A Systematic Review of the Nexus Between Campus Green Spaces and Mental Well-being in Mainland China and Hong Kong

The mental well-being of university students in mainland China and Hong Kong is significantly enhanced by the presence and accessibility of campus green spaces, according to a comprehensive systematic review of 22 studies. The research, published in Frontiers in Psychology, synthesized findings on how various measures of greenness relate to crucial mental health outcomes, including stress, anxiety, depression, and life satisfaction. The review underscores that despite methodological diversity across the examined studies, a consistent association emerges: increased exposure to campus greenery is linked to improved psychological health. This finding positions campus green infrastructure as a cost-effective and scalable intervention strategy for promoting student mental wellness within demanding academic environments.

The study highlights that while objective measures of greenness, such as the Normalized Difference Vegetation Index (NDVI), provided some insights, subjective assessments—which capture students’ perceptions of green space accessibility, quality, and usage—yielded more consistent and reliable positive results. This suggests that the experiential quality of green spaces plays a pivotal role in their impact on mental health. The review identified key pathways through which these benefits are realized, including increased opportunities for physical activity, enhanced social interaction, and a strengthened sense of place attachment.

The Growing Mental Health Challenge for University Students

The global challenge of mental health among university students is well-documented. With approximately 21% of first-year students reporting depressive symptoms and a significant 38% experiencing hopelessness, as noted in previous research, universities worldwide are grappling with escalating psychological distress among their student populations. This issue is particularly acute in the highly competitive academic cultures of mainland China and Hong Kong, where intense examination pressures and significant life transitions can exacerbate existing vulnerabilities. Comparative studies have indicated that Chinese students may experience higher levels of stress and psychological distress than their Western counterparts, emphasizing the urgent need for culturally relevant and accessible mental health support services.

The theoretical underpinnings for the positive impact of nature on mental health are rooted in Attention Restoration Theory (ART) and Stress Reduction Theory (SRT). ART posits that natural environments offer a form of "soft fascination" that allows for the recovery of directed attention, combating mental fatigue. SRT suggests that exposure to nature can trigger involuntary positive physiological and affective responses, reducing stress and promoting relaxation. Emerging research has begun to explore the mediating mechanisms, including physical activity, social cohesion, and perceptual restoration, which bridge the gap between green space exposure and improved mental well-being.

However, previous research has faced limitations, including a reliance on cross-sectional designs that preclude causal inference, variability in how green space is measured (objective vs. subjective), and an under-exploration of mediating mechanisms within East Asian university contexts. The unique socio-environmental landscape of mainland China and Hong Kong—characterized by dense urbanization, specific cultural orientations, and stringent academic standards—may further influence the impact of green spaces on student mental health. Factors such as congested living conditions and mobility restrictions, as experienced during recent global health crises, have underscored the importance of readily available campus green infrastructure.

Rigorous Methodology for a Focused Review

This systematic review was meticulously conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and its PRISMA-S extension for literature search strategies. The research team employed a structured protocol encompassing extensive database searches, rigorous screening of records against predefined eligibility criteria, full-text appraisal, and a narrative synthesis of findings.

Five key databases—Web of Science, PubMed/MEDLINE, China National Knowledge Infrastructure (CNKI), CrossRef, and OpenAlex—were systematically searched to ensure comprehensive coverage of both international and Chinese-language literature. While CNKI was included to capture relevant Chinese-language research, the review ultimately included only English-language studies due to resource and translation constraints. This decision, acknowledged as a potential limitation, may have led to the exclusion of valuable studies published solely in Chinese.

The search strategy was designed to be broad, combining controlled vocabulary and free-text keywords related to "green space exposure," "mental well-being outcomes," and the "population of university students." Mental well-being was defined as a multidimensional construct encompassing both negative psychological states (stress, anxiety, depression) and positive dimensions (life satisfaction, happiness, psychological restoration). The literature search was conducted on March 15, 2026, with a focus on articles published between 2000 and 2024, though all included studies ultimately fell within the 2020-2024 timeframe, indicating the recency of research in this field.

Study selection involved independent screening by two reviewers at the title/abstract and full-text stages, with discrepancies resolved through discussion and, if necessary, adjudication by a third reviewer. Data extraction followed a standardized form, with two reviewers cross-examining all extracted information to ensure accuracy and consistency. The methodological quality of the included studies was appraised using the Mixed Methods Appraisal Tool (MMAT), evaluating aspects such as study design suitability, data collection procedures, consideration of confounding factors, and outcome measurement validity.

Due to substantial heterogeneity in study designs, green space assessment methods, mental health outcome measures, and statistical reporting, a quantitative meta-analysis was not feasible. Instead, a structured narrative synthesis approach was adopted, grouping studies by key characteristics and identifying patterns in the direction and consistency of associations. Mediating and moderating variables were classified based on reported analytical approaches, with a distinction made between formal statistical mediation/moderation analyses and interpretative discussions of potential mechanisms.

