Converging evidence suggests a considerable plasticity of self-representation and self-other boundaries. But what are the factors controlling this plasticity? Here we explored how changes in an individual’s affective state impact his/her self-other representation. Participants watched short videos to elicit happiness or sadness before rating unfamiliar faces with happy or sad expressions. After watching the happy video, participants showed more self-other integration of happy than sad faces, while watching the sad video reduced integration for both happy and sad faces equally. This finding suggests the interaction of two processes: Positive mood biases metacontrol toward flexibility, which fosters the processing of features in which self and other might overlap, and possible overlap increases self-other integration. Negative mood, in turn, biases metacontrol toward persistence, which focuses processing on strictly task-relevant feature dimensions, so that possible overlap is less likely to have an impact. When we reach for a cup of water, we do not need to search for our hands first—we in some sense know who we are. This kind of “self-evidence” raises a fundamental philosophical and psychological question: how do we feel and know our bodies? The answer to this lies in how people represent and recognize themselves. The relationship between my body and “I” is very different from the relationship between my body and others, and the individual’s ability to recognize that s/he is different from the outside marks the formation of self-awareness. Human infants can only pass the mirror self-recognition task after a certain age, and Self-recognition presupposes a distinction between the self and others, which, in turn, is based on how individuals represent these two. In other words, self-representation is the basis of self-recognition and the perceived ownership over one’s body . The rubObservations that the self-other distinction is not fixed but variable raise the question when and how this distinction changes and which principles these changes may underlie. There is a consensus that perceiving the states of others facilitates the activation of personal, affective, and conceptual representation . The preThe second mechanism that might render emotions and affective states relevant for self-other integration is metacontrol. This mechanism refers to the fact that adaptive behavior requires a continuous balance between cognitive persistence and flexibility . AccordiThe present study sought to test these two predictions by combining two experimental factors. For one, we attempted to induce positive or negative mood by presenting participants with what we considered happy or sad videos, and confirmed the successful induction by means of affect ratings. Second, we presented participants with unfamiliar faces showing happy or sad facial expressions and asked them to rate the closeness between themselves and this face by means of the Inclusion of Other in the Self (IOS) Scale. Since its development, the IOS scale has been used effectively in various studies regarding relationships and can assess self-other closeness as good as or even better than other more complex and lengthy measures . Our firSD = 2.197, range 19–28) from Hangzhou Dianzi University, unfamiliar with psychological experiments, participated in exchange for course credit or pay. All participants were physically healthy and had no history of mental health problems. Ethical approval for this study was obtained from the local Psychology Research Ethics Committee, and written informed consent was obtained from all participants.Eighty student volunteers  and facial expression . The experiment consisted of two blocks. Each participant watched the happy video and the sad video sequentially . After each viewing, they would see a happy face and a sad face and needed to rate the overlap between themselves and the pictures (the computer randomly assigned the order of the happy and sad expressions).M = 7.78, SD = 2.006) and one with the highest level of sadness  were selected as the emotional primes for this experiment.We used two different videos as emotion priming materials, as indicated by a meta-analysis showing that film scenes are the most effective way of priming mood . First, Facial expression pictures were made by composing multiple photos of real people and processing them with face morphing software, so to disguise their identity. We first invited volunteers to the lab for the photoshoot, and the models were asked to maintain as neutral a facial expression as possible. We took photos of 16 male and 16 female faces with neutral expressions in this process. The photos were then synthesized in groups of 8 photos of the same gender by the synthesis software (FaceFusion) to obtain four synthesized photos of the faces (there were two different pictures for each gender). To process the synthesized faces with neutral expressions, we recruited thirty volunteers and asked them to complete the following task: moving the degree bar to get an expression that they thought naturally represented happiness or sadness with the same software. We then averaged the results and used them as a criterion to generate the corresponding happy/sad expressions.”) to pleasant feelings (“9”), and the vertical axis indicates the level of arousal, ranging from sleepiness (“1”) to high arousal (“9”). Participants were required to assess their emotional state after watching the video twice during the experiment. To avoid the interference of numerical or alphabetic information on their choices, we presented them with a blank grid with explanations on horizontal and vertical coordinates.We adopted the Affect Grid AG;  to assesThe Including other in the self (IOS) scale is a pictorial measure of the relationship between self and other, in which “self” and “other” are symbolized by two circles, respectively. Participants are asked to select the arrangement of the two circles that best describes their relationship between themselves and the specific “other” . These aThe experiment was performed on a computer, and all data  were recorded automatically in the database. Participants sat in front of the computer screen and performed the appropriate actions with the mouse. Before the experiment started, they had enough time to read the instructions and decide whether to continue or withdraw from the experiment. After confirming the start of the experiment, the participants selected their gender to ensure that they would see a face of the same gender as their own. After a “+” lasting for 500 ms, a composite photo with a neutral facial expression and the same gender as the participants appeared on the computer screen. Below the photo, there was the IOS scale, and the participants needed to select the most appropriate option according to their current perceived self-other overlap. Afterward, the participants watched a happy or sad short video of 30 s duration. They were allowed to control the starting time. After the video, the AG would be presented on the screen. Participants were instructed to click on the corresponding position in the grid according to their current affective state. Then, the same face but with different facial expressions appeared again with the requirement to judge the overlap degree. The photo was presented in animation, starting with a neutral face for 2 s (the same as the face the participants had seen before), and then the neutral expression gradually changed to a happy facial expression or a sad expression within 5 s. Once the animation was over, the IOS scale appeared again, and the participants could select the corresponding number to indicate their felt overlap degree with the new expression. This process was repeated twice, separated by a “+” lasting for 500 ms, with the expressions reversed, and random parameters of the program controlled the order of presentation. Specifically, after watching the video, the participants either saw the happy expression, then the sad expression, or vice versa.The first half of the experiment ended after two consecutive overlap degree selections. In order to reduce the effect of experience on the subsequent experiments, the participants were asked to solve some simple calculation problems between two parts of the experiment, which lasted for 5 min. The program recorded the number and percentage of correct answers and gave feedback on the correctness during the experiment to attract the participants’ attention to the arithmetic task. The video in the second half conveyed the opposite mood of the first, but the procedure was the same. The whole experimental procedure is shown in During the experiment, we thus collected participants’ basic information (age and gender), IOS scores toward neutral faces before watching the videos, AG scores after watching the video, and IOS scores for happy and sad faces after watching the videos. The IOS scores for neutral faces were the baseline of the self-other overlap degree, and the results obtained by subtracting the baseline from the IOS scores toward happy and sad faces after watching the videos represent how self-other overlap changed. Specifically, we reorganized the data and obtained arousal and valence scores after watching the happy/sad videos, which were used to validate the emotional priming effects. Also, IOS changes  before and after watching the videos were calculated. The reason for choosing IOS changes instead of raw scores as the dependent variable was to consider the individual differences between the subjective judgments of different participants; therefore, the degree of change would better reflect the interaction between watching happy/sad videos and the assessment of self-other integration.F = 13.053, p = 0.001, ηp2 = 0.142 , and valence, F = 220.394, p < 0.001, ηp2 = 0.736 , which indicates that the videos successfully primed the participants’ affective states as intended.As a manipulation check, we first analyzed the priming effect of video type on participants’ affective states by means of a univariate ANOVA. The effect of video type was significant for both arousal, F = 20.862, p < 0.001, ηp2 = 0.209, due to a drop of IOS for sad faces as compared to happy faces, and a significant interaction, F = 25.211, p < 0.001, ηp2 = 0.242, indicating that the facial-expression effect was more pronounced after watching the happy video than the sad video. The main effect of video type was far from significant, F < 1. Two-tailed paired samples t-tests further revealed that, after watching the happy video, IOS scores increased significantly for the happy expression, t(79) = 2.489, p = 0.015, d = 0.278, and decreased significantly for the sad expression, t(79) = 4.899, p < 0.001, d = 0.548, and these two IOS changes differed significantly, t(79) = 6.724, p < 0.001, d = 0.752. In contrast, after watching the sad video, IOS dropped significantly for both happy and sad expressions, t(79) = 3.086, p = 0.003, d = 0.345, and t(79) = 2.474, p = 0.016, d = 0.277, respectively, and these two IOS changes did not differ, t(79) = 0.773, p = 0.442, d = 0.086. To test our