{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:57:01Z","timestamp":1792033021228,"version":"4.4.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Cultural engagement is associated longitudinally with better mental health and reduced depression incidence, but evidence has largely relied on self-reported symptoms and diagnoses, leaving uncertainty about clinically recorded disorders, and residual confounding remains a concern.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine whether cultural engagement is associated with incident hospital-treated mental disorders.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This prospective cohort study included adults aged 50 years and older from the English Longitudinal Study of Aging (wave 4, May 2008 to July 2009), with follow-up through March 2024. Data were analyzed from November 2025 to March 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Frequency of engagement with any of the receptive arts activities (ie, watching or consuming performances or exhibitions) was categorized as never, infrequent (less than once a year up to once or twice a year), or frequent (every few months up to monthly or more).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Participant records were linked to diagnostic codes in Hospital Episode Statistics and mortality records with follow-up of up to 20 years. The primary outcomes were mental disorders overall and 4 main mental disorders (dementia, substance misuse, mood disorders, and neurotic disorders). Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) and 95% CIs, with a false discovery rate (FDR) approach for significance. To further probe causality, eye disease, ear disease, and traumatic brain injury\u2014which share similar sociodemographic profiles to mental disorders\u2014were prespecified as negative control outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n This study included 8274 adults (mean [SD] age, 65.4 [9.6] years; 4672 female [55.2%]). After fully adjusting for sociodemographic, lifestyle, and social factors and multiple testing, frequent cultural engagement was associated with lower risk of any mental disorders (HR, 0.71; 95% CI, 0.62-0.82;\n P<\/jats:italic>\n FDR<\/jats:sub>\n \u2009&amp;lt;\u2009.001), dementia (HR, 0.71; 95% CI, 0.56-0.89; FDR-adjusted\n P<\/jats:italic>\n \u2009=\u2009.01), substance misuse (HR, 0.75; 95% CI, 0.59-0.95; FDR-adjusted\n P<\/jats:italic>\n \u2009=\u2009.04), and mood disorders (HR, 0.73; 95% CI, 0.56-0.95; FDR-adjusted\n P<\/jats:italic>\n \u2009=\u2009.04), but not neurotic disorders. Associations persisted after excluding early incident cases and adjusting for baseline depressive symptoms and cognition and showed robustness to unmeasured confounders. Cultural engagement was not associated with any negative control outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this nationally representative cohort of older adults, cultural engagement was associated with a lower hazard of subsequent hospital-treated mental disorders, with particularly consistent associations for dementia, substance misuse, and mood disorders. These findings provide triangulated statistical data to suggest that cultural engagement is associated with reduced risk of several clinically recorded mental disorders and support further testing of cultural engagement as a population mental health strategy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.39041","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:00:22Z","timestamp":1791990022000},"page":"e2639041","source":"Crossref","is-referenced-by-count":1,"title":["Cultural Engagement and Hospital-Treated Mental Disorders in Older Adults"],"prefix":"10.1001","volume":"9","author":[{"given":"Pei","family":"Qin","sequence":"first","affiliation":[{"name":"Department of Behavioral Science and Health, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Steptoe","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science and Health, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Fancourt","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science and Health, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"6","key":"zoi261055r1","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1177\/15248399231183388","article-title":"Defining \u201carts participation\u201d for public health research.","volume":"25","author":"Sonke","year":"2024","journal-title":"Health Promot Pract"},{"key":"zoi261055r3","doi-asserted-by":"publisher","first-page":"S57","DOI":"10.1016\/j.puhe.2012.05.025","article-title":"Think of your art-eries: arts participation, behavioural cardiovascular risk factors and mental well-being in deprived communities in