Psychological benefits of hobby engagement in older age: a longitudinal cross-country analysis of 93,263 older adults in 16 countries

doi:10.21203/rs.3.rs-2349781/v1

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Psychological benefits of hobby engagement in older age: a longitudinal cross-country analysis of 93,263 older adults in 16 countries

https://doi.org/10.21203/rs.3.rs-2349781/v1

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published 11 Sep, 2023

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The growing ageing population has begun to pose a threat to global health due to social and psychological challenges experienced by older adults. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different cultural settings. We harmonised measures of hobby engagement and multiple aspects of mental health across 16 nations represented in five cohort studies. Fixed effects models and multi-national meta-analyses were applied to compare the longitudinal associations between hobbies and mental health internationally. Independent of confounders, having a hobby was associated with fewer depressive symptoms, and higher levels of self-reported health, happiness and life satisfaction. But prevalence of engagement and benefits correlated with macro-level factors such as life expectancy and national happiness levels. Consequently, ensuring equality in hobby engagement within and between countries should be the priority.

Health sciences/Health care/Quality of life

Health sciences/Health care/Public health/Epidemiology

Ageing populations are an increasing global concern given the social and psychological challenges older adults can experience, including loneliness, social isolation and worsening mental health, all of which are associated with increasing physical multimorbidity and mortality^1,2. In 2020, there were one billion people aged 60 years or over. The World Health Organization predicts that the number will continue to rise, with one in six people aged 60 or above globally by 2030 and an ageing population of 2.1 billion by 2050. This is placing untenable burdens on global health and social care services, providing financial and workforce planning predicaments. To help meet older adults’ needs and to support the sustainability of health and social care systems globally, there is a need to explore cost-effective strategies to enhance older adults’ mental health.

There is increasingly global interest in how engagement in psychosocial activities could address these challenges^3,4. Hobbies (defined as activities that people engage in during their leisure time for pleasure, such as listening to and making music, drawing, dancing, model-making, reading, playing games, and participating in societies/clubs) involve imagination, novelty and creativity, sensory activation, self-expression, relaxation, and cognitive stimulation, all of which are positively related to mental health via psychological, biological, social and behavioural pathways⁵. Participation in hobby groups can additionally provide social support and reduce loneliness and social isolation⁵. For this reason, many countries including the UK⁶, Japan⁷, the United States (US)⁸ have been promoting hobbies and leisure activities as part of their policies and recommendations to support and improve mental health, with a particular focus on investment to support participation amongst older adults.

These policies are underpinned by a large body of research which has shown how hobbies can enhance multi-dimensional aspects of mental health, including negative symptomatology and clinical diagnoses of depression and psychiatric conditions, experiential wellbeing (emotional quality of momentary and everyday experiences), evaluative wellbeing (e.g. life satisfaction) and eudemonic wellbeing (e.g. purpose in life) for older adults. Meta-analyses of both observational and interventional studies involving engagement in nature-based activities and volunteering have shown protective associations with depressive symptoms^9–12,. These findings are supported by individual studies in the US (n=16,043)¹³, Japan (n=37,627)¹⁴, UK (n=8,780)¹⁵, and China (n=6,287)¹⁶ showing concurrent and longitudinal relationships (three to 12 years follow-up) between other types of hobbies such as community groups, arts, and social clubs and lower incidence and prevalence of depression in older adults. Similarly, meta-analyses of various types of leisure activities such as dancing, nature-based activities and gardening have reported benefits for positive aspects of wellbeing^10,17–20. Again, these findings are supported by individual studies from the Sweden (n= 157 twins)²¹, UK (n=10,989)²², Japan (n= 6,093)²³, and US (n=12,111)²⁴ focusing on broader activities such as volunteering, arts, cultural engagement and indoor gardening.

However, the literature to date is hampered by several limitations. First, studies have focused on single countries at a time, so given differences in definitions, outcome measures, and methodological approaches between studies, it is unclear whether there is consistency in results across different cultural settings, and thus whether findings from one country population could be applied to populations in other countries. Second, many studies have focused on specific sub-categories of hobbies (e.g. volunteering vs nature-based activities vs arts participation vs cultural engagement etc), often applying conflicting definitions. Yet all hobbies share common 'active ingredients’ and activate similar causal mechanisms of action; it has been proposed that there is little to differentiate in their potential to affect population-level mental health outcomes^25,26. Individual meta-analyses focusing on specific hobby definitions thus present only a fraction of the literature available on the topic and provide an incomplete picture to policy makers.

