Abstract
The association of natural environmental exposure and air pollution with depression incidence among cancer survivors, as well as the potential role of plasma metabolomics, remains unclear. Here, we analyze 21,507 cancer survivors from the UK Biobank over a median follow-up of 12.39 years and find that individuals exposed to higher levels of green space and natural environment (tertile 3 vs. tertile 1) within a 1000-m buffer have 15.8% (95% CI: 4.0%-26.1%) and 18.2% (95% CI: 7.0%-28.1%) lower risks of depression, respectively. The strongest protective association is observed among breast cancer survivors. In contrast, higher exposures to nitrogen dioxide and nitrogen oxides are associated with an increased risk of depression. Meanwhile, plasma metabolic signatures associated with green space and natural environment may partially mediate these associations. These findings highlight that residential green space, natural environment, and lower air pollution levels may reduce depression risk among cancer survivors, possibly via metabolic pathways.
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Data availability
The UK Biobank patient-level data are available under restricted access for bona fide researchers; access can be obtained by applying at http://ukbiobank.ac.uk/register-apply/. Raw data are protected and are not available due to data privacy laws. All participants provided informed written consent to take part in the study. Ethics approval for the UK Biobank was granted by the North West Multi-Centre Research Ethics Committee in 2006 and was updated regularly after that (https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/about-us/ethics). This study was conducted after approval by the UK Biobank under application reference 724597. Source data are provided with this paper.
Code availability
The analysis code is available on GitHub (https://github.com/garic019/NCOMMS-25-08485-zjh) and has been archived on Zenodo (https://zenodo.org/records/17684180).
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Acknowledgements
This research was conducted using data from the UK Biobank study (Project ID: 724597). We would like to thank all UK Biobank participants and the UK Biobank management team. X.L. was supported by the National Natural Science Foundation of China (No. 82204019 and 82470543), Healthy Zhejiang One Million People Cohort (No. K-20230085), and the Zhejiang Provincial Clinical Research Center for CANCER (No. 2022E50008 and 2024ZY01056), and Key R&D Program of Zhejiang (No. 2023C03049). Y.D. was supported by the Key Research and Development Program of Zhejiang Province (No. 2024C03143). J.Z. was supported by the Fundamental Research Funds for the Central Universities (No. 2024BSSXM20) and Key Laboratory of Integrated Care for Geriatric Chronic Diseases, Yunnan Provincial Education Department (No. 2024HTHLYB05). L.X. was supported by the Key Laboratory of Integrated Care for Geriatric Chronic Diseases, Yunnan Provincial Education Department (2024HTHLYB01). Figure 1 was created in BioRender under a licensed agreement (Agreement number: NL29BITH86; https://BioRender.com/v51frxu).
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J.Z., formal analysis (lead), writing-original draft (lead), conceptualization (lead), methodology (equal); J.Y., software (lead), visualization (lead), writing-original draft (equal); E.X., methodology (lead), writing-review and editing (equal); L.X., writing-review and editing (equal), visualization (equal); J.S., writing-review and editing (equal); S.Z., methodology (supporting), writing-review and editing (supporting); T.L., visualization (supporting). H.C., software (supporting); Z.S., writing-review and editing (equal); W.W., writing-review and editing (equal); Y.H., writing-review and editing (equal), methodology (supporting); Y.D., conceptualization (lead), writing-review and editing (lead), supervision (equal); X.L., conceptualization (lead), writing-review and editing (lead), supervision (lead), methodology (equal). All authors critically reviewed the manuscript for important intellectual content. X.L. and Y.D. are the study guarantors. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
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Zhao, J., Ye, J., Xue, E. et al. Residential green space, air pollution, and related metabolites in association with depression among cancer survivors. Nat Commun (2026). https://doi.org/10.1038/s41467-026-70393-4
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DOI: https://doi.org/10.1038/s41467-026-70393-4