hypotheses, we then submitted the IOS rating changes  to 2 × 2 ANOVA with the factors video type (happy vs. sad video) and facial expression (happy vs. sad face). There was a significant main effect of facial expression, This study aimed to investigate the principles underlying people’s tendency to include others into their self-representation. We specifically focused on the role of affective state and made two predictions. The first was based on TECs feature-overlap principle, which suggests that people would include unfamiliar others more into their self-representation if they are sharing features with them. This predicts that IOS scores should be higher if the expression shown by an unfamiliar face matches (vs. mismatches) the participant’s affective state as induced by the video. The second was based on metacontrol theory, suggesting that people should tend to include others into their self-representation more if they are in a happy mood. We primed happy and sad affective states by means of happy and sad videos, respectively, and measured the degree of self-other inclusion through IOS. Our manipulation checks confirmed that the mood induction worked as expected , suggesting that the videos were effective in inducing happy and sad states in our participants.happy faceM = 3.38, sad faceM = 3.55). Such a phenomenon might be explained under the umbrella of metacontrol theory, however (see below).The first prediction was confirmed. It amounts to the prediction of an interaction between video type and facial expression, which was indeed significant. The pattern also confirmed our expectations: IOS scores were higher if the video-induced affective state matched the expression shown by the unfamiliar face. This provides evidence for the importance of the feature-overlap principle of TEC for predicting self-other integration. However, the prediction was more successful for positive-mood induction than it was for negative-mood induction. Indeed, the predicted feature-overlap effect was significant for positive-mood induction only, whereas the negative-mood induction resulted in an overall drop and an only numerically higher IOS score for the sad face—far from any conventional significance level. This might have been due to a greater efficiency of the positive-mood induction than of the negative-mood induction, but given the very low valence scores after the sad video (2.25) this seems rather unlikely. Another possibility relates to theoretical suggestions that happy mood facilitates global processing, whereas sad mood boosts local processing . AccordiThe second prediction was not confirmed. It amounts to predicting a main effect of video type, which was far from significance. At the same time, however, the metacontrol-inspired prediction accounts for three of the four data points obtained. The prediction worked perfectly well for the sad video, which indeed reduced IOS scores for both kinds of faces. It also worked for the happy faces after the happy video, for which IOS scores increased significantly. The only exception refers to the sad faces after the happy video, for which IOS scores are much lower than for sad faces after the sad video. This suggests that the mechanisms behind our two predictions might not be functionally independent, in the sense that the impact of mood on metacontrol might have repercussions for how mood impacts the processing of feature overlap between self and other. Indeed, this would fit with our observation that the success of the feature-overlap prediction depended on the induced mood.Taken altogether, this suggests that sharing an affective state with an unfamiliar face increases self-other integration if, and only if, metacontrol is biased toward flexibility, like when being in good mood. It is assumed that flexibility is accompanied by an integrative processing mode that does not strongly distinguish between strictly task-relevant and task-irrelevant information, in contrast to the strong focus on task-relevant information under a persistence bias . Given tM = 3.894, SD = 1.654), indicating a certain overlap between the participants and the synthetic photos they saw. Such a result may be due to the fact that the photos we used in the experiment were synthesized from real photos (each synthesized face was composed of eight different photos with the same gender). Although different individuals look very different, there may be some similarities between these differences, which could be one of the bases for the ability of human beings to empathize with others. However, this remains a speculation that calls for future research.As an aside, we found that participants’ baseline level of IOS ratings before watching the video was close to moderate , National Social Science Fund of China (20FZXB017), as well as China Scholarship Council (CSC).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


In this article, we analyse how researchers use the categories of race and ethnicity with reference to genetics and genomics. We show that there is still considerable conceptual “messiness” (despite the wide-ranging and popular debate on the subject) when it comes to the use of ethnoracial categories in genetics and genomics that among other things makes it difficult to properly compare and interpret research using ethnoracial categories, as well as draw conclusions from them. Finally, we briefly reconstruct some of the biases of reductionism to which geneticists (as well as other researchers referring to genetic methods and explanations) are particularly exposed to, and we analyse the problem in the context of the biologization of ethnoracial categories. Our work constitutes a novel, in-depth contribution to the debate about reporting race and ethnicity in biomedical and health research. First, we reconstruct the theoretical background assumptions about racial ontology which researchers implicitly presume in their studies with the aid of a sample of recent papers published in medical journals about COVID-19. Secondly, we use the typology of the biases of reductionism to the problem of biologization of ethnoracial categories with reference to genetics and genomics.The online version contains supplementary material available at 10.1007/s11019-022-10122-y. Many scholars agree that the distinction between different races and ethnicities is not based on biologically relevant features but should be specified in terms of nonbiological social kinds. This approach is also clearly discernible in the latest guidelines on reporting race and ethnicity in medical and science journals  can be epistemically useful in biomedical research and healthcare as there are some medically relevant (including genetic) differences between the continental populations they allegedly describe  should influence how researchers design, conduct, and interpret research with human subjects. Although the problem has been discussed in the US for decades, it was recently revived during the COVID-19 pandemic. For example, the authors of a commentary in Jama, discussing COVID-19 and racial/ethnic disparities during the early phase of the COVID-19 pandemic, wrote in May 2020: “The possibility that genetic or other biological factors may predispose individuals to more severe disease and higher mortality related to COVID-19 is an empirical question that needs to be addressed”  that makes it difficult to properly compare and interpret research using ethnoracial categories in genetic contexts, as well as to draw conclusions from them.The use of ethnoracial categories in medical and health sciences has been the subject of numerous studies that have focused on three main groups of questions: how researchers report on ethnoracial categories in their publications  of articles related to COVID-19 in PubMed. LitCovid is “a curated literature hub for tracking up-to-date scientific information about the 2019 novel Coronavirus. It is the most comprehensive resource on the subject, providing central access to hundreds of thousands (and growing) relevant articles in PubMed”.Our first search on September 3, 2021, “ AND (gene OR genetic OR genomic)”, generated 177 results within the metadata of papers indexed by the LitCovid database. Then, on September 9, 2021, we searched Web of Science (WoS) with the same search keywords (adding only “AND (Covid-19)” and searching through titles, abstracts, author keywords) to check the completeness of our previous LitCovid database search . We added 11 papers that had not been found previously in LitCovid. Limiting the search to PubMed and WoS was intended to ensure that we obtained a corpus of papers published in high-quality journals in which editorial practices have already been verified and approved by The National Library of Medicine and WoS, respectively.4The first step of the selection process involved screening titles and reading the abstracts. We excluded 49 publications because they did not concern race/ethnicity in a relevant sense . We also had to exclude 15 records for which we could not find a full text . In the final phase, which consisted of reading full papers, we excluded five more articles. Although they mentioned race/ethnicity in a relevant sense, they neither used racial/ethnic categories to interpret the results of empirical studies nor did they discuss them. Usually, they only referred to some other research on race/ ethnicity . Then, we divided papers into three main formal categories that represented the main types of scientific communication in biomedical literature: (1) original empirical studies (68); (2) reviews and meta-analysis (44); (3) conceptual/theoretical papers, including editorials and commentaries (7).In the next step, we analysed what racial terms  the articles belonging to each of these groups contain and what these terms refer to. We determined how many used the terms “race” or “racial”, and how many only used the term “ethnicity” (including terms such as “ethnic group” or “ethnic population”). In most articles, ethnoracial categories were not explicitly defined or discussed. The conceptual review allowed us “to compare and contrast the different ways in which authors have used a specific word or concept”  e.g., Caucasians, African Americans and Asians. Often this position is related to the belief that there are some biological differences between humans, which the category of race aptly captures. They also largely correspond to folk ethnoracial classifications and use their terminology, e.g., Blacks and Whites  this distinction does not reflect folk ethnoracial categories, like Blacks and Whites, or very broad continental divisions (like Asians and Caucasian). Demogeographic classifications try to capture people’s demographic or geographic origin more precisely, e.g., Amish, Latino, Ashkenazi Jewish, East Asian, Finnish etc.  folk, (b) demogeographic, (c) socio-cultural, (d) multileveled and (e) institutional , while the term “ethnicity” (without the co-occurring category of race) was used in 70 of them. Interestingly, the category of race appeared most frequently in the socio-cultural and multileveled sense (in a ratio of 19 for “race” to 