The present study was therefore designed to harmonise measures of hobby engagement and mental health in older adults across 16 nations represented in five cohort studies. We undertook novel analyses of representative data from the English Longitudinal Study of Ageing (ELSA), Japan Gerontological Evaluation Study (JAGES), US Health and Retirement Study (HRS), Survey of Health, Ageing and Retirement in Europe (SHARE), and China Health and Retirement Longitudinal Study (CHARLS). We followed participants for three consecutive waves (between four and eight years). Fixed effects models tested the longitudinal associations between engagement in hobbies and mental health, simultaneously accounting for all time-constant factors (regardless of whether they were observed, e.g. genetics, past leisure behaviours, medical histories and psychological traits) and identified time-varying factors (e.g. socio-demographic backgrounds, clinical conditions, and difficulties with activities of daily living). We then pooled our findings into novel multi-national meta-analyses.

Participants

To allow for comparison across all datasets, we limited the samples to participants aged 65 years and above. To explore how changes in hobby engagement were associated with changes in older adults’ mental health over time, a total of 93,263 respondents who provided data across all study measures were analysed: Austria (N = 2,524), Belgium (N = 2,304), China (N = 1,611), Czech Republic (N = 2,664), Denmark (N = 1,006), England (N = 4,267), Estonia (N = 3,584), France (N = 2,705), Germany (N = 966), Italy (N = 1,915), Japan (N = 57,051), Slovenia (N = 1,272), Spain (N = 2,099), Sweden (N = 1,315), Switzerland (N = 1,776), and the US (N = 6,204).

The average age of the respondents across the different countries was between 71.7 and 75.9 years. Generally, there was a higher proportion of females participating in the surveys (except for China, Japan and Germany). More than seven out of ten were retired, except for those living in China, Japan and Spain. Over 60% of the participants experienced long-standing mental or physical health conditions (Table S1). For hobby engagement, Denmark (96.0%), Sweden (95.8%) and Switzerland (94.4%) had the highest engagement levels, followed by Germany (91.0%), Austria (90.0%) and Japan (90.0%). China (37.6%), Spain (51.0%), and Italy (54.0%) had the lowest engagement levels (Fig. 1; Table S1).

(Fig. 1)

Depressive symptoms

Older adults with a hobby reported fewer depressive symptoms over four to eight years follow-up. The associations were found in Austria (coef=-0.24, 95%CI=-0.35,-0.13), Estonia (coef=-0.14, 95%CI=-0.22,-0.06), France (coef=-0.23, 95%CI=-0.31,-0.15), Japan (coef=-0.13, 95%CI=-0.15,-0.11), Spain (coef=-0.12, 95%CI=-0.19,-0.05), Sweden (coef=-0.20, 95%CI=-0.34,-0.06), and the US (coef=-0.09, 95%CI=-0.13,-0.05) (Fig. 2). Meta-analysis of the findings showed that hobby engagement was overall negatively associated with depressive symptoms (pooled coef=-0.10, 95%CI=-0.13,-0.07, I² = 69.5%, H² = 3.28).

Self-reported health

Older adults living in Austria (coef = 0.15, 95%CI = 0.05,0.25), Japan (coef = 0.10, 95%CI = 0.07,0.13), Spain (coef = 0.08, 95%CI = 0.03,0.13), Sweden (coef = 0.22, 95%CI = 0.07,0.37), and Switzerland (coef = 0.20, 95%CI = 0.08, 0.32), reported greater self-reported health over follow-up if they had a hobby, compared to those without (Fig. 3). Meta-analysis of the findings showed that hobby engagement was overall positively associated with self-reported health (pooled coef = 0.06, 95%CI = 0.03,0.08, I² = 48.1%, H² = 1.93).

Happiness

For happiness, analyses showed that older adults living in Austria (coef = 0.16, 95%CI = 0.05,0.27), China (coef = 0.21, 95%CI = 0.10,0.32), England (coef = 0.10, 95%CI = 0.04,0.16), Germany (coef = 0.18, 95%CI = 0.03, 0.33), Italy (coef = 0.21, 95%CI = 0.14,0.28), Japan (coef = 0.10, 95%C = 0.08,0.12), Sweden (coef = 0.21, 95%CI = 0.04,0.38), and the US (coef = 0.11, 95%CI = 0.07,0.15) were happier if they had a hobby (Fig. 4). Meta-analysis of the findings showed that hobby engagement was overall positively associated with happiness (pooled coef = 0.09, 95%CI = 0.06,0.13, I² = 67.0%, H² = 3.03).

Life satisfaction

Having a hobby was also related to higher levels of life satisfaction amongst older adults, particularly those living in Austria (coef = 0.18, 95%CI = 0.07,0.29), Czech Republic (coef = 0.17, 95%CI = 0.06,0.28), Denmark (coef = 0.26, 95%CI = 0.07,0.45), England (coef = 0.07, 95%CI = 0.02,0.12), Estonia (coef = 0.14, 95%CI = 0.04,0.24), France (coef = 0.11, 95%CI = 0.03,0.19), Japan (coef = 0.09, 95%CI = 0.07,0.11), Spain (coef = 0.17, 95%CI = 0.11,0.23), Switzerland (coef = 0.18, 95%CI = 0.07,0.29), and the US (coef = 0.10, 95%CI = 0.06,0.14) (Fig. 5). Meta-analysis of the findings showed that hobby engagement was overall positively associated with life satisfaction (pooled coef = 0.10, 95%CI = 0.08,0.12, I² = 33.6%, H² = 1.51).

