Hiking and incident mental disorders: A nationwide cohort study using global positioning system-derived behavioral data

<title>Abstract</title> <p>Background Mental disorders represent a growing global health burden, and pharmacological treatment alone is insufficient for population-level prevention. Nature-based physical activities, including hiking, may provide additional mental health benefits beyond those of exercise alone; however, longitudinal evidence using objective behavioral data and clinically defined outcomes remains limited. We examined the association between objectively measured hiking activity and the incidence of clinically diagnosed mental disorders. Methods We conducted a cohort study linking global positioning system (GPS)-derived hiking data from the Tranggle application with National Health Insurance Service records in South Korea. Eligible participants were adults with at least one recorded hiking activity in 2016; after exclusions, 32,737 individuals were included. Hiking activity was assessed over 1 year from each participant’s first recorded activity using four indicators: total distance, total duration, frequency, and regularity. Participants were classified as non-hikers or into tertiles of hiking activity. Incident mental disorders (ICD-10: F30–F55) were ascertained from administrative claims during 2018–2021. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Over 120,257 person-years of follow-up, 4,940 incident cases of mental disorders were identified. Compared with non-hikers, participants in the highest hiking activity group had a consistently lower hazard of mental disorders across all four indicators (HR range: 0.89–0.90), with point estimates indicating a consistent trend across activity levels. Conclusions Higher levels of hiking activity were associated with a lower incidence of mental disorders. These findings support integrating nature-based physical activities into public health strategies for mental disorders.</p>