12 for “ethnicity”). In contrast, when racial divisions were used in the folk-genetic or demogeographic sense, there were most often introduced using the category of ethnicity (in a ratio of 21 for “race” to 51 “for “ethnicity”).In all of the types of papers we analysed, among those using these categories in a genetic sense, about 33% applied folk racial divisions (23 of 71 papers). Moreover, folk racial classifications largely determine institutional guidelines in the US Spencer , and thuOur case study has several limitations. First, our method neatly encapsulates the discussed phenomena but does not facilitate an evaluation of its scale. Second, our analysis concerned a relatively small number of articles (to keep our corpus manageable to read) and was thematically limited to the literature on a specific topic (Covid-19). Third, we only analysed articles explicitly related to race, ethnicity, genetics, or genomics. Although the choice of database guarantees that the analysed papers were published in reliable biomedical journals (since only such papers are indexed by PubMed on which LitCov is based), we did not examine the disciplines their authors represent. Instead, we wanted to investigate how ethnoracial categories are used and interpreted when they are applied in the context of genetics and genomics . Thus, while all these articles are related to genetics and genomics to some degree, not all are written by geneticists. We also did not investigate whether the application and interpretation of racial categories was different in specific areas of biomedical research. This issue requires further study.We have distinguished two main topics for discussion in this section: (1) the issue of “messiness” in the use of the term “race” and “ethnicity” and (2) the relation between reductionist biases and the biologization of the category of race and ethnicity.There are already many voices claiming that the lack of specific, clear, and international guidelines for reporting and using demogeographic categories in research has led to considerable terminological and methodological “mess” that prevents us from, for example, the efficient comparison of different studies or data  admitted that racial categories may be an essential source of information, e.g., for contextualizing genetic test results for patients . Let us look at some of the quotes cited in Table 002: 159.Quote B1. includes the term “ethnic origin”  to refer to demogeographic groups that are meant to designate certain ancestral lines, and thus it is intended to serve as a proxy for looking for genetic polymorphisms etc. Quote D1. points to an institutional understanding of race based on the folk ethnoracial classifications. Finally, quote A6. radically reduces the category of race by identifying it with genetic differences.We also noticed considerable terminological “mess” when it comes to the separable or interchangeable understanding of terms “race” and “ethnicity”. As the term “ethnicity” has historically usually referred to a person’s cultural identity  Eriksen , when itWhile some researchers divide races from ethnicities, other scientists use the terms “race” and “ethnicity” interchangeably. For example, all of the quotes presented in Table The greater frequency of use of the term “ethnicity” than “race”, especially understood in the demogeographic sense, is at least to some extent because many of the analysed articles were written by scientists from countries where the category of race is not usually employed, with the term “ethnicity” generally preferred (like in the UK). However, in many cases this was also the case with US researchers, where the terms “race” and “ethnicity” are usually separated. We hypothesize that some researchers may avoid using the controversial category of race and replace it with the category of ethnicity  while ignoring or simplifying the environment of the system in the study , it may be due to some reductionist biases implicitly contained in genetic methodologies and explanations. By focusing on genes and genetic differences, researchers are geared to a series of epistemic risks that may lead to the biologization of the categories they employ. Knowing these risks can increase one’s methodological awareness and contribute to more reliable research practices. The manner in which participants in biomedical research are categorised and selected actively co-shapes the subsequent research results. These categories are not “discovered” by scientists; they are not natural kinds but rather constructs built on the process of idealization of certain populations to obtain specific scientific, political, economic, or cultural goals. Although this problem is clearly discernible in the case of races, it applies to other population categories used in biomedical research. Therefore, we believe that it would be desirable to define what values are behind each scientific decision in this regard: something that has not yet been properly investigated transparently (see the discussion concerning risk stratification in John ).In particular, we believe that current institutional requirements in the US (in contrast to the majority of EU countries) may reinforce the assumption that ethnoracial categories are relevant because the institutions that regulate research require them to be used. Moreover, US regulatory standards are disseminated in other parts of the world thanks to the harmonization of drug testing and regulation. For example, more EU than US pharmaceutical product labels contain statements about racial and ethnic differences and there is evidence that reporting of ethnoracial demographics in the labels of all novel drugs in the EU may be driven, at least in part, by statements on US labels  as a variable and a proxy in their research. Secondly, we should encourage them to report socioeconomic status and deprivation using disadvantage indices or other suitable measures. This would help to convey and reinforce the fact that racism, rather than race, is what drives major disparities in health.Supplementary file1 (DOCX 37 KB)Below is the link to the electronic supplementary material.


Phonological neighborhood density (PND) refers to the number of words that sound similar to a given word. The phonological neighborhood of a given word is said to be dense when it has many phonologically similar words or neighbors. However, when the word has few neighbors, it is said to have a sparse phonological neighborhood.spat /spæt/, at /_æt/, and cat /kæt/ are all neighbors of the word pat /pæt/ based on the addition, deletion, or substitution of a phoneme, respectively.A simple and widely used method  and Spanish (a Romance language) are both Indo-European languages. Semitic languages, which also include Hebrew, are known for their nonconcatenative morphology. Nonconcatenative morphology differs greatly from the concatenative morphology used in English and Spanish, where a new lexical item is formed by putting together at least two distinct morphemes .Second, Arabic is the most widely spoken Semitic language, making it important to study and understand the cognitive machinery involved in the acquisition, perception, and production of this language. Furthermore, Arabic ranks fourth after Chinese (Mandarin), Spanish, and English in terms of number of first-language speakers in the world  that we used for the present database.diglossia . Arabic SLVs differ among Arab countries, and sometimes different SLVs are spoken within the same country . In Arabic, this situation, termed MSA plays an important role in this continuum of dialects for a number of reasons. First, it represents the official language in the Arab world. Second, it is predominantly used in Arabic media in both written and spoken forms. Third, as Parkinson  has notebite and bow, respectively.MSA has a relatively small inventory of vowels. It consists of only three short vowels /i/, /a/, and /u/ and their corresponding long ones /i:/, /a:/, and /u:/. Two more diphthongs complement the vowel sounds of MSA. These are created by combining the short vowel /a/ with the two glides /j/ and /w/ to produce the diphthongs /ai/ and /au/ found in English words such as pharyngealized IPA diacritic (ˁ) added . The 28 MSA consonants are shown in Table In contrast, MSA has a larger inventory of consonants, with 28 consonants. Unlike English, MSA has postvelar consonants. Namely, it has both uvular and pharyngeal consonants. In addition, MSA has four consonants that are characterized by emphasis; that is, producing the sound “with a raised and a tensed tongue” Ryding, , pg. 14 In contrast to the concatenative morphology found in English, Spanish, and many other languages, Arabic uses nonconcatenative morphology to form words. For a word to be formed in Arabic, a root and a pattern must be mapped together Holes, . The rooThe root and pattern serve different functions. That is, whereas the pattern creates the phonological structure of the word and specifies its morphosyntactic properties, the root determines the semantic meaning of the word Wright, . The intEmpirical evidence suggests that the processing of roots and patterns in MSA is similar to the processing of roots and patterns in SLV . Unlike all consonants and long vowels which are marked by letters, short vowels and gemination (consonant doubling or prolonging) are marked by diacritics. However, the use of diacritics is optional. Only when diacritics are used, such as in the Quran or in language teaching materials, can there be a close correspondence between sounds and writing symbols  rendering Arabic orthography shallow or phonemic. When they are not used, however, which is generally the case in normal writing, some Arabic words become homographic. Consider the undiacritized spelling of the Arabic word علم. Without diacritics, this word is homographic with other words that share the consonantal root {ʕlm} such as /ʕalima/ “he knew”, /ʕulima/ “it was known”, /ʕilm/ “Knowledge or science”, and /ʕalam/ “flag”. If diacritics are used, the word will be written (عَلِمَ), (عُلِمَ), (عِلْم) and (عَلَم), respectively. Skilled Arabic speakers overcome the problem of interpreting homographs by extracting the meaning from context.taa marbutah (the “tied” taa) has different pronunciations in pausal and juncture contexts. This letter is either added to words word-finally to mark feminine gender in nouns or adjectives , or is intrinsically available in inherently feminine words . The taa marbutah is pronounced as /h/ when in pausal form. On the other hand, it is pronounced as /t/ when the case-ending vowel attached to it is pronounced in juncture.Another interesting feature of Arabic orthography is that the letter hamza  is spelled differently depending on its position in the word and the surrounding vowels  in ئةر /riʔah/ “lung”, shaped like (ا) in ألم /ʔalam/ “pain”, and shaped like (ﻭ) in لمؤم /muʔlim/ “painful”.Fixed rules govern how some letters representing certain sounds can be spelled. For example,  Ryding, . The hamhamza is referred to as a strong hamza because it is part of the sounds in the word. However, when the