London.","volume":"126","author":"Renton","year":"2012","journal-title":"Public Health"},{"issue":"7","key":"zoi261055r4","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1093\/geronb\/gbz085","article-title":"Longitudinal associations between short-term, repeated, and sustained arts engagement and well-being outcomes in older adults.","volume":"75","author":"Tymoszuk","year":"2020","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"issue":"1","key":"zoi261055r5","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1186\/s12889-019-8109-y","article-title":"Arts, mental distress, mental health functioning & life satisfaction: fixed-effects analyses of a nationally-representative panel study.","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Public Health"},{"issue":"7","key":"zoi261055r6","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbaf074","article-title":"Longitudinal associations between cultural engagement and mental and social well-being: a fixed-effects analysis of the English Longitudinal Study of Ageing.","volume":"80","author":"Finn","year":"2025","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"issue":"4","key":"zoi261055r7","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1192\/bjp.2018.267","article-title":"Cultural engagement and incident depression in older adults: evidence from the English Longitudinal Study of Ageing.","volume":"214","author":"Fancourt","year":"2019","journal-title":"Br J Psychiatry"},{"issue":"1","key":"zoi261055r8","doi-asserted-by":"publisher","first-page":"2226","DOI":"10.1038\/s41598-025-32007-9","article-title":"The association between cultural engagement and mental health in Chinese higher vocational students: a cross-sectional study.","volume":"16","author":"Benjing","year":"2026","journal-title":"Sci Rep"},{"issue":"3","key":"zoi261055r9","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1108\/JPMH-06-2020-0060","article-title":"Does arts engagement and cultural participation impact depression outcomes in adults: a narrative descriptive systematic review of observational studies.","volume":"20","author":"Elsden","year":"2021","journal-title":"J Public Ment Health"},{"issue":"3","key":"zoi261055r10","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1111\/bjhp.12657","article-title":"Engagement with arts and culture activities in the Danish general population: longitudinal associations with new onset or persistent depression and mental wellbeing.","volume":"28","author":"Santini","year":"2023","journal-title":"Br J Health Psychol"},{"issue":"1","key":"zoi261055r11","doi-asserted-by":"publisher","first-page":"10226","DOI":"10.1038\/s41598-018-28591-8","article-title":"Cultural engagement predicts changes in cognitive function in older adults over a 10 year period: findings from the English Longitudinal Study of Ageing.","volume":"8","author":"Fancourt","year":"2018","journal-title":"Sci Rep"},{"issue":"1","key":"zoi261055r12","doi-asserted-by":"publisher","first-page":"8336","DOI":"10.1038\/s41467-025-64173-9","article-title":"Creative experiences and brain clocks.","volume":"16","author":"Coronel-Oliveros","year":"2025","journal-title":"Nat Commun"},{"issue":"5","key":"zoi261055r13","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1192\/bjp.2018.129","article-title":"Cultural engagement and cognitive reserve: museum attendance and dementia incidence over a 10-year period.","volume":"213","author":"Fancourt","year":"2018","journal-title":"Br J Psychiatry"},{"issue":"4","key":"zoi261055r14","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1038\/s44159-026-00545-2","article-title":"Mechanisms underpinning the mental health impact of arts engagement.","volume":"5","author":"Fancourt","year":"2026","journal-title":"Nat Rev Psychol"},{"issue":"8","key":"zoi261055r15","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1016\/S2215-0366(26)00054-4","article-title":"Inherent commonalities between arts-based leisure activities and psychological therapies.","volume":"13","author":"Fancourt","year":"2026","journal-title":"Lancet Psychiatry"},{"issue":"4","key":"zoi261055r17","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1093\/aje\/kwaf149","article-title":"Advancing observational research on arts and health: theory-informed approaches using the RADIANCE framework.","volume":"195","author":"Fancourt","year":"2026","journal-title":"Am J Epidemiol"},{"issue":"2","key":"zoi261055r18","doi-asserted-by":"publisher","first-page":"e116","DOI":"10.1016\/S2468-2667(20)30284-X","article-title":"Cognitive and social activities and long-term dementia risk: the prospective UK Million Women Study.","volume":"6","author":"Floud","year":"2021","journal-title":"Lancet Public