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Mental health benefits of interactions with nature in children and teenagers: a systematic review
  1. Suzanne Tillmann1,
  2. Danielle Tobin1,
  3. William Avison2,3,4,5,
  4. Jason Gilliland1,3,4,5,6
  1. 1Department of Geography, Western University, London, Ontario, Canada
  2. 2Department of Sociology, Western University, London, Ontario, Canada
  3. 3Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
  4. 4Children’s Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
  5. 5Department of Paediatrics, Western University, London, Ontario, Canada
  6. 6School of Health Studies, Western University, London, Ontario, Canada
  1. Correspondence to Dr Jason Gilliland, Department of Geography, Western University, London, ON N6A 5K6, Canada; jgillila{at}


Background It is commonly believed that nature has positive impacts on children’s health, including physical, mental and social dimensions. This review focuses on how accessibility to, exposure to and engagement with nature affects the mental health of children and teenagers.

Methods Ten academic databases were used to systematically search and identify primary research papers in English or French from 1990 to 1 March 2017. Papers were included for review based on their incorporation of nature, children and teenagers (0–18 years), quantitative results and focus on mental health.

Results Of the 35 papers included in the review, the majority focused on emotional well-being and attention deficit disorder/hyperactivity disorder. Other outcome measures included overall mental health, self-esteem, stress, resilience, depression and health-related quality of life. About half of all reported findings revealed statistically significant positive relationships between nature and mental health outcomes and almost half reported no statistical significance.

Conclusions Findings support the contention that nature positively influences mental health; however, in most cases, additional research with more rigorous study designs and objective measures of both nature and mental health outcomes are needed to confirm statistically significant relationships. Existing evidence is limited by the cross-sectional nature of most papers.

  • child health
  • mental health
  • environmental health
  • stress
  • geography

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  • Contributors JG devised and supervised the project. All authors made substantial contributions to study design, including development of systematic review procedures. ST and DT conducted the literature search and data extraction and independently assessed the methodological quality of included studies and conducted analysis. JG adjudicated in any disagreements in methodological quality assessments and contributed to analysis. ST, DT and JG drafted the original manuscript and WA critically reviewed the manuscript for important intellectual content. All authors have given approval of this final version to be published and agree to be accountable for all aspects of the work. No others fulfil the criteria for authorship.

  • Funding This systematic review was made possible through funding from The Lawson Foundation. ST and DT received trainee support from the Children’s Health Research Institute through funding from the Children’s Health Foundation.

  • Disclaimer The funders were not involved in the design or completion of the review.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.