hamza is not part of the sounds in the word but rather is added at the beginning of the word to help in the pronunciation of its initial consonant clusters, the hamza is considered to be weak. A weak hamza is only pronounced when the word is utterance-initial. It takes the symbol (ا) rather than the symbols (أ) or ( إ), which represent a strong hamza in initial position.In all these examples, (ىعل) and ( اعل), respectively, where the underlined parts spell out the long vowel /a:/.Similarly, the long vowel /a:/ in Arabic has more than one spelling variant. The derivational etymology of the word plays an important role in deciding the spelling variant used. For example, the words for “on” and “rise” in English are homophonic in Arabic , but they are spelled Finally, there are a few cases in Arabic where the same letter can spell out different sounds. For example, the letter yaa (ﻳ) can represent either the consonant /j/ or the long vowel /i:/. Similarly, the letter waw (ﻭ) can represent either the consonant /w/ or the long vowel /u:/.., being the official language in the Arab world) in terms of the active and frequent addition of new words to keep up with advances in political, technical, and scientific fields.Given the characteristics of MSA described above, the corpus that would best underlie the Arabic Phonological Neighborhood Density Calculator (APNDC) should fit the following criteria. First, the corpus should contain words found in MSA as well as counts for how often the words occur in the language (either written or spoken). Ideally, the corpus should be large so that these word frequency counts are reliable. Second, the corpus should contain information regarding short vowels and gemination that are marked by diacritics  to disambiguate potentially homophonous forms. Finally, the corpus should be current so that it accommodates the dynamic nature of MSA , or religious and social questions . Thus, the corpus contains MSA as used in various natural contexts rather than in fixed, scripted ones . Finally, Ar ten ten was also used to construct a web-based phonotactic probability calculator for Arabic  was used for the database that underlies the APNDC. For example, when a word form with the feminine marker taa marbutah  or the plural marker/u:n/  appeared in the corpus, the lemmatized uninflected forms /muʕallima/ and /mu?min/ were used in the calculator. However, for irregular forms, such as irregular (broken) plural forms, the internal structure  of the word was changed . To avoid loss of the phonological information in the Arabic vowel patterns contained in these irregular forms, we instead used the phonemic transcriptions of the irregular forms.A frequency wordlist containing the 100,000 most frequent MSA words was purchased from Sketch Engine (https://www. sketchengine.co.uk/). For regular words, the lemma .Additionally, other choices were made regarding which pronunciation to keep for some sounds. Recall that weak  and  respectively. Multiple forms of the homophones were reduced to the most frequent form and included in the calculator. In the present example, the frequency of the preposition  “on” is one of the highest in the corpus with 1,586,898 occurrences, whereas the frequency of  “rise” is only 2764. Therefore, the frequency value of the more frequent form was the one added to the calculator.Finally, the Ar ten ten corpus provided the same lemmas for all inflected forms of the same word. This resulted in a large number of homophones among the lemmas of the wordlist. Other homophonic words included those containing /a:/ as in the examples given above. For example, and as mentioned above, the words for “on” and “rise” in English are homophonic in Arabic , but they are spelled https://www.almaany.com/. The final database had 11,164 unique lemmas of MSA in phonemic transcription. Frequency counts of these lemmas were used in the APNDC.All proper nouns and directly borrowed words  were also removed from the corpus. The pronunciations and transcription of all the entries in the database (lemmatized wordlist) were manually checked and edited (where needed) by a trained native speaker of Arabic (F.A.) with the help of the Almaany online Arabic dictionary As described above, phonological similarity among words was assessed using a simple and widely-used method , which must be added after a geminated consonant, counts as a phoneme.The APNDC can be freely accessed at The landing page offers the user the option to calculate neighborhood density for English, Spanish, or Arabic, and also has links to documents , enter their phonemic transcriptions using the ASCII characters provided in Table For each item the word (or nonword) that was entered will appear, followed by summary information about the word (or nonword) and the list of phonological neighbors. As shown in Fig. The frequency of occurrence in the APNDC is the number of times the word occurred in the corpus of 115 million words in the Ar ten ten wordlist. The number of phonological neighbors  is provided, followed by the mean frequency of occurrence of the phonological neighbors . The words that are phonological neighbors and their corresponding frequency of occurrence are reported below the summary information for each word. The information in the window can then be highlighted, copied, and pasted to a separate document and saved in the user’s preferred file format for further processing. To refresh the input window, we recommend clicking on the Arabic label  rather than using the back button on your browser. Using the back button on your browser will result in the word(s) or nonword(s) you previously entered appearing in the window, which will require you to select all, delete, and then enter or cut-and-paste a new set of entries.The Arabic Phonological Neighborhood Density Calculator described in the present work was based very closely on the Phonological Neighborhood Density Calculator for English (and Spanish) that is also available for use on this website. Like the English version, the APNDC uses a very simple and widely used measure of phonological similarity based on information theory, and that is relatively neutral regarding linguistic theory. Despite the simplicity of the one-phoneme metric, measuring phonological similarity and neighborhood density in this way has proven useful to language researchers from a variety of areas for stimulating new research questions and in examining a number of populations (e.g., Botezatu & Mirman,


The postnatal period is a vulnerable time for mothers to experience stress and mental health difficulties. There is increasing evidence that spending time in nature is beneficial for wellbeing. Nature-based interventions have been developed to support mental health, but not specifically tailored for mothers during the postnatal period. Understanding mothers’ views and experiences of nature would help determine the suitability for and potential impact of such interventions on postnatal wellbeing.To explore mothers’ views on the impact of spending time in nature on their postnatal mental wellbeing.Focus groups were held with mothers of young children (under five), including mothers from migrant and refugee communities, mothers living with mental health difficulties, and disabled mothers. Data were analysed using reflexive thematic analysis.Four focus groups were held, with a total of 30 participants. Six themes were developed: (1) mothers’ experiences of what constitutes ‘nature’; (2) sensing nature improves wellbeing; (3) natural spaces facilitate human connection; (4) nature provides escape and relief from daily indoor stressors; (5) nature allows new perspectives; and (6) mothers face a variety of environmental, practical, psychological, physical, socioeconomic, and cultural barriers to spending time in nature during the postnatal period.Mothers report significant benefits to their postnatal wellbeing when spending time in nature. Further research is warranted to understand whether nature-based interventions have the potential to support postnatal wellbeing, socially, mentally, and physically. Modern living and urbanisation have been associated with pressing environmental and public health challenges –3. TheseExisting evidence and guidelines support the use of psychosocial, psychological, and pharmacological interventions for common postnatal mental health difficulties , 11. HowOne of the ways in which women and families may choose to care for their own wellbeing is through spending time in nature. The important role of the natural environment in maintaining and improving mental and physical health has been well-established  across age ranges, cultures, and social class –18. AmonContact with nature has the potential to reduce health inequalities, given evidence of particular advantages to low-income populations –38. It iHowever, there is limited understanding about the role of nature in supporting postnatal mental health. The aim of this study was to explore mothers’ views about the effect of spending time in nature during the postnatal period, its impact on their wellbeing, and the challenges they face when trying to access natural environments.This exploratory focus group study was based in Bristol, UK. Focus groups were held with mothers of young children who self-reported experiencing postnatal mental health difficulties. They were also held with refugee mothers, migrant mothers and disabled mothers, whether or not they reported postnatal mental health difficulties. This method of data collection was chosen as an accessible, flexible method of facilitating interactive discussion and understanding shared cultural discourses , 44. It mothers self-reporting common postnatal mental health difficultiesrefugee mothersmigrant mothersdisabled mothersTo elicit a diversity of opinion, we set out to recruit mothers from the following groups:Eligible mothers needed to be over 18 years of age and have an infant or young child (under the age of 5). Participants were required to speak English, except those in the focus group for refugee women, for which an interpreter was available.An advert detailing the aims of the study and how those interested could take part was developed, with four versions each tailored to the specific groups described above. The respective advert was disseminated through the social media channels of a perinatal mental health charity, to a refugee centre, to an ethnically diverse mother-and-baby group, and through social media channels for disabled mothers. Women contacting the research team were given further information about the study and asked to sign and return a consent form, if they wanted to take part, as well as a brief demographic questionnaire. This included a question about whether the participant self-reported experiencing any postnatal mental health difficulties. Mothers for focus group 1 were recruited from a charity supporting women with postnatal mental health difficulties, which screened all of their service users for depression and anxiety using the Edinburgh Postnatal Depression Scale (EPDS) and Generalised Anxiety Disorder Assessment (GAD-7). We