Cultural engagement and mental health: Does socio-economic status explain the association?
ABSTRACT: There is a growing body of literature suggesting that the arts can support mental health. However, both arts participation and cultural engagement are unevenly patterned across the population, with a strong social gradient. This social gradient is also evident in mental health. So it remains unclear whether the relationship between arts engagement and mental health can in fact be explained by socio-economic status (SES). This study explores this question specifically in relation to cultural engagement (e.g. visiting museums/galleries/cinema/theatre/concerts) using data from 8780 adults aged 50 + from the English Longitudinal Study of Ageing. We used a statistical triangulation approach, running three separate sets of analyses that each have different strengths and address different statistical limitations or biases. Using logistic regression, the relationship between cultural engagement and mental health was still present when including covariates relating to SES, and there was no evidence of moderation by SES either through the inclusion of interaction terms or stratification. Using propensity score matching, matching participants based on their SES, we also consistently found evidence of the relationship. Finally, using fixed-effects regression which takes account of all time-invariant factors (which include multiple aspects of SES) even if unobserved, we also found no attenuation of the relationship. Overall, this confirms previous reports that cultural engagement is linked with a lower odds of depression amongst adults aged 50 + by demonstrating a robust association in a nationally-representative sample of older adults. While SES does explain around half of the association between cultural engagement and depression, we found no evidence that it either acts as a moderator or the main explanatory factor, with independent associations maintained across all three approaches. However, the fact that higher SES is associated with more frequent engagement indicates that, in population terms, SES is still an important determinant of the salutogenic impact of culture.
Project description:OBJECTIVES:Participation in the arts has well-documented benefits for health. However, participation in the arts is socially patterned, and it remains unclear why this is: what factors act as barriers or enablers of individual arts engagement. Therefore this study explored how individual characteristics predict individuals' capabilities, opportunities and motivations to engage in participatory arts activities. METHODS:We analysed data from 6,867 adults in the UK (61.2% female, average age 46.7 years) who engage infrequently in performing arts, visual arts, design and crafts, literature-related activities, or online, digital and electronic arts. We constructed a structural equation model to explore the relationship between demographic factors (including age, sex, ethnicity or socio-economic status), health factors (including physical and mental health) or social factors (including living alone, urban density, loneliness or socialising) and perceived barriers to arts engagement. RESULTS:Individuals with poorer physical and mental health experienced more barriers affecting their perceived capabilities to engage in the arts, whilst individuals with poorer mental health also described experiencing more barriers affecting their motivations to engage. Individuals of lower SES reported more barriers in terms of opportunities to engage, whilst loneliness was related to more barriers around opportunities and motivations and living alone was associated with more opportunity barriers. Interestingly, adults who were older experienced fewer barriers relating to capabilities or opportunities, as did men, whilst being of white ethnicity was associated with fewer barriers across all three domains. Adults who were more socially engaged or who had poorer physical health experienced fewer barriers relating to motivations. Geographical area of dwelling was not related to any barriers. CONCLUSIONS:This study has shown for the first time where the barriers leading to differential patterns of arts engagement lie. The findings could inform future behaviour change interventions designed to encourage arts engagement amongst individuals who are least likely to engage.
Project description:To investigate the association of participation in arts and cultural activities with health behaviours and mental well-being in low-income populations in London.Cross-sectional, community-based observational study.Data were taken from the cross-sectional baseline survey of the Well London cluster randomized trial, conducted during 2008 in 40 of the most deprived census lower super output areas in London (selected using the English Indices of Multiple Deprivation). Multiple imputation was used to account for missing data in the Well London survey. Descriptive statistics and regression analyses were used to examine the association between participation in arts and cultural activities and physical activity (meeting target of five sessions of at least 30 min of moderate-intensity physical activity per week), healthy eating (meeting target of at least five portions of fruit or vegetables per day) and mental well-being (Hope Scale score; feeling anxious or depressed).This study found that levels of arts and cultural engagement in low-income groups in London are >75%, but this is well below the national average for England. Individuals who were more socially disadvantaged (unemployed, living in rented social housing, low educational attainment, low disposable income) were less likely to participate in arts or cultural activities. Arts participation was strongly associated with healthy eating, physical activity and positive mental well-being, with no evidence of confounding by socio-economic or sociodemographic factors. Neither positive mental well-being nor social capital appeared to mediate the relationship between arts participation and health behaviours.This study suggests that arts and cultural activities are independently associated with health behaviours and mental well-being. Further qualitative and prospective intervention studies are needed to elucidate the nature of the relationship between health behaviours, mental well-being and arts participation. If arts activities are to be recommended for health improvement, social inequalities in access to arts and cultural activities must be addressed in order to prevent further reinforcement of health inequalities.
