Quality or quantity? Exploring the relationship between Public Open Space attributes and mental health in Perth, Western Australia Jacinta Francis a, * , Lisa J. Wood a , Matthew Knuiman a , Billie Giles-Corti b a School of Population Health, The University of Western Australia, M707, 35 Stirling Hwy, Crawley, Western Australia 6009, Australia b McCaughey VicHealth Centre for Mental Health and Community Wellbeing, MSPH, University of Melbourne, Victoria 3010, Australia article info Article history: Available online 13 March 2012 Keywords: Australia Mental health Built environment Public Open Space Parks Nature Social interaction abstract Mental health is a public health priority globally. Public Open Space (POS) may enhance mental health by facilitating contact with nature and the development of supportive relationships. Despite growing interest in the influence of the built environment on mental health, associations between POS attributes and mental health remain relatively unexplored. In particular, few studies have examined the relative effects of the quantity and quality of POS within a neighbourhood on mental health. Guided by a social eecological framework, this study investigated the relationship between POS attributes (i.e., quantity and quality) and better mental health (i.e., low risk of psychological distress) in residents of new housing developments in the Perth metropolitan area, Western Australia. The extent to which relationships between POS attributes and mental health were confounded by psychosocial factors (e.g., social support, sense of community) and frequent use of POS was also explored. Data were obtained from a cross- sectional survey (n ¼ 911), a POS audit, and Geographical Information Systems, and was analysed using logistic regression. Approximately 80% of survey participants were at low risk of psychological distress. Residents of neighbourhoods with high quality POS had higher odds of low psychosocial distress than residents of neighbourhoods with low quality POS. This appeared to be irrespective of whether or not they used POS. However, the quantity of neighbourhood POS was not associated with low psycho- logical distress. From a mental health perspective, POS quality within a neighbourhood appears to be more important than POS quantity. This finding has policy implications and warrants further investigation. Ó 2012 Elsevier Ltd. All rights reserved. Introduction Recently, there has been a growing awareness of the impact of the physical or ‘built’ environment on health (Jackson, 2003). While most health-related research regarding the built environment has focused on physical health (McLeod, Pryor, & Meade, 2004), there is an emerging body of evidence linking the built environment and mental health (Clark, Myron, Stansfield, & Candy, 2007; Cutrona, Wallace, & Wesner, 2006; Dalgard & Tambs, 1997; Evans, 2003; Galea, Ahern, Rudenstine, Wallace, & Vlahov, 2005; Guite, Clark, & Ackrill, 2006; Milligan & Bingley, 2007). Five of the ten leading causes of world-wide disability and premature death are psychi- atric conditions, while depression is predicted to be the second leading cause of global disease burden by 2020 (Murray & Lopez, 1996; WHO, 2004). Furthermore, positive mental health is recog- nised as a basic human right and a protective factor against both mental and physical illness (Raphael, Schmolke, & Wooding, 2005; WHO, 2004). Settings and interventions with the potential to benefit the mental health of whole populations are therefore required (Maller, Townsend, Pryor, Brown, & St Leger, 2005). Public Open Space (POS) is one such setting. Neighbourhood POS can be highly accessible, often attracting users of different ages, genders and cultural backgrounds. As land that is available to the public, POS can include parks, recreational grounds, sports fields, commons, esplanades and bushland/wilderness. To date, research regarding POS and health has tended to focus on POS as a setting for physical activity rather than mental health (Cohen et al., 2010; Kaczynski, Potwarka, Smale, & Havitz, 2009; Ries et al., 2009). However, evidence from studies of the broader built environment suggest that settings such as POS may influence mental health both directly and indirectly (Evans, 2003). POS may directly impact mental health via the restorative benefits arising from contact with nature (Herzog, Black, Fountaine, & Knotts, 1997; Kaplan, 1995). Alternatively, POS can indirectly influence mental health by providing places for people to meet and socialize (Semenza, 2003), which can yield social contact known to be * Corresponding author. Tel.: þ61 404 365 739; fax: þ61 864 881 199. E-mail address: jfrancis@meddent.uwa.edu.au (J. Francis). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2012.01.032 Social Science & Medicine 74 (2012) 1570e1577