did not conduct our own screening, as our objective was not to categorise mothers’ levels of distress. Rather, we aimed to understand whether contact with nature may represent a relevant strategy in the treatment or selective prevention of postnatal mental health difficulties .A flexible topic guide was developed to achieve consistency across the focus groups. It was based on the aims of the group, relevant literature, team discussions and input from wider stakeholders, for example mothers with lived experience of postnatal mental health difficulties and charity providers working with mothers from a diverse range of backgrounds. It included questions aiming to elicit information on whether and how the participants spent time in nature, what effect they thought nature had on their and their baby’s wellbeing (if any), and what challenges they faced in accessing nature.Focus groups were facilitated by KH, a psychiatry doctor who received prior training in qualitative methods, alongside another member of the research team. KH had secured ethical approval to conduct groups in person or online, depending on participants’ situations and COVID-19 guidelines at the time. The focus group for refugee women was conducted mostly in Arabic (with some participants speaking English), in the presence of an interpreter. For all groups, babies were allowed to be present. The groups were audio-recorded with participant consent.Audio-recordings were transcribed verbatim by University of Bristol-approved professional transcribers, and checked for accuracy by KH and RB. For the focus group conducted in Arabic, the original spoken Arabic was transcribed directly into English prior to analysis, by the same Transcription and Translation Service.Reflexive thematic analysis was chosen to identify patterns of meaning across the data , 47. OurFour focus groups were held, involving a total of 30 participants, between February and April 2022 Table .Table 1FEthnicity was reported by 28 of the 30 participants: Black African (n = 8), Arab (n = 5), White British (n = 5), Mixed/multiple ethnic groups (n = 3), Black Caribbean (n = 2), Asian Indian (n = 2), Asian Pakistani (n = 1), Asian Chinese (n = 1), White European (n = 1). Participants were aged between 20 and 42 years, with most mothers in their late 20s and early 30s. Around half of the mothers had more than one child. The age of the youngest infant was 3.5 weeks, with most mothers having a child aged between 4 months and 2 years. There was often overlap between groups; for example, one mother in FG-1 was also from a migrant background and disabled. All participants in FG-1 self-reported some form of postnatal mental health difficulty at the recruitment stage. We also found that high proportions of women across all other groups reported a range of postnatal challenges during the course of the discussions, including depression and anxiety, personality disorder, post-traumatic stress disorder, birth trauma, female genital mutilation, domestic violence, substance use, homelessness, loneliness and isolation, grief, single parenthood and disability .Analysis of the data resulted in the development of six key themes related mothers’ experiences of being in nature Table . QuotatiI do end up in just the local park at the end of my road ‘cause actually that’s all I can manage, but actually that feels alright. [FG-1]Mothers defined being in ‘nature’ as being outside, with most particularly valuing accessible local parks, or even simply stepping outside the home:To be honest, wherever there is a patch of grass where you can just sit down and breathe, that feels like nature to me. [FG-3]Indeed, most agreed that nature was not a specific destination, but could be found in simple places:Back home in Africa, we didn’t have parks. We had wide open spaces, but we didn’t have a slide or a swing, we didn’t have any of that. It was like, the beach is ten minutes down the road… It’s different [nature in England], it’s still peaceful, but it’s different. [FG-3]A smaller proportion spoke of further away places, such as ‘by the beach side’ [FG-2] or woodland, which allowed them to feel ‘in the middle of the nature’ [FG-2]. Mothers who had not grown up in the UK sometimes drew comparisons between nature in this country and their home country. However, they too agreed that peace could be found in a variety of natural settings, across different countries.I think I need to go to nature to really feel peaceful. There’s plenty of parks within walking distance from where I am, well ‘walking distance’ being in inverted commas, but it’s not as peaceful, and I feel to be in nature you need to be somewhere at peace. [FG-4]A sense of ‘peace and quiet’, where ‘you can’t hear the bustling of the city’ [FG-4], was felt by some to be better captured in wilder natural spaces further away from home.I go to the park quite regular, even on days it’s cold. Sometimes we sit on the grass with a blanket for like 10 minutes or so, just to feel the breeze, feel the grass, feel the mud, just to be in tune with nature as much as possible. [FG-1]Mothers emphasised the value of multi-sensory experiences from being in nature for themselves and their babies.[in English]: I feel it’s amazing when we go to the nature, because it’s beautiful to see, the blossom you can see in the spring… the leaves it’s grow, and in autumn they are fall all away. Autumn colours in nature. Yeah, nature is amazing, yeah. [FG-2]When mothers experienced these sensory connections with nature and noticed their baby’s senses being stimulated, many reported a resulting sense of admiration and awe for nature’s beauty and vastness.P5: I’m visually impaired… when I go out into nature, it’s not so much about the seeing, but the being in nature, it’s about the sounds and the smells and my personal feeling rather than actually how beautiful it looks, for example.P1: For me I think it’s tactile, being able to feel grass, being able to dip my feet in water or touch a rock or something, or just feel some bark, and I get that quite a lot with [baby’s name] as well. [FG-4]The diversity of ways in which mothers connected their senses with the outdoors was powerfully captured by disabled mothers. This group commented on how, when one sense is impaired, other senses ‘almost benefited as a result’, and how this can in some ways be ‘more heart-breaking, but in some ways it’s more beautiful’ [FG-4].I’ve been for a few walks in the rain there [local cemetery with wooded areas], and it's almost like, magical, being in amongst that forest, while the like, pitter patter of the rain, like all of the senses - and sounds that you can pick up whilst you’re strolling through. [FG-1]Although changes in seasons and weather conditions sometimes posed challenges, some mothers described changes in the elements as opportunities to awaken their senses in a different way.One of the things that I really struggled with was controlling my breath when I was unwell, so if I would speak, I’d lose control of my breath. I found it so much easier to breathe in open spaces, so if I was having a panic attack I would head straight outside. I think it is that sense of, kind of, the fresh air. Again, I don’t know whether it’s a change in temperature or whatever it is, but I found that really useful. [FG-1]Opportunities for sensory stimulation and fresh air were also credited for improving babies’ sleep, which also enhanced the mothers’ own sleep. Indeed, the wind, the fresh air, and the breeze were cited as important by most mothers across the focus groups. One mother who had experienced severe postnatal anxiety considered access to fresh air as essential to managing the symptoms she faced.feel the fresh air against their skin. Refugee mothers in particular described how ‘it’s helpful for your body when you have air’ [FG-2], and how ‘it relieves headaches’ [FG-2]. Mothers attributed a sensory connection with nature to imbuing a sense of awe and wonder, which was in turn felt to fuel the imagination and improve wellbeing. The quotations below illustrate how the theme of sensory connection with nature encapsulates both bodily senses and a sense of amazement:For me personally I love the air, the breeze is beautiful, being able to relax and having this nice fresh air coming at you, it’s amazing, it is, it is.  [FG-3][Translated from Arabic] When you walk in nature, you see the views outside, different trees, and especially in the summertime where we see different flowers. When you contemplate nature, you get a totally different feeling. It’s good for the imagination, good for wellbeing you know. [FG-2]Many of the mothers described finding it relaxing and calming to Mothers across all of the focus groups described how nature created a space in which they could connect with other people and with their baby. Meeting people with shared experiences felt particularly important during the postnatal period, in which mothers commonly reported feelings of isolation and loneliness.P4: [When we lived in a caravan] we found that just going on a walk in nature we would completely open our minds to a whole different conversation that we weren’t able to even indulge in inside, and I’ve felt the same now with having a baby—you end up just talking about the same things, and then when you go outside and “oh!” there’s a whole new different perspective of things you can talk about…P2: Yeah, talking and walking always kind of feels easier, I don’t know whether it’s because you don’t have to make eye contact, or if you’re focussing on something else, but it feels like, when you’re walking next to someone, you kind of, you’re able to say different things or communicate differently.P4: Yeah, you almost feel like there’s a floodgate that’s able to be opened and you’re actually like “yeah I can say this thought-provoking thing and it will be alright”, but when you’re like stuck indoors it’s like “oh no, if I say this, you’re gonna be like stuck in the same room”.P2: You get trapped in with it, don’t you. [FG-1]For many, the expansive and yet psychologically containing space created by nature also facilitated a different way of communicating with friends and loved ones.It’s one of the most relaxing spaces when you’re in nature, and I think it’s just an opportunity for people really to get to know each other. [FG-4]Mothers’ accounts indicated a facilitatory component of nature in fostering closeness with others.there you know, he’s listening, and it’s nice for him to actually be interested in what I’m saying because there’s other surroundings. [FG-1]I was there yesterday [in an inner-city park] and they’ve got like a garden area that they grow herbs and stuff… I could feel all the oxytocin going through my body holding [baby], being like “this is sage and this is a tree” [in a cheerful voice] and he’s like babbling away, it was really nice […] Like you know he has no idea of what I’m necessarily talking about when I’m naming random plants and stuff, but he is They also conveyed the sense that natural surroundings created a special space for treasured connections to develop with their babies and children, allowing mothers and babies to build their relationship through mutually enjoyable shared experiences. Opportunities for bonding in nature were attributed to a context conducive to joint attention and synchrony, and to feeling happier and more relaxed in each other’s presence when outdoors.P3: If I’m home I think ‘I should be cooking, I should be cleaning, I should be getting ready for school’P6: And I think especially when you live in a flat and you don’t have a garden and you go out in the park and things like that, it’s nice, you have fresh air, ‘cus the flats are small here and you are just sat inside like… uuurgh [motion of head exploding]P2: And it’s the same four walls. [FG-3]Mothers from refugee backgrounds used similar language to reflect the oppressive feeling of caring for children indoors, with many describing how getting outside alleviates this stress.