Project description:Little is known about the dose-response relationship between recreational arts engagement (for enjoyment, entertainment or as a hobby, rather than therapy) and mental well-being in the general population. The quantification of this relationship is of value to: (1) health professionals, clinicians and researchers interested in utilising the arts as a method for improving mental health; (2) to health promoters and policy makers in the development of population based health messages, policy and practice; and (3) to members of the general public in maintaining or improving their own well-being. As guided by theories of social epidemiology and the biopsychosocial model of health, the first aim of this study was to determine if there was a relationship between arts engagement (hours per year) and mental well-being in the general population. If an association was demonstrated, the second aim was to quantify this relationship.A random sample of 702 Western Australian adults aged 18+ years (response rate = 71%) were invited to take part in a telephone survey. The survey took 15 min to complete and included questions about arts engagement, mental well-being, demographics and potential confounders/effect modifiers. The dependent variable was subjective mental well-being (Warwick-Edinburgh Mental Well-being Scale, WEMWBS). The independent variable was hours engaged in the arts in the last 12 months.Respondent engagement in the arts ranged from zero to 1572 hours/year (mean = 100.8 hours/year, SD = 206.0). The prevalence of engagement was 83 %. The average WEMWBS score was 53 (SD = 7.4). After adjustment for demographics (i.e. sex, age group, location, income, education, marital status, children), general health, sports engagement, religious activities and holidays, respondents with high levels of arts engagement (100 or more hours/year, WEMWBS score = 55) had significantly better mental well-being than those with none (0 hours/year, WEMWBS score = 53), low (0.1-22.9 hours/year, WEMWBS score = 52) and medium (23-99.9 hours/year, WEMWBS score = 53) levels of engagement (p = 0.003). Respondents with none, low and medium arts engagement had similar WEMWBS scores (p = 0.358). The relationship between arts engagement and WEMWBS was nonlinear with evidence of a minimum threshold at 100 or more hours/year (p = 0.0006).Evidence of an arts-mental health relationship was found in this study. Those who engaged in 100 or more hours/year of arts engagement (i.e. two or more hours/week) reported significantly better mental well-being than other levels of engagement. The suitability of the arts as a population based strategy to influence the mental well-being of the general population should be investigated further.
Project description:OBJECTIVES:Previous studies have shown the beneficial impacts of arts participation and cultural engagement on health outcomes. However, this engagement is socially patterned and is also possibly influenced by geographical factors. STUDY DESIGN:The aim of this study was to examine the association between geographical factors (spatial setting and neighbourhood characteristics) and arts and cultural engagement amongst adults in the UK. METHODS:Data analysed were from Understanding Society Wave 2 (2010/12) with a total sample size of 26,215. Logistic and ordinal regression was used to identify geographical predictors for the patterns of the engagement. RESULTS:Our results show that there are geographical differences in participation independent of individual demographic and socio-economic backgrounds. In particular, there was more evidence for differences in the participation based on neighbourhood characteristics (e.g. level of area deprivation). We also found some interactions between individual and geographical factors for cultural engagement but not for arts participation. CONCLUSIONS:This study reveals a geographical and individual socio-economic gradient in arts and cultural engagement. Given the health benefits of arts engagement, improving access to arts and cultural programmes geographically may potentially help to reduce health inequalities.
