https://orcid.org/0000-0001-6991-2508
Figures
Abstract
Background
Environmental exposure significantly influences mental well-being. Green spaces offer psychological benefits, while noise exposure is a recognized environmental stressor. However, their effects on mental health outcomes such as depression, anxiety, and stress remain underexplored in Lebanon. This study investigates the influence of green space and noise exposure on mental health in the Lebanese population.
Methods
A cross-sectional study was conducted using an online survey distributed across the Lebanese population. A total of 653 participants aged 18–65 years completed the questionnaire, which assessed socio-demographics, green space exposure, noise exposure, and mental health using the Arabic versions of the validated scales for depression (PHQ-9), anxiety (GAD-7), and stress (PSS-10). Data was analyzed using SPSS version 25.
Results
Higher green space exposure—such as proximity to greenery, views of natural environments, and more frequent visits—was significantly associated with lower levels of depression, anxiety, and stress (p < 0.05). Conversely, greater noise exposure at home or work, and symptoms such as sleep disturbance, irritability, or difficulty concentrating due to noise, were significantly associated with higher scores across all three mental health domains (p < 0.001). Multiple linear regression showed that some noise-related symptoms were consistently associated with higher depression, anxiety, and stress.
Conclusions
Environmental exposures play a critical role in shaping the mental health. Increasing access to green spaces and reducing noise pollution may serve as effective public health interventions to decrease levels of depression, anxiety, and stress among Lebanese residents. Urban planning and public policy should integrate these findings into mental health promotion strategies.
Citation: Youssef R, Dassuki N, El Natour D, Al Achcar J, Maadarani R, Krayker G, et al. (2026) Effect of noise and green space exposure on depression, anxiety and stress among the Lebanese population. PLoS One 21(3): e0344534. https://doi.org/10.1371/journal.pone.0344534
Editor: Robert Jeenchen Chen, Stanford University School of Medicine, UNITED STATES OF AMERICA
Received: October 28, 2025; Accepted: February 19, 2026; Published: March 20, 2026
Copyright: © 2026 Youssef et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data available in supplementary material.
Funding: The author(s) received no specific funding for this work.
Competing interests: All authors have approved the final version of the manuscript and the authors have declared that no competing interests exist.
1. Introduction
Urbanization is rapidly transforming the world, with over half the population now living in cities, a number expected to grow. While urban life offers several benefits, it also brings environmental challenges that impact health. Among these, two critical yet contrasting urban environmental exposures, green space and noise pollution, have emerged as significant factors in shaping psychological well-being [1]. Green spaces, such as parks, gardens, and urban greenery, have long been studied for their health benefits. Research has linked them to lower risks of cardiovascular disease, sarcopenia, and adverse health outcomes such as stroke, diabetes, and mental health disorders [1–8].
Increasing attention has been given to their impact on mental well-being. Studies indicate that exposure to green spaces improves mood, reduces stress, and lowers the risk of depression and anxiety [4,9–13].
In childhood, proximity to greenery is associated with lower rates of hyperactivity and behavioral issues [14,15], while in adolescence, it correlates with improved emotional resilience and reduced psychological distress [15–17].
Meta-analyses reinforce these findings, showing significant links between green space exposure and lower risks of depression, anxiety, and stress-related disorders [18,19]. Additionally, studies in the US and Europe highlight the protective role of green environments against poor mental health [20,21]. A study in urban Texas further supported this association, finding that neighborhoods with higher Nature Scores had significantly lower mental health utilization rates for anxiety and stress [22]. However, more research is needed on longitudinal changes, particularly in early adolescence [23,24].
The interaction between green space and noise exposure is complex and can have significant implications for mental health outcomes. Green spaces can help reduce stress and anxiety by buffering the negative effects of noise. For instance, studies in Zurich and Shanghai found that vegetation can lessen noise perception and lower psychological stress, though benefits may plateau beyond a certain point [19, 25]. Conversely, noise can also diminish the restorative value of green spaces, as traffic sounds interfere with calming natural sounds like birdsong [26]. Thus, the mental health benefits of green spaces depend on both noise levels and sound quality.
Great attention has been devoted to this matter as noise pollution is regarded as the second greater environmental stressor impacting human health and well-being, after air pollution [27]. Noise exposure has been associated with negative mental health outcomes, including increased stress, anxiety, and depression [28–34].