[Translated from Arabic] I like to walk in the open air instead of sitting at home, where the house is small, and you are there where the baby is still small, it’s like it squeezes you inside [you feel pressurised mentally: translator’s note]… I enjoy that time outdoors, you would be relaxed then. [FG-2]Although most participants felt that ‘there is something’ [FG-1] intrinsic about nature itself that helps wellbeing—something intangible and ‘difficult to put into words’ [FG-4]—some wondered whether it was the escape from the indoors that was instrumental. Mothers in all groups expressed how oppressive the home environment could come to feel during the postnatal period. They described tasks ‘piling up’ , babies and children getting ‘agitated’ indoors , feeling bored, ‘trapped’ , ‘stuck’ [FG-2] and ‘enclosed in four walls’ [FG-1], feeling exhausted by the constant goal-orientated attention required in the indoor environment.If I’m like struggling indoors, or he’s agitated or I’m agitated, the best medicine is to go outside and just have some fresh air, and walk, and it’s all about distraction as well, distracting him, distracting me. [FG-1]Several also commented on how escaping the indoor environment was important for their children and their relationship with their children. The mother of a four-month-old described important opportunities for distraction when escaping the indoor environment, to the fervent agreement of other participants:Across all of the focus groups, mothers conceptualised natural environments as highly conducive to their wellbeing in the postnatal period, allowing sometimes profound shifts in perspective: altering their views of themselves, their thoughts and feelings, their priorities, and even their take on life.Mothers described how spending time in nature with their baby encouraged happiness and joy, interest and fascination, relaxation, calm, peace, feeling ‘grounded’ [FG-1], feeling soothed, as well as reducing stress and lifting depressed moods. These positive psychological states then allowed a feeling of restoration, as if spending time in nature is ‘like pressing reset’ [FG-1], like ‘therapy’ [FG-4], or ‘like the energy’s coming back’ [FG-2].Especially if you’re unwell - actually it’s really hard to leave the house - and so if you do manage to kind of get out of the house, then actually it does make you feel better, and I feel that you get that sense of perspective a little bit more, it’s easier to kind of [pause…] talk yourself down from a ledge if you’re outdoors. [FG-1]One mother poignantly described how critical such changes of perspective could be when experiencing severe postnatal mental health difficulties, and how these shifts facilitated emotional self-regulation.P6: Today I did go out in the rain, both of us got absolutely soaked, my socks were like sodden half way up my feet, but I was like, “I did though, I still did it! [triumphantly] and it was fine”.P3: It’s way more empowering when it’s not your ideal situation and you’ve actually done it. [FG-1]Mothers with lived experience of postnatal mental health difficulties described achieving an enhanced sense of self-efficacy, confidence, achievement, and empowerment through spending time in nature with their baby. This was particularly acute when they had faced a challenge, such as going out despite adverse weather conditions.[in English] And your eyes… it’s nice to see a lot [motions far away into the distance]…it’s like, green, light, lots of things. [FG-2]There’s something about being outdoors. My firstborn was really refluxy and he used to cry all the time, and that being stuck in the house just hearing him cry, well it sends you to like different levels of crazy doesn’t it [agreement from others], you’re like “I can’t do this, I can’t do this”. And then you get out of the house and suddenly they don’t sound as loud, it sounds really bad, but it, like, tones them down a notch, and it’s like “okay, alright, we can do this, it’s okay”. [FG-1]Shifts in visual and auditory perspective were described as important in the context of the demands of looking after a baby, and link to the previous idea of how a change in physical perspective can feel freeing, soothing, and restorative.When you’re sat in the house, I’m constantly like… how can I make this day shorter? It’s like this day is going on forever, like what can I do? “Let’s get out in nature!”, you go outside and an hour and a half’s gone by, you know time just goes a lot quicker because you’re distracted by everything around you… you’ve both got quality fresh air and come back, you reset. [FG-1]One mother described how her perspective on time changed when out in nature, which alleviated the boredom of the day and allowed her to feel restored.Mothers across the different focus groups, from a range of backgrounds, seemed aligned on the wellbeing benefits of nature. Where each group diverged more in its discussions was when considering barriers to accessing nature. These barriers were often specific to the postnatal period. For example, women differed in their views about whether breastfeeding facilitated or hindered getting outdoors, with some feeling ‘self-conscious breastfeeding in public’ [FG-1], and others feeling like ‘a free mum’ [FG-3].We don’t like cold. I’m coming from a very hot country. Here, you feel it’s always winter. In Britain, it is always winter. [FG-2]All groups voiced concerns about adverse weather conditions when caring for small babies, such as cold, wind and rain. A minority disagreed; for example, in FG-1 and FG-2, some felt that rain could enhance the repertoire of sensory experiences in nature. Many mothers described not wanting to go out in the rain, fearing getting wet whilst waiting for public transport, the baby ‘catching a cold’ [all groups], and the difficulties around wrapping babies in waterproofs. Mothers who had grown up in hot countries especially considered the cold a barrier to being in nature:That’s another thing that you have to overcome before you even start going into nature and stuff, and I just think there’s a lot as a disabled person that you have to face that you have to think about, like toilets, or accessibility to different things. [FG-4]Other practicalities, such as transport and facilities, took on new significance when factoring in a new baby. Many living in the inner city did not drive, and felt that public transport was too costly, unreliable, or difficult to be able to access nature with their baby. Although accessibility issues affected most mothers in the postnatal period, the theme came through particularly strongly in the group for disabled mothers.There’s the fear of the unknown as well, so if you don’t trust your own body and you don’t trust your own brain to give you the right cues, what if something scares you when you’re out, or what if something triggers your anxiety whilst you’re out, what will happen then? And like, “will I be safe?” and “how do I look after myself and my baby?”. So I think there’s quite a practical element to the logistics, but then there is also that, kind of, fear of not trusting yourself and your own, sort of, mind I suppose. [FG-1]One disabled mother described the impossibility of getting onto a bus with a pushchair, reflecting the added logistical complexity experienced by many disabled mothers on account of trying to manage their impairments as well as a new baby. Most participants emphasised feeling overwhelmed by the practical and mental preparation required to get out of the house in the first place with a baby, and particularly those struggling with mental health difficulties.Psychological barriers to leaving the house were compounded by, and linked to, physical problems in the postnatal period. These included birth-related complications, such as having had a caesarean section or episiotomy, or complications related to prior female genital mutilation in certain cultural groups, restricting physical mobility.P3: We’re African, we are outside a lot back home, we’re not indoors […] It’s different here, you’re thinking, is your child going in a gang, or is someone looking at your child to groom them. But in Africa like I said, it’s different.P1: I think in Africa it is very cemented that it takes a village to raise a child, whereas here you are by yourself. [Strong agreement from the whole group]P5: It’s just you and your children here. [FG-3]Many refugee mothers faced cultural considerations relating to leaving the house in the early postnatal period. The traditions of many included the practice of forty days of rest at home following childbirth, during which time mothers would recuperate from birth, bond with the baby, and receive help from elder female family members. However, many mothers described the need to adapt to the host country, in the absence of extended support, which resulted in leaving the house much sooner. Many migrant mothers also lamented the absence of extended family support, which they related to feeling alone and unsafe in their neighbourhood.P6 [Translated from Arabic]: It’s nice to be outside, but sometimes I’m worried because when my kids go to play with other families, maybe the parents are not happy or welcoming that, and that just makes me more worried in the park.P2 [In English]: That’s true. This happens a lot. There are families you feel that they put up walls, the reaction they have us not happy, so you feel that you must keep your child tied to you. [FG-2]Mothers from diverse ethnic backgrounds experienced racist comments in certain parts of the city, making them reluctant to explore unfamiliar places, including natural environments. Refugee mothers also experienced stress when other families were not welcoming:To our knowledge, this study is the first of its kind exploring the effects of spending time in nature during the postnatal period, from the perspectives of mothers from diverse backgrounds. The main findings were as follows: (1) What constitutes ‘nature’ depends on mothers’ circumstances, but most value access to peaceful, nearby nature during the postnatal period; (2) Mothers experienced wellbeing benefits from connecting with nature using the senses, which in turn led to a deep appreciation for nature’s beauty and wonder; (3) Nature created