals), or surrogates such as photographic images of nature. The control in these studies is typically
the built urban environment or images thereof. Using this design,
researchers have explored the impact of the natural environment
on stress physiology.
Spending time in nature, participating in activities associated
with gardening, or simply viewing scenes of nature have each been
associated with favorable responses as measured by autonomic
control and heart rate variability [7983]. As an illustrative
example, viewing scenes of nature versus an urban built
environment for 10 minutes prior to the induction of mental
stress results in enhanced heart rate variability and more
dominant parasympathetic activity [84]. These studies strengthen
the previously described evolutionary and epidemiological research that also suggest a strong connection between the natural
environment and mental health.
Research interest in so-called shinrin-yoku (Japanese term for
forest bathing) or forest therapy is increasing [85]. Researchers
engaged in eld work have evaluated various end-points while
subjects walk (or contemplate while seated comfortably) within
forest settings. They have compared these outcomes with similar
walking or contemplation within urban built environments while
under similar weather, atmospheric conditions and time of day.
Improvements in mood are reported after experiences within
forest settings. Subjective reports are matched by changes in stress
physiology and associated markers such as lower cortisol, reduced
sympathetic tone, lower burden of oxidative stress and systemic
inammation, improved blood pressure, natural killer cell count/
activity and heart rate variability [8595].
Cognition
Several studies have found inverse relationships between
childhood play experiences in green/blue spaces and hyperactivity
and/or inattention [9699]. The results of controlled laboratory
experiments indicate that certain environments are more likely to
facilitate cognitive restoration following mental fatigue. For
example, viewing scenes of nature (vs. urban built scenes) can
lead to more rapid recovery of cognitive performance (executive
attention, memory recall, target identication, reaction time,
logical reasoning, anagram task performance) in the period
following research-induced mental fatigue [100106].
Field studies indicate that natural environments can mitigate
cognitive fatigue. For example, researchers induce neuro-cognitive
fatigue in subjects via mentally challenging tasks, after which they
take a walk in a vegetation-rich park or on streets with very few
elements of natural environments. Prior to and at the conclusion of
the walk, neuropsychological tests are utilized to measure effects
of the differing environmental experience. Using this general
design, researchers have reported signicant cognitive benets
following a walk within urban natural (versus built) environments
in adults with depression [107], children with attention decits
[108], and otherwise healthy adults [109,110].
Natural environments may be an effective means to mitigate
consequences of the increased cognitive load that is often
characteristic of modern urban environments. Research shows
that humans discount the value of future rewards, instead
prioritizing smaller immediate rewards, and that greater discounting is associated with impulsivity, depression, obesity, and a

A. Mantler, A.C. Logan / Advances in Integrative Medicine 2 (2015) 512

host of detrimental lifestyle habits [111113]. Overall cognitive

load, perceived competition for resources, and even physical
aspects of urban environments may magnify delay discounting. For
example, when queried on an urban street while in the vicinity of a
fast-food outlet, respondents are much more likely to discount the
value of a future nancial reward, choosing instead a smaller
immediate gain [114]. On the other hand, researchers have found
that viewing scenes of nature or actually being in urban natural
environments (versus control scenes of, and actually being in, the
urban built environment) is associated with signicant reductions
in impulsivity and future discounting [115,116].
Time spent in natural environments has also been associated
with improved creativity and overall vitality [117,118]. If natural
environments can buffer stress, improve cognition and inuence
affect, as cited in the literature above, then it would seem plausible
these benets might carry forward to academic performance.
Although this is a new area of enquiry, emerging studies have
linked proximity of academic settings in relation to natural
environments as well as classroom views to natural environments
with enhanced academic performance [119121]. In occupational
settings, window views to nature and the presence of indoor
potted plants have been linked to improved workplace performance [[7_TD$IF]122,123].
Non-visual aspects, natural light
Studies involving photographic images lend strong support to
the idea that physiological responses to natural environments can
be mediated through the visual system [100]. However, real-world
experiences in the natural environment involve all sensory
systems; thus, differences in natural versus urban built environments are not limited to those detected by the visual system.
Building on aforementioned research, studies have indicated
benecial effects on stress physiology, relaxation and mood using
auditory (sounds of nature), olfactory (volatile chemicals released
from leaves), and even tactile (touch of real leaf vs. synthetic leaf
made of resin) experiences [[8_TD$IF]124[9_TD$IF]130]. Research related to charged
ions and respirator health is controversial; however, recent
reviews support the assertion that negative ions have moodregulating properties [[10_TD$IF]131,132]. While there is little doubt that the
relative concentration of negatively charged ions is higher in
natural environments [[1_TD$IF]133], there is no evidence to guide a clinical
dose and duration of exposure via ion-generating machines.
The hygiene hypothesis suggested that modern environmental
changes contribute to a loss of contact with microbial diversity and
increased risk of allergy/autoimmune conditions [[12_TD$IF]134]. However,
over a decade ago it was suggested that benecial inuence of nonpathogenic microbes in regulating allergy (through T helper cell
TH1:TH2 immune effects [[13_TD$IF]135] and other pathways [[14_TD$IF]136]) might
also extend into conditions where diminished mood is commonly
reported. Groundbreaking studies in rodents and humans have
supported the concept that environmental microbiota may
inuence mood [[15_TD$IF]137]. Although the research primarily examines
the relationship between microbes and mood using probiotics as
the modality, it is worth noting that lactic acid bacteria and other
benecial microbes are frequently found in natural environments
[[16_TD$IF]138,139]. The microbes within the mammalian intestinal tract,
although undoubtedly inuenced by dietary factors, are also a
product of environmental bacteria [[17_TD$IF]140,141]; thus, it can be
postulated that similar effects may be conferred through interaction with microbes in an environmental setting.
Greater overall diversity of microbes is found in the rural (vs.
urban) near-surface atmosphere, including a relatively higher level
of the phyla that are commonly found on human skin and in the
intestines such as Actinobacteria, Bacteroidetes, Firmicutes and
Proteobacteria [[18_TD$IF]142]. How geography and culture inuences