Adolescents exposed to high noise levels had a 1.56 times greater incidence of depression and 1.60 times higher anxiety levels compared to those in quieter environments [35]. A study conducted in Zurich found that noise pollution was associated with higher levels of perceived stress and long-term physiological stress responses [36]. Similarly, a study in England found that transportation noise was a significant mediator of factors associated with depression prevalence, particularly in areas with higher levels of deprivation [37]. Although several studies and meta-analyses have linked road traffic noise to increased risks of depression and anxiety—with some reporting a 4% rise in depression and a 12% rise in anxiety per 10 dB increase—the overall quality of evidence remains “very low” [29–38]. Despite this, the biological plausibility of the relationship suggests noise should still be considered a potential risk factor for mental health issues [30]. Notably, noise pollution remains an underexplored environmental determinant in mental health research, often overlooked even in broader studies on atmospheric pollution [39].
Despite growing global interest in the mental health impacts of environmental exposures, Lebanon lacks integrated research examining the combined effects of green space and noise pollution on depression, anxiety, and stress. While some studies have explored these factors separately, most of the existing literature in Lebanon lacks the direct assessment of the association between green space and noise exposure and mental health. Therefore, this study aims to assess the effect of green space and noise exposure with depression, anxiety, and stress among the Lebanese population, in addition to assessing their interaction with sociodemographic factors.
2. Methodology
2.1. Study design and settings
This cross-sectional study targets the Lebanese population, aiming to investigate the effect of green space and noise exposure on mental health parameters: depression, anxiety, and stress. An online questionnaire was developed using Google Forms as a part of the study.
2.2. Study participants
A Google Forms link was used to collect data from participants; the link was distributed on several social media platforms using snowball method. Data was collected between May and June 2025. Included responders were Lebanese and aging above 16 years were included in the study, while excluded responders were those not residing in Lebanon, younger than 16 years of age, illiterate, deaf, and those with no access to technology or internet.
2.3. Questionnaire
The questionnaire consisted of 6 main sections, and to be noted, all the scales have validated English and Arabic versions.
- The first section consists of some study variables, including sociodemographic characteristics such as age, gender, work, education, and marital status.
- Second section assessed depression using the Patient Health Questionnaire-9 (PHQ-9), a 9-item questionnaire used to screen and measure the severity of depression symptoms over the past two weeks. Each item will be rated from 0 to 3, with a total score ranging from 0 to 27 [40].
- Third section assessed anxiety using the Generalized Anxiety Disorder-7 (GAD-7), a 7-item questionnaire based on DSM-IV criteria used to measure the severity of generalized anxiety disorders. Score will be calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively, of “not at all,” “several days,” “more than half the days,” and “nearly every day.” The total score ranges from 0 to 21 [41].
- Fourth section assessed stress using the Perceived stress scale (PSS-10), a 10-item scale used to assess stress level and evaluate the degree to which an individual perceives their life as unpredictable, uncontrollable, and overwhelming over the past month. Each item was rated from 0 to 4, with a total score ranging from 0 to 40 [42].
- Fifth section assessed green space exposure, where participants were asked some questions about their place of residency and its surroundings, and the frequency of exposure to green spaces.
- Sixth section assessed noise exposure, where participants were asked about noise exposure inspired by the 10 items noise exposure questionnaire (NEQ10) described by Johnson et al [43]. This scale was modified carefully to suit the nature of noise that the Lebanese people are exposed to.
2.4. Ethical considerations
This study was approved by the institutional review board IRB of Beirut Arab University (ID: 2025-H-0161-M-R0762) on April 28, 2025. The study respected the anonymity of the participants, and all those included signed an online informed consent on the first page of the survey. All participants were also informed about the objectives and benefits of the study before starting, and all patients gave online consent before starting the survey. This study was conducted in accordance with the Declaration of Helsinki [44].
2.5. Statistical analysis
The dataset collected underwent cleaning and coding; afterward data were analyzed using SPSS version 25. Descriptive analysis was conducted where continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were presented as numbers and percentages. As for the bivariate analysis, the independent samples t-test was used to test mean differences between two groups and one-way ANOVA was used to compare means between more than two groups. As for the multivariable analysis, multiple linear regressions were conducted to assess the correlation between depression, anxiety, and stress with all factors having p value <0.2 in bivariate analysis. Statistically significant results were considered when p value <0.05 was observed.
3. Results
3.1. Sociodemographic characteristics
Table 1 shows the sociodemographic characteristics of the included sample. This study recruited a total of 653 participants, the majority of whom are females (62.3%), aged between 18 and 25 years (66.6%), and single (80.2%). As for educational status, 85.3% were university students. Only 17.8% reported working in healthcare sectors, while more than half were unemployed (53.3%).
Fig 1 shows the distribution of depression, anxiety, and stress severity among participants. For depression, 21% reported minimal symptoms, 31% mild, 22% moderate, 17% moderately severe, and 9% severe symptoms. Regarding anxiety, 21% had minimal symptoms, 38% mild, 23% moderate, and 18% severe anxiety. Stress levels were predominantly moderate (77%), followed by severe (12%) and mild stress (11%).