a favourable space for mothers to form human connections, both with their baby and other people; (4) Nature provided an escape from the stressful indoor environment and daily tasks; (5) Time in nature allowed powerful shifts in perspective which were restorative and conducive to wellbeing; (6) Mothers faced specific environmental, practical, psychological, socioeconomic and cultural barriers to accessing nature during the postnatal period. These findings may be useful for determining how to support postnatal mothers, and are therefore discussed in these terms below.Mothers’ appreciation for nearby, accessible, peaceful, safe natural spaces reflects wider research highlighting the importance of proximity to green space , 51. ResThe sensory connection experienced in natural settings was perceived as highly conducive to wellbeing. Indeed, sensory contact with nature has been conceptualised as one of the ‘Five Pathways’ to nature connection . These fPrevious research suggests that it is not the amount of time spent in nature, but rather noticing and engaging with nature through simple activities that is most beneficial . ExampleOur findings support the notion that natural environments, which offer space, sensory stimulation, interest, and opportunities for creativity, have the potential to be highly conducive to shared enjoyment between parents and even very young infants. Research has found that environments allowing the infant to be an active partner within the dyadic interaction, for example engaged in mutual enjoyment, fosters positive parent-infant interactions . ResearcThe fourth theme specifies how nature’s previously documented capacity to provide an escape from daily stresses is pertinent to mothers in the postnatal period; the sense of freedom and happiness that being outdoors brings to mothers seems to have profound effects on their wellbeing. ‘Being away’, a reduced sense of urgency, and engaging in a more reflective mode of thought is described as part of Kaplan’s Attention Restoration Theory . This thThere were many similarities between all four focus group discussions, especially regarding themes 1 to 5. Facilitators were struck by how all of the women, from very diverse backgrounds, used surprisingly similar terms to describe the wellbeing benefits of being in nature during the postnatal period. Differences between groups were more pronounced around the theme of barriers to accessing nature. Although mothers clearly valued time spent in nature with their infant, a variety of environmental, practical, psychological, physical, socioeconomic, and cultural barriers rendered this challenging. Research has found that the majority of the population spends large amounts of time indoors, including mothers of young children . People The use of focus groups with women with shared characteristics generated rich, lively, and free-flowing discussion. Our recruitment strategy successfully identified mothers from diverse backgrounds, and with differing relationships to the natural world, although our sample was primarily urban. The number of participants in each group ranged from 5 to 12. A high number of participants in the group of 12 refugee women meant that each individual had less time to speak, although this was the second-longest focus group. Nevertheless, conversation between participants appeared to flow freely and comfortably. This may have been because the women knew each other already, and because they identified as coming from ‘collectivist’ cultures, in which being part of strong, cohesive groups is important. For all focus groups, flexibility in the discussions was required to accommodate the presence of babies. This allowed participants to respond to their babies and re-join the conversation when possible, although none of the participants needed to leave any of the groups. Whether the focus groups were held in person or online, mothers reported feeling at ease, knowing that other participants were in a similar situation to them. The online forum did not seem to compromise the flow of conversation. Some mothers with mental health difficulties or disabilities reported that groups being held online made them more accessible, both for logistical reasons and because they felt less apprehensive joining remotely. By contrast, some other mothers (for example from the refugee community) mentioned that they were pleased to engage in person, for reasons of preference, not having the digital facilities to access an online group, and to make it easier for the interpreter.Most mothers across groups identified some sort from ‘postnatal distress’ throughout the discussions, a term reflecting the range of interrelated emotional difficulties experienced at this complex time of life . Given tDuring focus groups, mothers were asked to think about the postnatal period specifically (defined as the first two years following childbirth). Most participating mothers were currently in the postnatal period, but we chose not to exclude those with slightly older children who wanted to take part. Some may wonder whether the accounts from these women may have been more open to retrospective reconstruction, but these mothers gave clear accounts of their postnatal experiences, and indeed the passage of time had given them an opportunity to reflect on them. Nesting our data collection within a nature-based intervention development study may have attracted participants who felt particularly affiliated with nature, given that our sample was self-selecting. This issue was mitigated in the focus groups for refugee and migrant mothers, given that all those who usually attended their weekly groups were happy to take part in the study.A further strength of this study was the involvement of a highly multi-disciplinary team in the research design, execution, and analysis. The team comprises members with lived experience of postnatal mental health difficulties (RH), experience working with marginalised groups (RM), experience of disability and disability advocacy (RN), nature-based practice (LD), academic expertise on the relationship between nature and health (CB), environmental humanities (SW), perinatal academic expertise (JE), clinical experience (JE) and charity provision (MW).Being in nature can benefit women during the postnatal period, mentally, physically, and socially. It can also help them to connect with their infant. Our findings have implications for supporting postnatal mothers, potentially both in the prevention and treatment of postnatal stresses. One example is by developing tailored nature-based interventions that optimise the benefits described in this study, are cost-effective, sustainable, and transferrable across different contexts, addressing the needs of mothers from different socio-economic and cultural backgrounds and with different personal circumstances. Qualitative findings may inform choice of intervention sites, programme content, and how to maximise inclusivity of minority groups and cross-cultural validity. This study may also inform future research into the impact of nature on women throughout the perinatal period, defined as the time during pregnancy and up to either one or two years following birth.


To the Editor,People with pulmonary hypertension (PH) are more vulnerable to the SARS‐CoV‐2 virus; for example, greater severity of COVID‐19 symptoms and higher rates of mortality having been observed in this clinical group.Overall, 121 participants took part; mean age 58.3 years, 74% were female and 99% self‐reported as White. Participants were diagnosed with PH for an average of 8.5 years. Nearly two thirds had either idiopathic PH or chronic thromboembolic PH, with almost half self‐reporting their WHO functional class as II or III.Table There was a general sense that participants felt they have lost part of their life having to shield for so long and somewhat ‘cut off’ or left behind by society. Participants expressed anxiety over integrating ‘back into a, frankly, frightening community’. This fear also stemmed from other people failing to take infection control guidelines ‘seriously enough’. Individuals were concerned over social rejection due to their own views toward infection control. There was an impression that some felt guilty as their health risks imposed upon others. Loss of perceived safety was reported with participants uncertain of knowing when or how this would be returned. This resulted in feelings of ‘helpless’ and for the first time, ‘a person with an actual illness’. Uncertainty seemed to be, in part, perpetuated by inconsistent or lack of information about the virus and PH and the government's response. Overall, the pandemic has added to the burden of living with PH. Unlike most who find some comfort in knowing they may only experience mild symptoms, if any, those with PH expressed ‘worrying excessively that I will die’.Friends, family, employers, volunteers and key workers were important sources of support: ‘They [family and friends] were what got me through my diagnosis [of PH] last year’. Contact with healthcare services and organisations, or just knowing they are there, was valuable. Participants described using technology to help manage feelings of isolation and maintain relationships. Website and apps provided participants with additional strategies to cope with difficult emotions and prevent rumination or ‘overthinking it all’. Technology also alleviated boredom and facilitated accessing advice on mental health and achieving daily chores. Distractions and developing new hobbies were common ways of coping; however, this often involved sedentary‐based activities. Denial, keeping busy, alcohol and avoidance were also described. Potentially more adaptive approaches were discussed such as going outdoors, acceptance, staying positive and volunteering. There was a general sense that following guidelines provided participants with a sense of control and safety, although could also fuel anxiety.It was not our aim to provide an exhaustive overview of the difficulties this group have experienced. For starters, based solely on demographics, the voices of many are underrepresented. Our findings are consistent with the wider literature demonstrating the effects of the initial stages of the pandemic, including lower physical activity, sleep qualityThe authors have no conflict of interests to declare.Ethical consent was obtained from the Department of Psychology at the University of Sheffield (035318).Gregg H. Rawlings was responsible for the conception of this article, data collection and analysis and writing the report for publication. He approved the final version for publication. Andrew R. Thompson made substantial contributions to research design and provided feedback on data analysis and final report. He approved the final version for publication. Iain Armstrong made contributions to data analysis and provided feedback on the final report. He approved the final version for publication. Nigel Beail made substantial contributions to research design and provided feedback on data analysis and final report. He approved the final version for publication.


