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Background The association between active cultural and leisure participation and lower all-cause mortality is well established. However, less is known about the specific role of different cultural activities. Baseline data from 2000, combined with mortality data up to 2019, provide a unique opportunity to examine the association between cultural activity and all-cause mortality. Methods We examined this association using data from the Finnish Health 2000 study (6,548 participants aged 30 years and older), linked to mortality follow-up data (1,789 deaths) up to the end of 2019 obtained from Statistics Finland. Cultural activity was measured as: 1) event participation (visiting cultural events or going to the theater, cinema, concerts, and art exhibitions); 2) reading and listening to music (reading books, listening to records and tapes); and 3) artistic and productive activities (singing, playing an instrument, painting, handicrafts, photography and collecting). Hazard ratios were estimated using the Cox proportional hazards models, adjusting for key sociodemographic variables, health, and health behaviors. Men and women were analyzed separately. Results For women, intermediate levels of engagement in all three domains as well as high levels of engagement in event participation and artistic and productive activities were associated with a lower risk of mortality. For men, intermediate and high levels of engagement in event participation as well as high levels of engagement in artistic and productive activities were associated with a lower risk of mortality. Conclusions The results corroborate the findings of earlier research showing that cultural activity is associated with lower all-cause mortality. However, the possibility of reversed causality or the role of unmeasured factors cannot be ruled out, even though a range of relevant confounders were controlled for. Assessing the mechanisms behind the association was beyond the scope of this study. The study suggests that engagement in cultural activities could be one factor associated with longevity, but more research is needed to examine the causality.

Background Living alone has become more common in today’s societies. Despite the high number of the population living alone, research directed towards the mental wellbeing issues related to living alone has been limited. This systematic literature review aimed to assess the association between living alone and positive mental health. Methods We conducted searches in Medline, Web of Science, Cochrane Library, CINAHL, PsycINFO, and other complementary databases from January 1998 to May 2019. Randomised trials and observational studies investigating adults over 18 years of age and living alone (defined as living in a single household or a household size of one person) were eligible. The primary outcome was positive mental health, defined as comprising both hedonic and eudaimonic elements of mental wellbeing, and it was measured with the Warwick-Edinburgh Mental Well-being Scale and/or theWHO-5 Index. Two reviewers independently screened and selected data; one reviewer extracted data, and the second checked the extracted data. A narrative synthesis described the quality and content of the evidence. Included studies were appraised using relevant Joanna Briggs Institute checklist. Results A total of 4 cross-sectional studies (22,591 adult participants) were included after screening of 341 titles and abstracts and 46 full-text articles. These studies were conducted in Europe and were published between 2014 and 2017. The studies differed in their measurements of positive mental health (WHO-5 Well-Being Index, 3 studies; WEMWBS, 1 study), sources of data (1 regional, 1 national, and 2 European-level studies), and study populations (regional study, adults over 65 years of age; national-level study, mental health nurses over 21 years of age; European-level studies, employees between 15 and 65 years of age and adults over 18 years of age). A potential association between living alone and low positive mental health was found in three out of the four studies. Our findings were limited as the number of included studies was low and the quality of evidence varied across studies. Conclusions This review allows a limited look at the association between living alone and positive mental health. Because the number of included studies was low and the quality of evidence varied across studies, further research is warranted.

Background Living alone has increased globally and especially in Finland where 45% of all households are single occupancy. Epidemiological research has found that living alone a risk factor for a wide range of adversities related to quality of life but the rapidly-changing demographics of people living alone calls for a more detailed investigation of their subjective health status. Methods Using a cross-sectional survey sent for a random sample of Finnish residents in single-person households ( n  = 884), we explored with latent class analysis whether the respondents form different health profiles based on the three health dimensions defined by the World Health Organization: physical, social, and mental well-being. The identified groups were then compared in terms of demographic characteristics with the χ 2 test and quality of life using linear regression models. Sensitivity analyses were run using more refined, manual 3-step BCH method. Results Four distinct health profiles were found: Languishing (4%), Managing (35%), Healthy (30%), and Flourishing (31%). The groups differed in most socio-demographic aspects such as marital and employment status, but not in terms of geographic location or gender (apart from group Languishing that contained more men). Controlling for these socio-demographic differences, all groups showed different average levels of perceived quality of life to the expected direction. Conclusions Our findings suggest that people living alone are indeed a very heterogeneous group in terms of subjective health. Instead of seeing living alone as a mere risk for low quality of life, concept of living alone should be understood more broadly both in public discussion and scientific research.

