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      Cultural engagement and mental health: Does socio-economic status explain the association?

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          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.

          Highlights

          • Cultural engagement is related to mental health independent of socio-economic status.

          • Socio-economic status (SES) explains only half of the association.

          • SES does not act as a moderator of the relationship.

          • The relationship remains when matching participants on SES.

          • The relationship remains when accounting for all unidentified time-constant factors.

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          Most cited references28

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          Stress, social support, and the buffering hypothesis.

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            Health Services and Outcomes Research Methodology, 2(3/4), 169-188
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              Estimability and estimation in case-referent studies.

              The concepts that case-referent studies provide for the estimation of "relative risk" only if the illness is "rare", and that the rates and risks themselves are inestimable, are overly superficial and restrictve. The ratio of incidence densities (forces of morbidity)-and thereby the instantaneous risk-ratio-is estimable without any rarity-assumption. Long-term risk-ratio can be computed through the coupling of case-referent data on exposure rates for various age-categories with estimates, possibly from the study itself, or the corresponding age-specific incidence-densities for the exposed and nonexposed combined-but again, no rarity-assumption is involved. Such data also provide for the assessment of exposure-specific absolute incidence-rates and risks. Point estimation of the various parameters can be based on simple relationships among them, and in interval estimation it is sufficient simply to couple the point estimate with the value of the chi square statistic used in significance testing.
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                Author and article information

                Contributors
                Journal
                Soc Sci Med
                Soc Sci Med
                Social Science & Medicine (1982)
                Pergamon
                0277-9536
                1873-5347
                1 September 2019
                September 2019
                : 236
                : 112425
                Affiliations
                [1]Department of Behavioural Science and Health, University College London, UK
                Author notes
                [* ]Corresponding author. 1-19 Torrington Place, London WC1E 7HB, UK. d.fancourt@ 123456ucl.ac.uk
                Article
                S0277-9536(19)30419-8 112425
                10.1016/j.socscimed.2019.112425
                6695288
                31336219
                78067c14-7236-4d39-8aa1-a09c45a28e70
                © 2019 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 26 February 2019
                : 4 July 2019
                : 16 July 2019
                Categories
                Article

                Health & Social care
                cultural engagement,mental health,depression,socio-economic status,social gradient

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