The forest-landscape image is the bridge for communication between human beings and the forest. The aim of this paper is to construct the landscape-image conceptual model from the personal perception of the forest, with what people are looking at and how they are viewing themselves as a part of the forest. This research constructed a forest-landscape image by young adults by utilizing the landscape-image-sketching technique and selecting 140 young adults who had lived in Changsha, Central China for ten years, using convenience sampling, during April and May 2018. The results demonstrated that the forest was considered as the people’s life world, as rural scenery around the respondents’ homes, instead of the perception of the objective forest, an important habitat for animals and a limited resource supplier for human living. In fact, the natural values of the forest, such as the ecological and aesthetic values, received more attention than the social ones of the forest, including the life, production, and cultural values. Finally, it is important to raise the public’s awareness of the objective entity of the forest and to guide the variety of experiences for the respondents in the forest. The utilization of the forest has been transformed into a strategic supply space for the ecological public goods of the forest . Forest Since the introduction of the topic “forests in development—a vital balance” at the 13th World Forestry Congress in 2009, studies on individual perception have become one of the hot spots of the service functions of the forest ecological system ,5,6,7,8.A variety of methods for researching the public perceptions of and preferences regarding the forest landscape were applied in previous studies ,14,15, sRecently, the visual-stimuli method was usually adopted to directly measure the individual perception of the forest landscape , concentThe young adults (18–25 years old) have quite stable values and personalities, which could substantially affect their perception and attitude to the forest . MeanwhiFour steps were taken to develop a conceptual-image model of the interaction between the young adults and the forest in Changsha, Central China see . Firstly2, which was dominated by the subtropical evergreen broad-leaved forest, with 59.82% of forest coverage rate in 2021. Changsha is also a famous tourism destination, with lots of natural and cultural heritage sites in Central China.Changsha is the capital city of Hunan province, Central China, in the range of 111°53′ to 114°15′ N and 27°51′ to 28°41′ E see . It is aThe landscape image was a result of the observers’ subjective understanding of the information which they received from the landscape object, for example, the individual characteristic and meaning and the morphological structure . Ueda etLinguistic knowledge usually concerns the use of oral or written words to depict landscape elements. Previous studies showed that linguistic knowledge was considered as the first step for the respondent to classify forest-landscape elements in the sketches which contained landscape elements and forest types ,35. SpatThe measurement scale of the forest-landscape image for respondents refers to Wang and Luo (2022).From April to May 2018, this research used convenience sampling to select 140 young adults (18–25 years old) who had lived in Changsha, Hunan Province for more than ten years. There was no universal standard for a “young adult”, so this research used the age interval between 18 and 25 years to define this group of “young adults”. Then, 140 copies of forest landscape-image sketches were collected on site in the Central South Forestry & Technology University, Hunan Women’s University, Hunan Normal University, of which 131 copies were valid (response rate of 94%). The research showed that female respondents accounted for 61% of all the interviewed respondents.The main research process consisted of five steps. Firstly, a preliminary communication with the respondents was conducted to confirm the investigation target, process and requirements, and collect the respondents’ demographic data, including their age, gender, studying major, grade, permanent residence, duration of residence in Changsha, and so on. Secondly, the respondents were asked to answer the following question: “what firstly appears in your minds when listening to the word of ‘forest’?” Thirdly, the respondents were expected to finish a painting by themselves of the forest in their minds on A4 paper in less than 15 min. If the respondents could not draw some landscape elements, they were asked to make a circle with the name of the landscape element as a substitute for the image on the paper. Fourthly, the respondents were required to describe concisely what kinds of landscape elements were included and what social meanings were contained in their paintings. Finally, the collected paintings (including 31 elements) were analyzed in terms of linguistic knowledge, spatial view, self-orientation, and social meaning. This process resulted in 31 landscape elements, which were further analyzed using MS Excel, whereas “1” or “0” was marked for an existing or non-existing element, respectively.The results showed that ‘herbaceous plants’ (64.12%) and ‘sky’ (60.31%) were the top two in the frequency of landscape elements in sketches, followed by ‘creatures’ (43.51%), ‘water’ (36.64%), ‘trails’ (25.95%), ‘terrain’ (34.35%) and ‘artificial object’ (30.53%). Meanwhile, ‘people’ and ‘brightness’ only accounted for 5.34% and 3.05%, respectively . The resThe type of the forests was preferred as follows: ‘broadleaf forest’, ‘mixed forest’, ‘needleleaf forest’, ‘bamboo forest’, ‘unknown type’, and ‘fallen trees’ . The resThe results demonstrated that ‘sideways view’ for the forest landscape was ranked top, accounting for 74.81% of the total spatial-viewing sketches , with, fThe results showed that the ‘sideways view’ dominated in the spatial view, with a few whole broadleaf or needleleaf trees. This was a similar phenomenon in daily life, where greenery was around houses or there were street trees on both sides of the road. When hearing the word “forest”, most of the respondents often did not imagine a picture of a lush forest, because they were more familiar with scattered tree species. It indicated that most respondents observed the forest at a medium distance, from the outside, and few looked at it from the inside, meaning that the breadth of the forest was neglected by the respondents.The results showed that ‘objective scene’ ranked first (76.34%) , represeThe results showed that ‘scenic view’ and ‘forest structure’ were preferred in the sketches, accounting for 27.48% and 27.48%, respectively. An ‘ecological system’, a ‘recreational space’, and ‘life world’ were often mentioned, accounting for 23.66%, 15.27% and 21.37%, respectively. The ‘natural resources’ was rather low, accounting for 5.34%. In addition, a ‘symbolic place’ and a ‘forestry operation’ were almost neglected in the sketches, with each only taking up 1.53% .A ‘scenic view’, such as ‘objective scene’ or ‘scenic place’ depicted a beautiful forest sketch, such as the foreground and background from the ‘sideways view’ and ‘distant view’ (terrain), respectively a. ‘ForesThe results also stated that when listening to the word “forest”, the respondents would imagine a symbol of a tree or trees, and other natural landscape elements, for example, lakes, streams, animals and non-timber resources, indicating that there was a combination of a diversity of landscape elements inside the forest in the respondents’ imagination, for example, a natural landscape cluster of trees, grasses, and fields. Interestingly, water was the favorite to be used in the sketches frequently. This imagination resulted in the frequent appearance of ‘forest structure’ and ‘ecological system’ in the sketches. The respondents preferred to paint mountains as backgrounds in a beautiful rural forest landscape as a favorite ‘scenic view’ in the sketches. Interestingly, there was a house under a chimney in the sketch, which indicated that the respondents unconsciously regarded the rural landscape and the fragmented urban green spaces closely connected to the residential place as part of the forest. It was vital to present a life world in the sketches. In addition, the respondents initially imaged the primary forest rather than the forest scenic areas when hearing the word “forest”, due to the limited time spent in the forest or having less impression of the forest landscape in their minds. There were, however, a small number of the symbolic places in sketches. The rise of recreational space accorded with the occurrence of the trail, resulting in only taking a walk instead of other recreational activities in the forest. This phenomenon reflected the fact that some of respondents undervalued the recreational values of the forest, on account of the shortage of positive experiences in the past or the difficulty of acquiring interesting experiences when in contact with nature. Natural resources were less depicted in the sketches because the respondents usually seldom walked into the forest to pick up edible fungi and berries. In addition, the forestry operation was seldom referred to, because of less familiarity with forestry on the part of the respondents since the ban on logging at the end of the 1990s.The results demonstrated that there existed a fundamental differences in ways of viewing the forest through individual perceptions, rather than normative views on the forest , dependiFrom the point of view of linguistic knowledge, ‘broadleaf forest’, as the type of the native vegetation in Central China, was a favorite type of forest in this study. Similarly, ‘mixed forest’ and ‘broadleaf forest’ were preferred in Russia and Japan, respectively ,20. The From the point of view of landscape elements, the respondents preferred the forest as a ‘natural space’ in China for painting natural landscape elements, such as ‘herbaceous plants’ and ‘sky’. Interestingly, previous studies demonstrated that the Japanese preferred to paint human landscape elements in sketches, such as, ‘trails’, ‘people’, and ‘brightness’ , due to For the spatial view, the respondents preferred a ‘sideways view’ to observe the forest, indicating that the observers were a little far from the forest, with poor accessibility to the forest. Previous studies also demonstrated that respondents from Japan preferred the ‘bird’s eye view’ and ‘close-up view’, while those from Irkutsk and the Kamchatka Peninsula of Russia preferred the ‘bird’s eye view’, and those from Moscow in Russia the ‘sideways view’ and ‘close-up view’ . PreviouIn the self-orientation and ‘social meaning’, the objective scene’ and ‘scenic view’ of the rural landscape played a leading role in the sketches, which indicates that the respondents considered the forest most as an objective forest, not a subjective on, and did not make efforts to push the interaction between themselves and the forest. The urbanization rate, traditional landscape sketches, and the perception of forest value attributes were considered as the important factors in self-orientation and social meaning. With the increase of the urbanization rate from 30.89% to 64.72% from 1999 to 2021 in China, the Chinese people felt homesick for their own homes around the forest in the rural area and were living in cities for a long time, making them unconsciously paint houses under chimneys in a rural scene. This traditional style of landscape sketches in China was characteristic of the combination of foreground and background in a sketch to depict beautiful rural landscapes, with various viewing points [Therefore, with the statistic and content analysis of linguistic knowledge, spatial view, self-orientation, and social meaning for young adults in Central China, this manuscript tentatively establishes the conceptual model of forest-landscape image for young adults in Central China, as shown in This paper analyzed individual perceptions of the forest-landscape image using the landscape-image-sketching technique and constructed a conceptual model of landscape image for the forest in a Chinese context. The findings showed that the forest was regarded as the people’s living surroundings and the rural scenery around their own homes, instead of the objective forest, in their minds. Linguistic knowledge of the forest landscape, including broadleaf forest, objective scene, sky, artificial view, and scenic view depicted the forest as a pleasant landscape. The forest was also considered as an important habitat and a limited space to meet the needs of the people’s living, production, and recreation. The respondents therefore chose to appreciate the beauty of the forest from a sideways view, and neglected the cluster of landscape elements inside the forest and the breadth of the forest. Natural values such as, ‘forest structure’, ‘ecological system’ and ‘scenic view’, dominated in the social meaning in the sketches.In practice, it is important to increase public or elective courses about the forest or nature, to enhance the public’s awareness of the objective forest, especially for children and teenagers; the courses should be about the knowledge of forest structure, forestry operations, inter-forest attractions, and so on. With the construction of a natural-reserve system with national parks as the main body of this in China, a variety of experiences in these natural reserves would be developed for the public, and given priority in the future. Our findings showed that many university students still did not understand what the difference between the natural-reserve system and national parks was.Future research is needed to verify the conceptual model of the forest landscape image for young adults on a broader scale and to explore the construction of the model of the forest-landscape image for other age groups. In addition, we also found that the forest could be considered as a subjective forest in Japan , and an In addition, there were some limitations in this manuscript. Firstly, limited samples were collected, and the respondents, who lived in Changsha, could not represent all young adults in Central China. Secondly, some respondents were good at drawing the sketch by hand, which might insufficiently exhibit some landscape elements in the sketch.