Project description:There is increasing evidence that leading an active, socially engaged lifestyle might protect against cognitive decline. The arts have been proposed as potentially beneficial activities due to their combination of cognitive complexity and mental creativity. Yet it remains uncertain which types of arts engagement and what level of engagement is required for potential benefits to accrue. This study therefore explored the association between three types of cultural engagement (visiting museums/galleries/exhibitions, going to the theatre/concert/opera and going to the cinema) and change in cognitive function over 10 years amongst adults aged over 52. Our participants (n?=?3,445), drawn from the English Longitudinal Study of Ageing, were assessed in 2004/5 and 2014/15. We measured memory and semantic fluency at baseline and follow-up, analysing results using ordinary least squares regression models. Independent of demographic, health and social confounders, visiting museums/galleries/exhibitions and going to the theatre/concert/opera were associated with a lesser decline in cognitive function. Sensitivity analyses confirmed effects were unaffected by considerations of mobility or dementia diagnoses. However, going to the cinema was found to hold little effect for cognitive preservation. Overall, our results suggest that more frequent cultural engagement is associated with more marked effects, but even annual engagement may be protective.
Project description:OBJECTIVE:To assess the frequency and intensity of arts engagement inclusive of active and passive engagements in arts, culture and heritage activities among Singaporean adults aged 50 and above, and examine the relationships between participatory art and holistic well-being. DESIGN:Cross-sectional stratified household survey. SETTING:All residential areas across Singapore's Central, East, North, North-East and West Regions. PARTICIPANTS:1067 community-dwelling, Singaporean older adults between the ages of 50 and 95 years were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES:Respondents completed a self-reported questionnaire, consisting of standardised ad hoc items assessing the frequencies and durations of active and passive participatory arts engagement, as well as validated psychometric assessments on psychosociospiritual health including the primary outcome measure on quality of life, and the secondary outcome measures on physical, psychological, emotional, spiritual, and social well-being. sociodemographic information, as well as frequency and intensity of physical activity were also collected. RESULTS:Passive engagement (60%) and active engagement (17%) in the arts were associated with better holistic wellness and social support. Specifically, findings from the propensity score matching and independent t-test analyses revealed that adults aged 50 and above who passively engaged in arts and culture-related events experienced higher quality of life (t(728)=3.35, p=0.0008, d=0.25), perceived health (t(728)=2.21, p=0.0277, d=0.16) and sense of belonging (t(728)=2.17, p=0.03, d=0.16), as compared with those who did not. Moreover, those who actively engaged in participatory arts experienced greater quality of life (t(442)=3.68, p=0.0003, d=0.36), self-rated health (t(442)=2.59, p=0.0099, d=0.25), spiritual well-being (t(442)=3.75, p=0.0002, d=0.37), meaning in life (t(442)=5.03, p<0.0001, d=0.50) and sense of peace (t(442)=3.72, p=0.0002, d=0.36), as compared with those who did not actively engaged in the arts. CONCLUSION:This study provided robust evidence to support a significant causal relationship between arts engagements and holistic well-being. Recommendations for art-based public health and elderly care research, practice and policy are discussed.
Project description:In recent years the health-arts nexus has received increasing attention; however, the relationship is not well understood and the extent of possible positive, negative and unintended outcomes is unknown. Guided by the biopsychosocial model of health and theories of social epidemiology, the aim of this study was to develop a framework pertaining to the relationship between arts engagement and population health that included outcomes, confounders and effect modifiers. A health-arts framework is of value to researchers seeking to build the evidence base; health professionals interested in understanding the health-arts relationship, especially those who use social prescribing for health promotion or to complement treatments; in teaching medical, nursing and health-science students about arts outcomes, as well as artists and health professionals in the development of policy and programmes.A qualitative study was conducted. Semistructured interviews were analysed thematically.Western Australia.33 Western Australian adults (18+ years). Participants were randomly selected from a pool of general population nominees who engaged in the arts for enjoyment, entertainment or as a hobby (response rate=100%).A thematic analysis was conducted using QSR-NVivo10. The resulting framework contained seven outcome themes and 63 subthemes. Three themes specifically related to health, that is, mental, social and physical health, while economic, knowledge, art and identity outcomes were classified as health determinants. Within each theme, positive, negative and unintended outcomes (subthemes) were identified and categorised as relating to the individual and/or to the community. A list of confounding and/or effect modifying factors, related to both the arts and health, was identified.Given the increasing pressure on health resources, the arts have the potential to assist in the promotion of health and healing. This framework expands on current knowledge, further defines the health-arts relationship and is a step towards the conceptualisation of a causal health-arts model.
