Branching out: Feasibility of examining the effects of greenspace on mental health after traumatic brain injury

Alexandra B. Holland, Achituv Cohen, Afik Faerman, Trisalyn A. Nelson, Brittany Wright, Raj G. Kumar, Esther Ngan, Susan Herrera, Shannon B. Juengst

Research output: Contribution to journalArticlepeer-review


Aim: This pilot study's aim was to determine the feasibility of examining the effects of an environmental variable (i.e., tree canopy coverage) on mental health after sustaining a brain injury. Methods: A secondary data analysis was conducted leveraging existing information on mental health after moderate to severe traumatic brain injury (TBI) from the TBI Model System. Mental health was measured using PHQ-9 (depression) and GAD-7 (anxiety) scores. The data were compared with data on tree canopy coverage in the state of Texas that was obtained from the Multi-Resolution Land Characteristics (MRLC) Consortium using GIS analysis. Tree canopy coverage as an indicator of neighborhood socioeconomic status was also examined using the Neighborhood SES Index. Results: Tree canopy coverage had weak and non-significant correlations with anxiety and depression scores, as well as neighborhood socioeconomic status. Data analysis was limited by small sample size. However, there is a higher percentage (18.8%) of participants who reported moderate to severe depression symptoms in areas with less than 30% tree canopy coverage, compared with 6.6% of participants who endorsed moderate to severe depression symptoms and live in areas with more than 30% tree canopy coverage (there was no difference in anxiety scores). Conclusion: Our work confirms the feasibility of measuring the effects of tree canopy coverage on mental health after brain injury and warrants further investigation into examining tree canopy coverage and depression after TBI. Future work will include nationwide analyses to potentially detect significant relationships, as well as examine differences in geographic location.

Original languageEnglish
Article number100129
JournalDialogues in Health
StatePublished - Dec 2023
Externally publishedYes


  • Environmental health
  • Greenspace
  • Mental health
  • TBI Model Systems
  • Traumatic brain injury
  • Tree canopy coverage


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