Chapter 154
Promoting Mental Health — 2
Astudy based on the NatureScore in Texas using 61 million outpatient encounters, of which about 370,000 visits were for mental health, found a correlation of higher NatureScore and lower mental health utilization across 1,169 zip codes. Significantly less stress anxiety and depression were seen in places with a NatureScore above eighty, adjusted for socioeconomic and demographic factors. Residential green space was assessed in the Nurses’ Health Study cohort of more than thirteen thousand middle-aged women, with better scores on cognitive tests, psychomotor speed, and attention associated with quantity of ground vegetation. Besides the link with mental health, a meta-analysis of all green space impact on health studies provides evidence for its association with reduced cardiovascular mortality and both the prevalence and incidence of diabetes.
Acknowledging the nature deficit disorder, nature “prescriptions” from health or social professionals are coming into vogue, recommending a fixed amount of time per week in a park or other natural setting. A comprehensive review of all randomized and observational studies of nature prescriptions showed less anxiety, less depression, improved blood pressure data, and increased physical activity. After reviewing all these papers, I’ve begun prescribing nature walks and visits to my patients, an opportunity I have missed until now.
One thing you will hear in nature, and you don’t have to travel into exotic wilderness, is birdsong. From nature’s music to the myriad human versions, the health effects are more powerful that we tend to think.
The magic of music to help alleviate symptoms from a variety of illnesses and reduce anxiety, stress, and depression has led to a whole new field in medicine—music-based interventions. In 2017, the National Institutes of Health had its first Music and the Brain workshop; it reconvened hundreds of experts at the end of 2023 to review the progress made in the science of music and to plan the next phase of research, including randomized trials.
At a more recent Music as Medicine conference, among many new studies reported, one was a music-based intervention to reduce chronic pain. That turned out to be substantially more effective when patients sang in a group rather than individually. A small, randomized study of singing for thirty minutes showed improvement of vascular endothelial function in older adults with heart disease. While there’s still so much to be learned about music’s potential therapeutic effects, advances have been made in unraveling some of the impact on brain circuits using brain MRI, electroencephalograms, transcranial magnetic stimulation, behavior capturing technology, and experimental models such as the songbird. Breaking music down to its three major elements, melody, harmony, and rhythm, alongside mode of delivery, solo or group, passive (listening) or active (performing), helps to dissect the specific effect. The auditory pathway that first processes music appears to be linked to motor and affective neural networks. These connections show benefits for Parkinson’s disease, stroke, anxiety, and stress. The interlink between auditory and cognitive or sensory system processing may underlie potential impact in Alzheimer’s disease, pain, or cardiovascular diseases. This may also promote healthy interoception: how the brain senses the body, interpreting and integrating body signals. For the latter, body maps were created for hundreds of participants’ perceptions of chord progressions, particularly those with surprise or uncertainty features. A consistent finding from brain imaging assessments is the activation of reward circuits, which aligns with the perception of music-induced pleasure. It’s fair to say that it’s still early in the music-based intervention field for proof of efficacy, but surely there is no mental health disadvantage to enjoying music, whatever your personal taste—Bach, Beatles, or Taylor Swift.