Virginia Cioncoloni

Background: The deleterious effects of built environments on mental wellbeing are a global health concern, especially impacting deprived neighbourhoods. Green and blue spaces (GBS) are increasingly recognised as health assets, but the role of their aesthetic qualities in health protection remains unclear.Methods: Combining large-language modelling and machine learning, we developed an automated scoring system to score GBS photos based on the Contemplative Landscape Model (CLM). The tool was applied to >17,000 GBS photos from nine European study-areas identified in the GreenME Horizon Europe project for high rates of socioeconomic deprivation. These scores were used to distinguish two groups of aesthetic landscape features: CLM-static, including long-distance views, natural topography, diversified skyline, and archetypal elements such as water bodies and large solitary trees, and CLM-dynamic, such as richness in species. We analysed data from 6,173 neighborhood residents who provided GBS-visit locations and wellbeing self-reports as part of the GreenME survey. Ordinal mixed-effects regression linked GBS landscape qualities with wellbeing. Models were validated through sensitivity analysis.Findings: CLM-static features were consistently associated with greater Life Satisfaction, Life Meaning and Happiness, while CLM-dynamic features were detrimentally associated with Life Satisfaction only. For life satisfaction, these effects were attenuated among individuals with higher perceived nature access. Importantly, findings were robust across sensitivity analyses, independent of socio-demographic variables, and demonstrated relatively low risk of unmeasured confounding.Interpretation: Preserving and introducing CLM-static features may support widespread health protection. Urban planning strategies focusing narrowly on CLM-dynamic features may not, on their own, deliver broader mental health benefits. Strategic integration of scenic landscape features into public health and urban planning may support population health and wellbeing, especially in the context of deprived neighbourhoods.

Background Mental health conditions are widespread over the society and stigma exacerbates mental health impact on the individual. Nature-based therapies (NBTs) show potential to improve mental health and could have a role in modifying the links between stigma and mental health, but robust evidence remains limited. This paper describes a multi-country experimental study protocol designed to evaluate whether diverse NBTs are superior to usual care in reducing stress among adults at risk of developing mental health conditions. Secondary objectives include examining superiority in improving quality of life and subjective wellbeing, the durability of effects, exploring whether NBT participation modifies the relationship between stigma and mental health, assessing cost-effectiveness, and investigating nature connectedness as a potential mechanism. Methods Seven interventions are included: two in Spain, two in the United Kingdom, two in Italy, and one in Sweden. Participants are adults experiencing moderate-to-high perceived stress. Participants are randomized to NBTs plus unrestricted usual care or unrestricted usual care alone. Interventions involve non-clinical activities with direct contact with nature (gardens, forests, or the ocean), typically lasting 120 minutes over 12 consecutive weeks and facilitated by trained practitioners. Usual care varies by context. Data is collected at screening, baseline, post-intervention, 1-month and 3-months follow-ups. Measures include stress – as the primary outcome-, quality of life and subjective wellbeing – as the secondary outcomes-, exposure to green care, nature connectedness, internalized stigma and covariates. Primary analyses will follow the intention-to-treat principle, with intervention-level analyses followed by individual-level meta-analyses. Secondary analyses will also examine mechanisms, effect modification, and cost-utility and cost-effectiveness analyses. Discussion This study will generate robust evidence on health effects and cost-effectiveness of NBTs. Findings can support scaling up NBTs effectively for mental health.

Urban gardens are increasingly framed as multifunctional components of urban green infrastructure, yet limited evidence exists on how ordinary, municipally managed gardens are experienced through everyday and long-term use. This study examined perceived environmental restorativeness, self-reported well-being, and patterns of social and motivational engagement among users of municipally managed urban gardens in Padua, Italy. A mixed-methods design combined a qualitative phase, including document analysis, site observations, and interviews with municipal stakeholders and garden representatives, with a quantitative survey completed by 210 gardeners across ten sites (response rate ≈62%). The questionnaire collected data on sociodemographic characteristics, garden use, social interactions, motivations, and self-reported well-being, and assessed perceived restorativeness using the validated Italian 11-item Perceived Restorativeness Scale (PRS-11). Results showed that gardens were widely perceived as restorative environments, with a mean total PRS-11 score of 7.0 and high internal consistency (Cronbach’s alpha = 0.91). Cluster analyses identified distinct user profiles based on seasonal attendance, social interactions, motivations, and perceived restorativeness. In an exploratory Ordinary Least Squares (OLS) regression, motivations related to being in nature and cultivating the land were significantly associated with higher PRS-11 scores, while meeting friends showed a borderline positive association. Self-reported well-being was highly positive across the sample and showed a descriptive gradient across PRS-11 groups. Overall, the findings suggest that municipally managed urban gardens can function as everyday, socially embedded green infrastructures whose perceived restorative value depends on patterns of access, engagement, motivation, and governance, with implications for inclusive urban green infrastructure planning and municipal policy.