human microbiota is an open question [[19_TD$IF]143]. Recent European

studies have connected the level of green space and biodiversity of
vegetation surrounding ones residence with both diversity of
select bacteria on the skin, and lower odds of an allergic IgE
reaction to common allergens [[20_TD$IF]144,145]. These results appear even
more intriguing in the context of a recent report showing that live
Mycobacterium vaccae (non-pathogenic microbe, typically found in
soil, mud and/or natural water wells [[21_TD$IF]146]) can improve cognition
and reduce experimental signs of anxiety in an animal model [[2_TD$IF]147].
While the research is still in its beginning stages, it indicates that
microbial load is another way in which the natural environment
may interact with mental health.
Although the relationship between reduced daylight exposure
and excessive light at night (LAN) has been the subject of extensive
reviews in the mental health realm, there is no question that nonimage forming components of the eyes are critical in the
transduction of light energy into circadian-regulating communications [[23_TD$IF]148]. This system is a product of the multi-millennia
experience of life outside in day light and under a dark sky at night
[7]. Residing in areas that were particularly dense in green space
in the range of 80% was associated with healthier patterns of
sleep (duration), a nding that was distinct from association with
physical activity, socioeconomic status or current psychological
distress [[24_TD$IF]149].
The extent to which green space is a surrogate marker for less
exposure to light at night is an open question; however, spending
time outdoors allows individuals to obtain levels of light levels
associated with mood support and lower body mass index
[[25_TD$IF]150,151]. In particular, in the morning there are high levels of
the shorter wavelength blue light and this may have a specic
evolutionary relationship to the processing of emotion, and
maintaining/resetting circadian rhythms [[26_TD$IF]152[27_TD$IF]154]. Thus, areas
with greater green space may increase the time spent outdoors
during these critical times when blue light is at its maximum, and
less LAN, enabling the body to set appropriate circadian rhythms
and establish healthier sleep patterns.
Grey space, vulnerable populations
It is difcult to discuss the potential health benets of natural
environments without reference to the Janus of detriments known
as grey space. These are residential areas with disproportionate
industrial and commercial activity, high levels of trafc, freight
transportation hubs, bars/liquor stores, convenience stores, fastfood outlets, and highly visible marketing toward unhealthy lifestyle
choices [[27_TD$IF]154[28_TD$IF]163]. As these references indicate, grey spaces do not
occur at random in urban areas, they are more prevalent in lower
socioeconomic areas. Also noteworthy is the higher burden of
mental health disorders and psychological distress that is slanted in
the direction of disadvantaged populations [[29_TD$IF]164].
Green space may simply be a surrogate marker for less of the
grey space factors that work against mental health. In other words,
more green space, if only through displacement alone, may equate
to less noise, trafc, environmental toxins and marketing cajoling
toward (and opportunity to partake in) unhealthy lifestyle choices
[[30_TD$IF]165[31_TD$IF]167]. Urban vegetation is an essential ecosystem service, and
its density is often slanted along socioeconomic, political and
demographic lines in favor of the socially advantaged [[32_TD$IF]168].
Furthermore, since trees clear millions of tonnes of pollutants each
year, their absence from grey space is not merely an aesthetic issue
[[3_TD$IF]169].
Environmental degradation
If natural environments are working toward the promotion of
public health mental health in particular we would expect