Project description:BACKGROUND:There is a large literature on the health benefits of engagement with the arts. However, there are also well-recognised challenges in ensuring equity of engagement with these activities. Specifically, it remains unclear whether individuals with poor mental health experience more barriers to participation. This study used a behaviour change framework to explore barriers to engagement in participatory arts activities amongst people with either depression or anxiety. METHODS:Data were drawn from a large citizen science experiment focused on participation in creative activities. Participants who reported engaging infrequently in performing arts, visual arts, design and crafts, literature-related activities, and online, digital and electronic arts were included and categorised into no mental health problems (n?=?1851), depression but not anxiety (n?=?873) and anxiety but not depression (n?=?808). Barriers and enablers to engagement were measured using an 18-item scale based on the COM-B Self-Evaluation Questionnaire, with subscales assessing psychological and physical capabilities, social and physical opportunities, and automatic and reflective motivations. Logistic regression analyses were used to identify whether individuals with either depression or anxiety reported greater barriers across any of the six domains than individuals without any mental health problems. Where differences were found, we calculated the percentage of protective association explained by various demographic, socio-economic, social, physical or geographical factors. RESULTS:Individuals with depression and anxiety felt they would be more likely to engage in arts activities if they had greater psychological and physical capabilities, more social opportunities, and stronger automatic and reflective motivations to engage. However, they did not feel that more physical opportunities would affect their engagement. Covariates explained only 8-37% of the difference in response amongst those with and without anxiety and depression. CONCLUSIONS:Findings suggest that for individuals with poor mental health, there are certain barriers to participation that are not felt as strongly by those without any mental health problems. Mapping the behaviour change domains to potential interventions, activities that focus on increasing perceived capabilities, providing social opportunities, and reinforcing both automatic and reflective motivations to engage has the potential to help to redress the imbalance in arts participation amongst those with poor mental health.
Project description:Self-esteem is regarded as vital to children's social and cognitive development and emotional well-being. To date, a few studies have suggested that arts activities can improve self-esteem in young people. However, such studies mainly focused on small, nonrepresentative samples. In this study, data from 6209 children included in the United Kingdom Millennium Cohort Study were analyzed using propensity score matching to investigate the association between children's arts engagement ((1) listening to or playing music; (2) drawing, painting, or making things; and (3) reading for enjoyment) and self-esteem at age 11. All three activities were associated with higher levels of self-esteem when matching for all identified demographic, socioeconomic, and familial confounders. Additionally, the relationship was more prominent when children engaged in these activities with their parents on a regular basis. However, there was no clear evidence that ability in either music or arts activities moderated the relationship with self-esteem, although English language ability may moderate the association between reading and self-esteem. These results suggest that initiatives to promote arts engagement in children may provide a practical and efficient way to improve children's self-esteem. This is the key given self-esteem in childhood tends to decline as children enter adolescence, yet is linked to lifelong development and well-being.
Project description:OBJECTIVES:There is a large literature linking inflammation with mental ill health, but a much smaller literature focusing on mental wellbeing. Specifically, it remains unclear whether mental wellbeing is longitudinally and independently associated with inflammation or only via associated changes in mental ill health. METHODS:This study used data from 8780 adults aged 50+ in the English Longitudinal Study of Ageing. Hedonic wellbeing (both positive affect and life satisfaction) and eudemonic wellbeing (self-realisation and control-autonomy) were measured at data collection waves 2 (2004/05), 4 (2008/09) and 6 (20012/13), along with measures of C-reactive protein (CRP), fibrinogen and white blood cells (WBC). Fixed effects modelling was performed to identify the longitudinal relationship between wellbeing and inflammation, adjusting for time-varying mental ill health and other identified confounders. RESULTS:Both measured aspects of hedonic wellbeing were associated with lower WBC count, independent of mental ill health. For life satisfaction, this relationship was explained by confounders, whilst for positive affect it persisted. Both measured aspects of eudemonic wellbeing were associated with lower CRP, fibrinogen and WBC, independent of mental ill health. For control-autonomy, this relationship was explained by confounders, whilst for self-realisation it persisted. Results were present in both men and women, although more strongly in men, and were robust to a range of sensitivity analyses. CONCLUSIONS:This study builds on the strong literature showing a relationship between mental ill health and inflammation by showing that there is also an apparently independent relationship between mental wellbeing, in particular eudemonic wellbeing, and inflammation that is unexplained by socio-economic or other time-constant factors and in some instances persists independent of time-varying confounders.