Background Over the decades, global public health efforts have sought to reduce socio-economic health differences, including differences in mental health. Only a few studies have examined changes in socio-economic differences in psychological symptoms over time. The aim of this study was to assess trends in socio-economic differences in self-reported insomnia and stress over a 24-year time period in Finland. Methods The data source is a repeated cross-sectional survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK), from the years 1979 to 2002, divided into five study periods. Indicators for socio-economic status included employment status from the survey, and educational level and household income from the Statistics Finland register data. We studied the age group of 25–64 years (N = 70115; average annual response rate 75%). Outcome measures were single questions of self-reported insomnia and stress. Results The overall prevalence of insomnia was 18-19% and that of stress 16-19%. Compared to the first study period, 1979–1982, the prevalence of stress increased until study period 1993–1997. The prevalence of insomnia increased during the last study period, 1998–2002. Respondents who were unemployed or had retired early reported more insomnia and stress over time among both men and women. Lower education was associated with more insomnia especially among men; and conversely, with less stress among both sexes. Compared to the highest household income level, those in the intermediate levels of income had less stress whereas those in the lowest income levels had more stress among both sexes. Income level differences in insomnia were less consistent. In general, socio-economic differences in self-reported insomnia and stress fluctuated some, but did not change substantially over the study period 1979–2002. Conclusions Self-reported insomnia and stress were more common during later study periods. The socio-economic differences in insomnia and stress have remained fairly stable over a 24-year time period. However, some of the associations in socio-economic differences were curvilinear and converse. Future studies are needed to explore the complex socio-economic gradients, especially in stress.

Objective To examine whether specific dimensions of social capital are related to self-rated health and psychological well-being. Methods Cross-sectional data from a health survey representing the adult Finnish population ( N  = 8,028) were used. Logistic regression analysis was used to reveal and quantify the possible associations between three dimensions of social capital (social support; social participation and networks; trust and reciprocity) and two general health indicators (self-rated health and psychological well-being). The roles of age, gender, education, living arrangements, income, type of region, functional capacity, and long-standing illness were also assessed. Results Good self-rated health was associated with high levels of social participation and networks and trust and reciprocity, but social support did not remain statistically significant after adjustment for socio-demographic factors, long-standing illness, and functional capacity. The association between social support and psychological well-being was explained by the other two dimensions of social capital. The strong positive association between trust and psychological well-being persisted after controlling for all the other factors in our model. Conclusions Our findings suggest that trust and reciprocity and social participation and networks contribute to good self-rated health and psychological well-being.

Background: Non-married persons are known to have poor mental health compared with married persons. Health differences between marital status groups may largely arise from corresponding differences in interpersonal social bonds. However, official marital status mirrors the social reality of persons to a decreasing extent, and living arrangements may be a better measure of social bonds. Little is known about mental health in different living arrangement groups. This study aims to establish the extent and determinants of mental health differences by living arrangement in terms of psychological distress (GHQ) and DSM-IV psychiatric disorders (CIDI). Methods: Data were used from the nationally representative cross sectional health 2000 survey, conducted in 2000–1 in Finland. Altogether 4685 participants (80%) aged 30–64 years were included in these analyses; comprehensive information was available on measures of mental health and living arrangements. Living arrangements were measured as follows: married, cohabiting, living with other(s) than a partner, and living alone. Results: Compared with the married, persons living alone and those living with other(s) than a partner were approximately twice as likely to have anxiety or depressive disorders. Cohabiters did not differ from the married. In men, psychological distress was similarly associated with living arrangements. Unemployment, lack of social support, and alcohol consumption attenuated the excess psychological distress and psychiatric morbidity of persons living alone and of those living with other(s) than a partner by about 10%–50% each. Conclusions: Living arrangements are strongly associated with mental health, particularly among men. Information on living arrangements, social support, unemployment, and alcohol use may facilitate early stage recognition of poor mental health in primary health care.