A. Mantler, A.C. Logan / Advances in Integrative Medicine 2 (2015) 512

there to be consequences when such environments are subjected

to degradation. Industrial activities, climate change, invasive
species, or a combination are examples of environmental variables
that alter natural environments. Indeed, emerging research
highlights that visible environmental degradation impacts health.
Changes to vegetation and tree loss at the community and regional
level are associated with increased physical illness and declining
mental health. Specically, these losses appear to provoke
depressive symptoms and a loss of sense of place [[34_TD$IF]170[35_TD$IF]175].
Clinical considerations
For now, there remain signicant knowledge gaps in the
relationships between natural environments and mental health.
However, despite the limitations and the obvious need for more
research, it seems safe to conclude that an increasingly robust body
of research suggests natural environments are of clinical importance. Given the signicant aforementioned body of evidence,
clinicians can play an important role in bridging the gap between
the potential benets of nature and the realized promotion of
positive mental health.
Natural environments provide top-level opportunity for physical activity and social engagement both factors encouraging
positive mental health. Community gardening and horticultural
group activities that can inuence social connections, physical
activity, healthy dietary habits and nature connection [[36_TD$IF]176[37_TD$IF]183];
however, some research has shown that the benets of green space
seem to transcend physical activity alone [[38_TD$IF]184]. For the clinician it
is worth noting that physical activity conducted in natural
environments is reported to be more enjoyable and less taxing
(vs. indoor, treadmill, oval track, or in the built environment) [[39_TD$IF]185
[40_TD$IF]189]. Such motivation may be particularly benecial for patients
with mental disorders for whom exercise may not feel pleasurable;
therefore, using natural environments could lead to enhanced
compliance [[41_TD$IF]190,191].
Since there are no specic dose and duration clinical
guidelines, best judgment based on familiarity with a patient
and their tness for select activities will prevail. However, in
prescribing nature, clinicians may enhance positive outcomes by
providing advice on mindfulness techniques for the patient to
utilize while in natural environments. At least one study has shown
that cognitive behavioral therapy conducted in an arboretum
(forest) setting was more effective than hospital-based CBT or
standard care in the community [[42_TD$IF]192]. Despite the impracticality
to the provider, it is interesting to speculate that some of the inbetween-session homework may be more effective if the patient
approaches some aspects of contemplation in nature settings.
Caveats
Since ours is an illustrative review rather than a meta-analysis
or a critical interpretation of the methodological shortcomings of
the existing data, we advise caution concerning broad interpretations of the research quality. Much of the epidemiological evidence
is not resting on the strength of longitudinal research. The strength
of the argument in favor of a mental health value of natural
environments is largely derived from layering existing singlediscipline research (e.g. epidemiology) on top of separate singlediscipline research (e.g. environmental psychology) and laboratory
work on stress physiology, such that a more powerful mosaic
emerges.
Throughout this review we may also (unintentionally) give the
impression that time spent in natural environments is a continuous and universally benecial experience. Not all natural
environments are cognitively or emotionally restorative, especially
when perceptions of safety are compromised [[43_TD$IF]193]. Natural

environments are not without risk; examples include excess

exposure to ultraviolet radiation, contact with disease-carrying
vectors, encounters with dangerous animals [[4_TD$IF]194[45_TD$IF]197]. However,
with proper precautions these potential risks are signicantly
minimized.
Conclusion
Despite limitations and knowledge gaps, it is evident that the
natural environment and its parts (e.g. natural light) has a
signicant impact on numerous levels of mental health. The
results of epidemiological studies are being bolstered by laboratory and eld studies that examine markers of stress physiology.
While many questions remain, especially those concerning
mechanisms, effect size and gradients of importance based on
gender, socioeconomic status, and specic natural environment
attributes (features; blue space vs. green space; safety; aesthetics),
the available research may have implications in clinical application. The extent to which the natural environment can inuence
mental health, as well as how it can be effectively utilized, is an
area for future research.
Contributions
Both authors made substantial contributions to this illustrative
review, including acquisition, analysis and interpretation of data;
both authors drafted and revised the article for important
intellectual content and agree to its nal version.
Conicts of interest
AM, none; ACL is co-author of Your Brain on Nature (HarperCollins, 2012).
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