Health"},{"issue":"6","key":"zoi261055r19","doi-asserted-by":"publisher","first-page":"1640","DOI":"10.1093\/ije\/dys168","article-title":"Cohort profile: the English longitudinal study of ageing.","volume":"42","author":"Steptoe","year":"2013","journal-title":"Int J Epidemiol"},{"issue":"3","key":"zoi261055r20","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1097\/EDE.0b013e3181d61eeb","article-title":"Negative controls: a tool for detecting confounding and bias in observational studies.","volume":"21","author":"Lipsitch","year":"2010","journal-title":"Epidemiology"},{"issue":"6","key":"zoi261055r21","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1136\/jech-2024-223341","article-title":"Socioeconomic factors and the risk of eye diseases in an elderly Danish population.","volume":"79","author":"\u00d8rskov","year":"2025","journal-title":"J Epidemiol Community Health"},{"issue":"2","key":"zoi261055r22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019615","article-title":"Socioeconomic differences in hearing among middle-aged and older adults: cross-sectional analyses using the Health Survey for England.","volume":"8","author":"Scholes","year":"2018","journal-title":"BMJ Open"},{"issue":"4","key":"zoi261055r23","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1111\/1753-6405.12878","article-title":"Epidemiology of hospitalised traumatic brain injury in the state of New South Wales, Australia: a population-based study.","volume":"43","author":"Pozzato","year":"2019","journal-title":"Aust N Z J Public Health"},{"key":"zoi261055r24","doi-asserted-by":"publisher","first-page":"l6377","DOI":"10.1136\/bmj.l6377","article-title":"The art of life and death: 14 year follow-up analyses of associations between arts engagement and mortality in the English Longitudinal Study of Ageing.","volume":"367","author":"Fancourt","year":"2019","journal-title":"BMJ"},{"issue":"1","key":"zoi261055r25","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing.","volume":"57","author":"Benjamini","year":"2018","journal-title":"J R Stat Soc B"},{"issue":"4","key":"zoi261055r26","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value.","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"issue":"7","key":"zoi261055r27","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1176\/appi.ajp.2018.17111194","article-title":"Physical activity and incident depression: a meta-analysis of prospective cohort studies.","volume":"175","author":"Schuch","year":"2018","journal-title":"Am J Psychiatry"},{"issue":"6","key":"zoi261055r28","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1001\/jamapsychiatry.2022.0609","article-title":"Association between physical activity and risk of depression: a systematic review and meta-analysis.","volume":"79","author":"Pearce","year":"2022","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"zoi261055r30","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1136\/jech-2019-213029","article-title":"Community engagement and dementia risk: time-to-event analyses from a national cohort study.","volume":"74","author":"Fancourt","year":"2020","journal-title":"J Epidemiol Community Health"},{"key":"zoi261055r31","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2019.112425","article-title":"Cultural engagement and mental health: does socio-economic status explain the association?","volume":"236","author":"Fancourt","year":"2019","journal-title":"Soc Sci Med"},{"key":"zoi261055r29","doi-asserted-by":"crossref","DOI":"10.1093\/med:psych\/9780198528883.001.0001","volume-title":"Cognitive Behavioural Processes Across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment","author":"Harvey","year":"2004"},{"key":"zoi261055r2","doi-asserted-by":"crossref","unstructured":"Fancourt D, West R, Steptoe A, . Theorising the arts as a health-promoting behaviour. Open Science Framework. Preprint posted online May 14, 2026. Accessed September 10, 2026. doi:10.31234\/osf.io\/ygr94_v1","DOI":"10.31234\/osf.io\/ygr94_v3"},{"key":"zoi261055r16","doi-asserted-by":"crossref","unstructured":"de Witte? M, Bradt? J, Aithal? S, ? The effects of arts-based interventions in the treatment and management of non-communicable diseases: an umbrella review and meta-analyses.? ResearchGate. Preprint posted online February 2025. doi:10.21203\/rs.3.rs-5961850\/v1","DOI":"10.21203\/rs.3.rs-5961850\/v1"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2855279\/qin_2026_oi_261055_1791381209.73633.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:00:26Z","timestamp":1791990026000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2855279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":31,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.39041","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]}}}