Although health issues are more common in people living alone than in those living with someone, research on the service use of people living alone has focused on older age groups. Based on large Finnish cross-sectional health survey (FinHealth 2017, n = 4686), we examined the difference in the use and assessment of health services between those living alone and those living with someone, and whether some sub-groups within those living alone use or perceive the use of health care services differently to those living with someone. The adjusted proportions, based on logistic regression models controlling for demographic variables and perceived health and mental health, showed that those living alone had seen a doctor in the past year less often (65.5%) than those not living alone (71.9%). People living alone had also less often had a health examination in the past 5 years (72.4%) than those not living alone (79.2%), and this proportion was particularly low within people living alone with high levels of depressive symptoms (59.0%) compared to lower levels (75.0%). Conclusively, among people living alone, those who suffer from depressive symptoms might be a potential group that does not receive the same levels of preventive care than others.

Background The aim of this study was to explore long-term predictors of leisure time physical activity in the general population. Methods This study comprised 718 men and women who participated in the national Mini-Finland Health Survey from 1978–1980 and were re-examined in 2001. Participants were aged 30–80 at baseline. Measurements included interviews, health examinations, and self-administered questionnaires, with information on socioeconomic position, occupational and leisure time physical activity, physical fitness, body mass index, smoking, alcohol consumption, and physical functional capacity. Analyses included persons who were working and had no limitations in functional capacity at baseline. Results The strongest predictor of being physically active at the follow-up was participation in physical activity at baseline, with an OR 13.82 (95%CI 5.50-34.70) for 3 or more types of regular activity, OR 2.33 (95%CI 1.22-4.47) for 1–2 types of regular activity, and OR 3.26 (95%CI 2.07-5.15) for irregular activity, as compared to no activity. Other determinants for being physically active were moving upwards in occupational status, a high level of baseline occupational physical activity and remaining healthy weight during the follow-up. Conclusions To prevent physical inactivity among older adults, it is important to promote physical activity already in young adulthood and in middle age and to emphasize the importance of participating in many types of physical activity.

Knowledge of the determinants of use of formal home-based services among older people is of particular importance for predicting the need for and cost of care in the future. The aim of this study was to estimate the frequency of formal and informal help among community-dwelling older people and to assess the determinants of home-based formal help, with a special emphasis on the frequency of help from spouse, from children and other relatives and friends. We used nationally representative cross-sectional data from 1,166 community-dwelling Finnish persons aged 70–99. Determinants of formal help were assessed with logistic regression models. Receiving formal help was most strongly related to need factors such as age and functional capacity. Adjusted for need factors, receiving help from spouse or living with someone else than the spouse decreased the odds of receiving formal help. In contrast, the more frequently the children helped, the larger were the odds of receiving formal home-based help. Help from other informal sources did not affect receipt of formal help. Our results thus suggest that intra-household help from spouse or from other co-residents may partly offset expected cost increases in the formal care sector brought about by an aging population. The results further suggest that help from children and help from formal sources is likely to be concomitant and that children may act as agents seeking formal help also in a welfare state based on the universal and equal care services.

Background: In earlier studies, determinants of socioeconomic gradient in mobility have not been measured comprehensively. Aim: To assess the contribution of chronic morbidity, obesity, smoking and physical workload to inequalities in mobility. Methods: This was a cross-sectional study on 2572 persons (76% of a nationally representative sample of the Finnish population aged ⩾55 years). Mobility limitations were measured by self-reports and performance rates. Results: According to a wide array of self-reported and test-based indicators, persons with a lower level of education showed more mobility limitations than those with a higher level. The age-adjusted ORs for limitations in stair climbing were threefold in the lowest-educational category compared with the highest one (OR 3.3 in men and 2.9 in women for self-reported limitations, and 3.5 in men and 2.2 in women for test-based limitations). When obesity, smoking, work-related physical loading and clinically diagnosed chronic diseases were simultaneously accounted for, the educational differences in stair-climbing limitations vanished or were greatly diminished. In women, obesity contributed most to the differences, followed by a history of physically strenuous work, knee and hip osteoarthritis and cardiovascular diseases. In men, diabetes, work-related physical loading, musculoskeletal diseases, obesity and smoking contributed substantially to the inequalities. Conclusions: Great educational inequalities exist in various measures of mobility. Common chronic diseases, obesity, smoking and workload appeared to be the main pathways from low education to mobility limitations. General health promotion using methods that also yield good results in the lowest-educational groups is thus a good strategy to reduce the disparities in mobility.