Table 2 shows the bivariate association between sociodemographic characteristics and depression, anxiety, and stress. Gender was found to be significantly associated with stress levels, with females having higher stress levels than males (20.61 ± 5.46 vs 18.84 ± 5.62) (p < 0.001). Divorced participants had higher levels of depression compared to others (21.00 ± 8.48; p = 0.014). However, no statistically significant associations were reported between the studied mental health parameters and age groups, educational level, or working sector.
3.2. Association between green space exposure and depression, anxiety, and stress
Table 3 shows the bivariate association between green space exposure and depression, anxiety, and stress. Those residing in urban areas were shown to have higher anxiety levels than those in rural areas (9.63 ± 5.893 vs 8.73 ± 5.343; p = 0.04), and surprisingly, those living in apartments scored a lower stress level than those living in a house (19.13 ± 5.30 vs 20.55 ± 5.71; p = 0.001). Home and work view was significantly associated with depression, anxiety and stress, with those viewing green spaces from their homes scoring less depression level (p = 0.009), less anxiety (p = 0.031), and less stress (p = 0.005), and those viewing green spaces from work/study scoring less depression level (p = 0.037) and less stress (p = 0.016).
Adding to that, proximity to green space was a significant factor; being 5 minutes away from green space was associated with lower depression levels (p = 0.045), anxiety (p = 0.041), and stress (p = 0.026) in comparison to those living in farther areas. Similarly, spending weekends or summer vacations in the mountains was associated with lower anxiety and stress in comparison to spending them in the city (p < 0.05). Finally, those who visit green spaces daily, was shown to have less stress level than others (p = 0.023).
3.3. Association between green space exposure and depression, anxiety, and stress
Table 4 shows the bivariate association between noise exposure and depression, anxiety, and stress. Higher levels of anxiety, stress, and depression were significantly associated with frequent or constant exposure to loud noises at home and work, inability to concentrate or sleep, headaches/ irritability due to loud noise, and needing to use noise-reducing measures (e.g., earplugs) with a p-value <0.001 for all.
None of the noise sources was associated with anxiety, stress, or depression, whereas time of exposure was, with those exposed to noise in the afternoon reporting higher levels of anxiety (p = 0.028) and stress (p = 0.012).
Table 5 shows the multiple linear regression considering depression as a dependent variable. Experiencing headache and/or irritability due to loud noise was significantly associated with depression symptoms (B = 1.14, 95% CI: 0.42–1.85, p = 0.002).
Table 6 shows the multiple linear regression considering anxiety as a dependent variable. Spending summer vacation outside the city (B = –0.76, 95% CI: –1.37 to –0.14, p = 0.016) was significantly associated with lower anxiety scores. In contrast, frequency of experiencing headache and/or irritability due to loud noise (B = 1.36, 95% CI: 0.72–1.99, p < 0.001) and frequency of having to take action to reduce noise exposure (B = 0.62, 95% CI: 0.10–1.15, p = 0.020) were significantly associated with higher anxiety scores.
Table 7 shows the multiple linear regression considering stress as a dependent variable. Being female (B = 1.22, 95% CI: 0.33–2.12, p = 0.007) was significantly associated with higher stress scores. In contrast, living in a house (B = –1.34, 95% CI: –2.45 to –0.23, p = 0.018) and having a highway view from the workplace (B = –1.12, 95% CI: –2.21 to –0.04, p = 0.042) were significantly associated with lower stress scores. Additionally, higher exposure to loud sounds while working in a paid job was significantly related to increased stress (B = 0.75, 95% CI: 0.20–1.30, p = 0.008). Other environmental and noise-related variables, including private garden access, frequency of green space visits, and noise-related irritability, showed only borderline associations, while the remaining predictors were not significantly related to PSS-10 scores.
4. Discussion
This study aimed to investigate the relationship between environmental exposures—namely green spaces and noise pollution—and mental health outcomes in the Lebanese population. The results showed lower stress, anxiety and depression levels among frequent green space visitors and higher levels among people exposed to noise pollution both at home and in the study/workplace. These findings align with international literature suggesting that environmental surroundings are closely linked to psychological well-being.
4.1. Green space exposure and its association with mental health
Participants living in urban areas reported significantly higher anxiety levels than those in rural settings. On the other hand, those who were living in rural areas showed lower anxiety. This aligns with existing evidence from meta-analyses, systematic reviews, and longitudinal studies, which have demonstrated similar associations, even when the observed effects were small or statistically non-significant [18,45–50].
