Original ArticlesSpatial Analysis of Greenspace and Mental Health in North Carolina Consideration of Rural and Urban CommunitiesRyan, Sophia C. BA; Sugg, Margaret M. PhD, MA; Runkle, Jennifer D. PhD, MPH; Matthews, Jessica L. PhD, MS Author Information Department of Geography and Planning, Appalachian State University, Boone, North Carolina (Ms Ryan and Dr Sugg); North Carolina Institute for Climate Studies, North Carolina State University, Raleigh (Dr Runkle); and NOAA's National Centers for Environmental Information (NCEI), Asheville, North Carolina (Dr Matthews). Correspondence: Sophia C. Ryan, BA, Department of Geography and Planning, Appalachian State University, Rankin Science West, Boone, NC 28608 ([email protected]). The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is an advanced, statewide public health surveillance system. NC DETECT is funded with federal funds by the North Carolina Division of Public Health (NC DPH), Public Health Emergency Preparedness Grant (PHEP), and managed through a collaboration between NC DPH and the University of North Carolina at Chapel Hill Department of Emergency Medicine's Carolina Center for Health Informatics (UNC CCHI). The findings and conclusions in this publication are those of the author(s) and do not necessarily represent the views of the North Carolina Department of Health and Human Services, Division of Public Health. The authors thank their external funder for supporting this work. This work was supported by the Faculty Early Career Development Program (CAREER) award (grant #2044839) from the National Science Foundation and the National Institute of Environmental Health Sciences (NIEHS) award (grant # 1R15ES033817-01). The authors declare no conflict of interest. Human Ethics Statement: Data were exempt under human subjects category #4 for secondary data from Appalachian State University's institutional review board (IRB#19-0270). Family & Community Health 46(3):p 181-191, July/September 2023. | DOI: 10.1097/FCH.0000000000000363 Buy Metrics Abstract Greenspace positively impacts mental health. Previous research has focused on the greenspace-mental health relationship in urban areas. Yet, little work has looked at rural areas despite rural communities reporting similar rates of poor mental health outcomes and higher rates of suicide mortality compared with urban areas. This ecological research study examined the following research questions: (1) Do public and/or private greenspaces affect the spatial distribution of mental health outcomes in North Carolina? (2) Does this relationship change with rurality? Emergency department data for 6 mental health conditions and suicide mortality data from 2009 to 2018 were included in this analysis. Spatial error and ordinary least squares regressions were used to examine the influence of public and private greenspace quantity on mental health in rural and urban communities. Results suggest greenspace benefits mental health in rural and urban communities. The strength of this relationship varies with urbanity and between public and private greenspaces, suggesting a more complex causal relationship. Given the high case counts and often lower density of mental health care facilities in rural areas, focusing attention on low-cost mental health interventions, such as greenspace, is important when considering rural mental health care. © 2023 Wolters Kluwer Health, Inc. All rights reserved.