High Per-capita Area of Accessible Urban Green Space and Lower Self-reported Anxiety/Depression Problems among Older Adults in Korea: A Nationwide Multilevel Study

Although a growing body of literature has linked urban green space to better mental health, less is known about population-normalized area-level green-space provision intended for everyday use, particularly among older adults. This study examined the association between district-level per-capita living-area urban forest area and self-reported anxiety/depression problems among older adults in South Korea. We analyzed data from 79,931 participants aged 65 years or older in the 2024 Korea Community Health Survey. Anxiety/depression problems were assessed using the anxiety/depression dimension of the EQ-5D-3L. Exposure was measured using the 2023 Korea Forest Service per-capita living-area urban forest indicator, assigned to each participant’s district of residence, and categorized into quartiles. Associations were examined using two-level random-intercept logistic regression models accounting for clustering within public health center areas and adjusting for individual-level covariates, including the urban-rural residential classification. Overall, 17.5% of participants reported anxiety/depression problems. Compared with the lowest exposure quartile (< 9.7 m 2 /person), the highest quartile (≥ 31.8 m 2 /person) was associated with lower odds of anxiety/depression problems (adjusted odds ratio, 0.74; 95% confidence interval, 0.63–0.87), whereas no statistically significant associations were observed for the intermediate quartiles. These findings suggest that a high level of district-level living-area urban forest provision may be associated with lower odds of anxiety/depression problems among older adults, with potential implications for age-friendly urban planning.