(Figs. 2–5)

Country-level predictors

Hobby engagement was shown to positively correlated with the world happiness index score²⁷ (r = 0.63) and life expectancy²⁸ (r = 0.39), and were negatively correlated with country wealth²⁹ (r=-0.62) and the Gini index³⁰ (r=-0.63) (Figs. 6a-6d).

(Figs. 6a-6d)

Meta-regressions were then conducted to explore whether the between-study heterogeneity can be explained by these country-level predictors. For the prevalence of hobby engagement (Figures S1a-S1d), country wealth (Figures S2a-S2d) and Gini index (Figures S3a-S3d), no associations were found between effect sizes and the predictors. For the world happiness index score, no associations were shown between effect sizes and the predictor, except for life satisfaction (Figures S4a-S4d). Results showed that, with a confidence level of 90%, for every additional unit in the world happiness index score, the effect size of a study is expected to rise by 0.05 (95%CI=-0.01,0.11; p = 0.079). Finally, for life expectancy, a positive correlation was shown between the predictor and self-reported health effect sizes; for every year increase in life expectancy across countries, the association between hobby engagement and self-reported health was 0.01-points larger (coef = 0.01, 95%CI = 0.01,0.02). No associations were shown for other outcomes (Figures S5a-S5d).

Sensitivity analysis

When using multiple imputation to account for missing data, results were largely replicated (Table S2). When including respondents aged 55 and above (except for Japan where all participants were aged 65 and over), the evidence for longitudinal associations between hobby engagement and the outcomes across countries became stronger, likely due to the increase in sample size (Table S3).

When stratifying the samples by gender, we found some variations between countries. However, our pooled effect sizes from meta-analysis showed that engagement in hobbies remained beneficial for both females (depressive symptoms: pooled coef=-0.10, 95%CI=-0.15,-0.06; self-reported health: pooled coef = 0.06, 95%CI = 0.03,0.08; happiness: pooled coef = 0.08, 95%CI = 0.03,0.12; life satisfaction: pooled coef = 0.10, 95%CI = 0.07,0.14) and males (depressive symptoms: pooled coef=-0.09, 95%CI=-0.12,-0.06; self-reported health: pooled coef = 0.06, 95%CI = 0.03,0.09; happiness: pooled coef = 0.10, 95%CI = 0.07,0.12; life satisfaction: pooled coef = 0.09, 95%CI = 0.06,0.11) (Figures S6a-S9b).

Finally, a subgroup meta-analysis was conducted to assess whether the type of hobbies measures (i.e. binary measure or index created from a list of options) was responsible for differences in effect sizes between studies. Pooled analyses showed no subgroup differences between the measures and hobbies continued to associate with all outcomes (p > 0.05; Table S4).

This study was the first to compare and contrast longitudinal associations between hobby engagement and multidimensional aspects of mental health across 16 countries. The prevalence of hobby engagement varied substantially across countries, from just two in five people to over nine in ten. Meta-analysis of the findings revealed that having a hobby was associated with fewer depressive symptoms, better self-reported health, more happiness and higher life satisfaction, with life satisfaction most consistently related to hobbies. Sensitivity analysis showed that these associations did not vary by gender. Both males and females could experience the benefits of hobbies for their mental health. On average, more older adults had hobbies in countries with higher world happiness index score and life expectancy. Further, the relationship between hobby engagement and life satisfaction was stronger in countries with higher happiness levels and the relationship between hobby engagement and self-reported health was stronger in countries with longer life expectancy.

Our findings are in line with the rich cross-disciplinary, international literature indicating that having a hobby may enhance mental health amongst older adults and that such enhancement can be found in both female and male participants. They also extend previous literature in several keyways. First, our pooled effect sizes from meta-analysis revealed that hobby engagement was associated with fewer depressive symptoms and higher levels of self-reported health, happiness and life satisfaction. The results provide evidence for the consistency in results across cultural settings and countries, highlighting the relevance to global public health. In particular, our results show that, of the four outcomes, hobby engagement has the most consistent association with life satisfaction. Life satisfaction is a subjective evaluation of one’s social, emotional and physical wellbeing, which can be independent of ‘objective’ health status or functional ability that tends to decline with age³¹. Hobbies have many qualities that could enable them to support older adults’ life satisfaction, including feeling in control of their minds and bodies, finding a purpose in life, and feeling competent in tackling daily issues²⁶. The result for life satisfaction is particularly promising given the benefits of hobbies were not only seen in healthier samples but also in samples such as the US where a very high proportion of the respondents were living with long-standing mental or physical health conditions.