Key Findings: Green Spaces Foster Student Well-being

The systematic search identified a total of 988 records, from which 22 studies met all inclusion criteria. These studies, all conducted in mainland China and Hong Kong, predominantly employed cross-sectional designs (17 out of 22), with a smaller number of longitudinal (3) and experimental or quasi-experimental (2) studies. Sample sizes ranged from 243 to 10,022 students.

Summary of Effects:
Across the 22 studies, a significant and consistent positive association was observed between campus green space exposure and improved mental health outcomes.

• Stress, Anxiety, and Depression: The majority of studies reported lower levels of stress, anxiety, and depressive symptoms among students who spent time in campus green spaces.
• Life Satisfaction and Psychological Well-being: Enhanced life satisfaction and overall psychological well-being were also frequently reported in association with green space access and use.
• Psychological Restoration: Studies specifically examining psychological restoration, the process of recovering from mental fatigue, consistently found positive effects linked to campus greenery.

Measurement Matters: Subjective vs. Objective Greenness:
A crucial insight from the review is the comparative reliability of different green space measurement approaches. Studies utilizing subjective assessments of green space—such as perceived accessibility, quality, and frequency of use—consistently reported positive relationships with mental health outcomes. In contrast, studies relying on objective measures like NDVI showed more variable results, with some yielding significant findings and others no statistically significant associations. This suggests that students’ lived experiences and perceptions of their campus environment are potent indicators of its mental health benefits.

Mediating Pathways:
The review identified several key pathways through which campus green spaces contribute to student mental well-being:

• Physical Activity: Green spaces often provide opportunities for physical activity, which is independently linked to improved mental health.
• Social Interaction: Parks and natural areas can serve as social hubs, fostering connections and reducing feelings of isolation.
• Place Attachment: A sense of connection to the campus environment, including its green elements, can contribute to a feeling of belonging and psychological security.
• Perceptual Restoration: The aesthetic and restorative qualities of green spaces allow students to mentally disengage from academic stressors and recharge.

While formal mediation analyses were conducted in a limited number of studies, the consistent reporting of these pathways across the research landscape strengthens the understanding of the underlying mechanisms.

Discussion: Implications for Campus Planning and Well-being Initiatives

The findings of this systematic review carry significant implications for university administrators, policymakers, and mental health professionals. The consistent association between campus green spaces and improved student mental health underscores the importance of integrating these environments into campus planning and development strategies.

Green Infrastructure as a Scalable Intervention:
The review positions campus green infrastructure as a scalable and cost-effective intervention for mental health promotion. Unlike some therapeutic interventions that can be resource-intensive, investing in and maintaining accessible green spaces offers a broad-reaching and sustainable approach to supporting student well-being. Universities in high-density urban contexts, where students may have limited access to nature outside of campus, are particularly poised to benefit from this strategy.

The Value of Perceived Greenness:
The stronger and more consistent findings from subjective greenness measures highlight the need to consider the student experience in designing and managing campus green spaces. This includes not only the quantity of green space but also its quality, perceived safety, accessibility, and aesthetic appeal. Features such as shaded seating areas, walking paths, and diverse natural elements can enhance the restorative experience and encourage greater use.

Addressing Equity and Access:
The review also implicitly points to the importance of equity in green space provision. Differences in how gender, socioeconomic status, and residential context affect the relationship between green space and mental well-being suggest that not all students derive equal benefits. Universities must ensure that green spaces are equitably distributed across campus and accessible to all students, particularly those who may have limited alternative access to nature.

Methodological Considerations and Future Directions:
While the evidence base is compelling, the review acknowledges several methodological limitations. The predominance of cross-sectional studies necessitates caution regarding causal inferences. Future research should prioritize longitudinal and experimental designs to establish clearer temporal relationships and causal pathways. Furthermore, standardizing greenness measures and psychometric analyses will enhance the comparability and robustness of findings across studies. Exploring mediating factors through more sophisticated analytical techniques, including physiological and behavioral measures, will provide deeper insights into the complex interplay between nature exposure and mental health.

Conclusion: A Call to Action for Greener Campuses

In conclusion, this systematic review provides robust empirical evidence that access to and use of campus green spaces have a statistically significant positive impact on the mental health of university students in mainland China and Hong Kong. The consistent correlation between green space engagement and reductions in depression, anxiety, and stress, alongside improvements in life satisfaction and perceived restoration, aligns with established theories of environmental psychology.

Despite methodological challenges, including the prevalence of cross-sectional designs and variability in measurement approaches, the aggregate findings strongly advocate for the deliberate design and maintenance of green environments as integral components of campus well-being initiatives. As universities confront rising levels of psychological stress among their student populations, investing in accessible, high-quality green infrastructure is no longer a mere aesthetic consideration but a critical strategy for enhancing mental health promotion and long-term campus planning. By prioritizing the integration of nature into the academic landscape, institutions can cultivate healthier, more resilient, and more supportive environments for their students.