Outdoor play and nature connectedness as potential correlates of internalized mental health symptoms among Canadian adolescents


Engagement with natural environments may provide adolescents with some protection against symptoms of poor mental health

This study explored how outdoor play and perceived importance of nature connectedness related to psychosomatic symptoms in Canadian adolescents. Psychosomatic symptoms are indicators of poor mental health. Earlier studies indicate that spending time outside can potentially reduce the risk of mental health in young people. Previous studies have also shown a positive link between connectedness with nature and mental health. This previous research, however, did not focus on adolescents. This research addresses this gap. Because just being outside doesn’t necessarily mean being connected to nature, this study explored both outdoor time and connectedness to nature in relation to psychosomatic symptoms in adolescents.

Data for this research was based on over 20,000 children (age 11-15) participating in the 2013/2014 Health Behaviour in School-aged Children (HBSC) study which involved students from 377 schools in Canada. An outdoor play measure asked students to report how much time they usually spend playing outdoors outside school hours during the week and on weekends. For nature connectedness, students were asked to respond to two questions: (1) “How important is it for you to feel connected to nature?” and (2) “How important is it for you to care for the natural environment?” Their response options ranged from 1 (“not at all important”) to 5 (“very important”). For psychosomatic symptoms, students were asked to indicate how often they experienced the following symptoms in the past six months: feeling low or depressed, irritability or bad temper, feeling nervous, difficulties in getting to sleep, headache, stomach ache, backache, and feeling dizzy.

Students reported playing outdoors outside of school hours for an average of 15 hours per week. Almost 9% (8.9) reported no time playing outdoors. Boys reported more outdoor time than girls. Almost 60% (59.2) of the participating students considered connection to nature “important,” with slight differences noted between boys and girls (57.2% for boys; 61.0% for girls). Approximately 28% of the students reported high levels of psychosomatic symptoms. These symptoms were found to be associated with various personal and environmental factors: perceived family wealth, ethnicity, urban-rural status, school climate, neighborhood social capital, family support, family communication, and friend support. Data analysis showed that outdoor time and connections to nature related to psychosomatic health. Engagement in outdoor play (even 30 minutes per week) was associated with decreased psychological symptoms of girls. Appreciating the importance of feeling connections with nature was associated with decreased psychosomatic symptoms in both boys and girls.

These findings suggest that engagement with natural environments may provide some protection for adolescents against symptoms of poor mental health. This research also highlights the importance of considering gender differences when developing public mental health initiatives related to outdoor environments.


Piccininni, C., Michaelson, V., Janssen, I., Pickett, W., (2018). Outdoor play and nature connectedness as potential correlates of internalized mental health symptoms among Canadian adolescents. Preventive Medicine, 112, 168-175.



Mental health benefits of interactions with nature in children and teenagers: A systematic review


Interactions with nature may positively influence the mental health of children and teenagers

This systematic review of the literature examined evidence of the mental health benefits for children and teenagers interacting with different types of nature.  This research differs from some other studies relating to children and teenagers’ mental health status in that it focuses on external influences (including home and neighborhood environments) versus individual-level factors (such as biological and socio-economic characteristics). A specific objective of the review was to determine how interacting with different types of nature may benefit the mental health of children and teenagers. Such a determination could have long-term implications, as mental health issues developed during childhood may persist into adulthood.

Studies included in this review met the following criteria: (1) the population included children and teenagers 18 years and under, (2) the intervention incorporated an element of nature, (3) the outcome or outcomes included a component of mental health, and (4) the study was based on quantitative versus qualitative data. Additional search parameters included publication dates 1990 to March 1, 2017 and published in English or French. Studies deemed to be of poor quality were eliminated. The remaining 35 papers meeting all the selection criteria were included in this review.

Eleven of the studies were conducted in the USA, 8 in the UK, and 2 in Canada. The 14 remaining studies were conducted in other countries. The studies addressed eight categories of mental health outcomes: emotional well-being, attention deficit disorder/hyperactivity disorder, overall mental health, self-esteem, stress, resilience, depression, and health-related quality of life. Of these, emotional well-being and attention deficit disorder/hyperactivity disorder were studied the most often. Childhood depression was rarely studied, and anxiety was not studied at all. Approximately half of the studies reported statistically significant positive relationships between nature and mental health outcomes; approximately half reported no statistical significance. The studies addressed various forms of interactions with nature, including accessibility, exposure, and engagement. Of these, engagement was the most commonly used interaction to assess the relationship between mental health and nature; however, engagement was the least likely of the three forms of nature interaction to yield positive results. In contrast, exposure was the most likely to yield positive results.

low ropes course Glenhaven Park

The overall findings of this review support the understanding that nature positively influences the mental health of children and teenagers. While additional and more rigorous research is required to confirm these findings and to include a broader population, the evidence of a positive link between nature engagement and mental health is strong enough to support planning and policy initiatives designed to increase children’s and teenager’s access to natural environments.


Tillmann, S., Tobin, D., Avison, W., Gilliland, J., (2018). Mental health benefits of interactions with nature in children and teenagers: A systematic review. Journal of Epidemiology and Community Health



Characteristics associated with high and low levels of ecological literacy in a western society


Nature-related childhood experiences are positively related to ecological literacy in adulthood

Ecological literacy includes an understanding of how the Earth’s life-systems work and is fundamental to the health and survival of humans and many other living beings. The aim of this research was to identify “the underlying characteristics associated with ecological literacy or its deficiency, and to highlight any informative patterns.”

