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.