Our results align with findings from several other studies including reviews that concluded that green space access is associated with better mental health outcomes [10,18,51–53]. Their findings support theories such as the Attention Restoration Theory and Stress Reduction Theory, which propose that simply viewing natural environments can improve mental health by reducing cognitive fatigue and physiological stress responses.
Recent research highlights the “20-minute park” effect, which suggests that even short visits to green spaces can significantly reduce cortisol levels and boost endorphin production. This physiological response contributes to lower stress and greater emotional balance, reinforcing the mental health benefits of brief but regular exposure to natural environments [54].
In the context of the Lebanese population who suffer ongoing socio-economic and urban challenges and especially for those who lives in the capital Beirut, where there is scarcity of green spaces, our study agrees with the growing body of literature highlighting the mental health benefits of exposure to green spaces. Most of the population living in Beirut, who suffer from financial hardship, suffer also from depression, anxiety, and stress. Raad et al also showed a moderate positive correlation (Spearman’s rho = 0.30) between the quality of public spaces and improved psychological well-being, highlighting the importance of spatial quality in urban mental health in a study targeting as well the Lebanese population [55].
Moreover, evidence suggests that increasing green space and reducing noise exposure can reduce psychological distress and even lower the risk of ischemic stroke in the Lebanese population [56]. Additionally, urban–rural comparisons have shown that while urban dwellers may experience more persistent depression, rural populations report higher levels of sadness and loneliness, pointing to the importance of public space interventions in both settings [57]. Our study shows that there is an association between green space access and better mental health, and this underscores the urgent need for public policies to enhance and protect urban greenery, especially in under-resourced communities.
In cities like Beirut, improving the availability, safety, and quality of green spaces could serve as a low-cost, high-impact approach to support mental resilience in the face of overlapping economic, environmental, and public health crises.
4.2. Noise exposure and its association with mental health
Noise pollution is increasingly recognized as the second most significant environmental stressor affecting human health after air pollution [27]. Chronic noise exposure has been linked to higher risks of depression, anxiety, and stress in multiple contexts. For example, a meta-analysis by Dzhambov and Lercher (2019) concluded that road traffic noise significantly increases the risk of depression and anxiety disorders [29]. Similarly, Gong et al. (2022) found that annoyance from environmental noise is linked to depression, generalized anxiety disorders, and poorer general mental health [28]. Moreover, adolescents in noisy urban environments have been shown to experience a 1.5-fold higher incidence of depression and anxiety compared to peers in quieter areas [35].
In our study, the timing of noise also appeared relevant, with afternoon exposure significantly associated with elevated anxiety and stress levels. This aligns with research suggesting that disruption of circadian rhythms and concentration during daytime activities may exacerbate the psychological burden of noise [36]. Physiologically, prolonged exposure to high noise levels has been shown to activate the hypothalamic–pituitary–adrenal (HPA) axis, increase cortisol secretion, and elevate blood pressure, mechanisms that may underlie the observed increase in psychological distress [30].
Lebanon’s unique urban context may intensify these effects. Prior studies in Beirut documented how persistent environmental noise contributes to stress, sleep disturbances, and hearing problems [58]. More recently, El Masri et al. (2024) demonstrated that the combined exposure to noise and lack of green space significantly increased the risk of ischemic stroke in Lebanon, highlighting the intersection between environmental exposure and health risks [56].
4.3. Limitations
Several limitations in the study should be acknowledged. First, the method applied is cross-sectional study which means data collection was done at a single time point. This may hinder the ability to establish a correlation between noise or green space and psychological well-being. Second, the results were collected by a questionnaire to report environmental exposure and mental health symptoms, which may be subjected to recall, selection, information and residual confounding biases. Third, the assessment of exposure was relatively subjective taking into consideration the geographic information system, the green space mapping and the noise measurement. These factors may have affected the accuracy of the results. Fourth, even though a large sample was taken for this study, it may not be fully representative of the entire Lebanese population in terms of geographic distribution and socioeconomic class, which may hinder generalization. Fifth, extraneous variables may have affected the results, such as pollution, habits, lifestyle and many other factors. Finally, in the last several years Lebanon was facing tremendous economic and political problem, which may had independently affected the Lebanese population mental health and well-being.
5. Conclusion
In conclusion, this study highlights the significant impact of green space access and noise pollution on mental health. The results underscore the urgent need for urban planning strategies, given Lebanon’s dense urbanization, and public health interventions that prioritize environmental quality especially in areas of poor living conditions. Creating and providing access to more green spaces like parks and natural spaces and taking measures to reduce noise pollution are essential steps that should be taken to improve the well-being of the Lebanese population who are experiencing growing rates of mental health disorders. Future studies using longitudinal designs and objective environmental exposure measures are needed to better assess the effect of green space and noise exposure on mental health.
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