Over 1000 South Australian adults completed a survey instrument assessing their levels of ecological literacy. Items on the survey addressed their local and global environmental knowledge and their understanding of how local and global systems interconnect with each other and with human society. The participating adults also responded to survey questions focusing on a range of socio-demographic and lifestyle characteristics as well as perceived contributors to their ecological knowledge and understanding. Researchers used the ecological assessment scores to establish five levels of ecological literacy: extremely low, low, moderate, high, and extremely high. Most of the participants’ scores were in the high and moderate groups. For purposes of this study, just two groups were included: a “high group” (limited to those who scored “extremely high”) and a “low group” (consisting of the combined “low” and “extremely low” groups). The two groups were similar in size: 45 in the high group; 53 in the low group.

In analyzing the data, the researchers compared the high and low scorers in relation to a range of socio-demographic characteristics, including gender, age, education levels, place of growing up, student status, and employment status. They also compared the two groups in relation to psychological and lifestyle characteristics as these related to nature. Findings showed distinct difference between the two groups. Characteristics of the “high group” (i.e., the group with the most ecologically literate individuals) included (a) rating nature as very important in both their childhood and current households, (b) considering spending time outdoors as extremely important to their enjoyment of life, (c) spending at least one to two days per week involved in a natural setting, (d) engaging in pro-environmental volunteer activity, (e) growing a portion of their own food and consuming food grown or produced locally, and (f) being very interested in improving their knowledge and understanding of the natural environment. Other characteristics associated with high ecological literacy included higher levels of education (especially, science- and natural resource-based education); learning through mentors, colleagues and peers; growing up in small communities; and being male.

These findings support previous research indicating that spending time in nature contributes to human health and well-being and may promote pro-environmental behaviors. This research adds to the literature by finding a positive link between time in nature and ecological literacy. While the participants in this study tended to have a professional or personal environmental interest and thus not representative of a more diverse population, the results suggest that promoting greater engagement with natural environments may help individuals and groups become more ecologically literate.


Pitman, S.D., Daniels, C.B., Sutton, P.C., (2018). Characteristics associated with high and low levels of ecological literacy in a western society. International Journal of Sustainable Development & World Ecology, 25(3), 227-237.



Combining Acceptance and Commitment Therapy with Adventure Therapy to promote psychological wellbeing of children at-risk


The natural environment seemed to play a key role in advancing the goals of a therapeutic program for children with challenging emotional and/or behavioral needs

This study represents a preliminary evaluation of a therapeutic program combining two different approaches: Acceptance and Commitment Therapy (ACT) and Adventure Therapy (AT).  ACT uses a cognitive behavioral approach to helping individuals “achieve a valued and meaningful life.” The AT approach is designed to “remedy psychosocial difficulties through one’s engagement with outdoor activities and experiential learning exercises.” The integrated program is referred to as “ACT in the Outdoors.”

Nine children (age 11 -12) from the ACT in the Outdoors program participated in this study. All of the children were identified as having behavioral and emotional difficulties. The program consisted of 8 weekly sessions conducted in outdoor settings, including a beach and a park. The first 7 sessions were one hour in length; the last session was 2 hours in length. Program activities were planned and conducted by a multidisciplinary team of professionals consisting of a registered psychologist with specific ACT training, a specialist in outdoor learning and experiential education, a therapeutic recreation specialist, and a nature pedagogue. The focus of the activities included the six core processes of ACT: acceptance, defusion, contact with the present moment also known as mindfulness, self-as-context, valuing, and committed action. These processes working together are designed to help individuals achieve psychological flexibility, defined as “the ability to be present in the moment, pursue important values and select behavior that is aligned to these values whilst accepting the presence of unpleasant experiences.”

Program evaluation measures included pre and post psychological assessments of participants and post interviews with participants and teachers. Interview responses indicated that changes for participating children from before to after the program included “self-calming through mindfulness, committing to action, enhanced teamwork and ability to trust others, and showing support and respect for others.” Teachers indicated that the children’s ability to calm themselves in situations where they felt angry, frustrated, or anxious was the most prominent impact of the program. Children reported that mindfulness was an important new skill they learned through the program.

The quantitative pre- and post-assessment results showed that five of the nine participants made significant progress in at least one aspect of psychological well-being. All five of these participants attended seven or eight of the program sessions. Children who attended less than seven sessions did not make such changes. Areas of improvement identified through the quantitative assessment included general school self-concept, anxiety and depression, life interference associated with anxiety, mindfulness, and psychological flexibility. In addition to attendance, level of psychological well-being when entering the program also seemed to influence the outcomes for individual children, as the data indicated that children with particularly low levels of psychological well-being at entry tended to experience greater gains from the program than the other children.

The overall results of this study suggest that the integration of Acceptance and Commitment Therapy and Adventure Therapy may positively impact the psychological well-being and skill development of children with challenging emotional and/or behavioral needs. The natural environment in this integrated model seemed to be a key facilitator in promoting some of the desired results.


Tracey, D., Gray, T., Truong, S., Ward, K., (2018). Combining Acceptance and Commitment Therapy with Adventure Therapy to promote psychological wellbeing of children at-risk. Frontiers in Psychology