However, it is also relevant to consider why, even in the context of significant meta-analytic findings, associations between hobby engagement and mental health showed some variation across countries and cultures. Notably, results from meta-regressions show that there may be a positive correlation between world happiness index score and effect sizes for life satisfaction, suggesting that the effect sizes of studies increase according to how happy people are on a country-level. Similarly, the effect sizes of studies for self-reported health are also likely to increase with an increase in life expectancy of the country. One interpretation for this is that individuals living in countries with higher life expectancies or countries with greater happiness index may be more likely to have a hobby as shown in Figs. 6c & 6d (e.g. Denmark, Sweden and Switzerland), which may have inflated the size of the coefficients. However, there are some exceptions. For example, while people living in Spain had a lower engagement rate comparatively, the strength of the association between hobby engagement and life satisfaction was similar to countries with much higher engagement rates (including Austria, Czech Republic and Switzerland). This suggests that the health benefits of hobbies (at least for life satisfaction) are not simply driven by high prevalence of engagement rates but can also be found in countries where hobbies are less popular. Similarly, the longitudinal protective associations between hobbies and the outcomes continued to be found in countries with lower world happiness index scores such as Japan and China as well as countries with lower life expectancy like the US. Taken together, our results suggest that having a hobby may have the potential to be associated with improvements in health amongst the older population universally. However, the differential participation rate across countries implied that some countries may experience greater barriers to engaging in hobbies.

Indeed, hobbies are often perceived as an ‘asset’ possessed by older people who are healthier, happier and wealthier. Within countries, previous literature has highlighted a social gradient in hobby engagement, where gender, social class, ethnicity and health conditions could influence the likelihood of engagement amongst older adults³². Although our analyses adjusted for individual socio-economic factors, we still found greater hobby engagement rates in more affluent countries. Differences in hobby participation are thus concerning, as they could contribute to or exacerbate health inequalities both within and across countries. As a result, it is important that in working to capitalise on the findings presented here, a systematic approach is taken, considering both how to address individual-level barriers to hobby engagement that older adults may face, as well as considering how societal interventions could be designed to build stronger relationships at a public health level between hobby engagement and mental health outcomes. In recent years, public health strategies such as social prescribing schemes in the UK, US, Japan and part of Europe have focused on building hobby engagement into healthcare services, providing new referral pathways that can help to address existing individual and societal barriers to engagement, positively influencing motivations and propensity to engage amongst older populations, and in turn providing opportunities to strengthen the associations between hobby and health outcomes.

Overall, our findings have important policy and health implications for older adults, especially those who are retired (the majority in our sample). Contemporary life-course research has demonstrated that the concept of ageing has shifted from seniority to an emphasis on lifestyle and consumption³⁴. This aligns with the idea of ‘the third age’ emphasised in previous research, which suggests that older adults who enter the retirement age are now presented opportunities for self-development and are liberated from the previous label of an ‘old age pensioner’ and from ‘the fourth age’ of decline and dependency³⁴. As suggested in our findings, hobbies such as physical activity, arts and cultural engagement, and social and community participation have the potential to lengthen ‘the third age’ period and make it one of ‘productive ageing’ through protecting against age-related declines in mental health and enhancing wellbeing, which have profound consequences for morbidity and mortality.

There are many strengths in this study including the use of five nationally representative datasets to compare and contrast the longitudinal associations between hobby engagement and health across 16 nations. It is also the first study using public surveys to compare hobby engagement rates internationally, as well as assessing the strengths of the associations against population statistics relating to country wealth, Gini index, world happiness index score, and life expectancy. We were also able to stratify the samples by gender to test the gender differences in the associations. However, the study is not without limitations. Whilst fixed effects analysis was used in which all time-invariant variables and important time-varying variables were modelled, causality cannot be established due to the use of observational data. Further, whilst there was overall relative homogeneity in the way that questions about hobbies were asked and we collapsed questions into a binary indicator, some countries chose to list examples whereas others did not, which may have led to differences in interpretations of the question by participants. However, no differences in associations between hobbies and outcomes were found with different measures. Future research is needed to also consider the frequency and the length of hobby engagement in different countries. On a related note, more research is encouraged to explore whether modulation of specific active ingredients in hobby engagement (such as the presence or absence of physical activity or social interaction) could affect outcomes.

Our study provides three main additions to existing literature. First, similar to inequalities in life expectancy, world happiness index score and country wealth, there are inequalities in hobby engagement amongst older adults across countries. Over 90% of the sample in countries including Denmark, Sweden, Switzerland and Germany reported having a hobby, whereas roughly a half of the sample living in countries such as Italy, Spain and China (less than a half) had a hobby. Second, our fixed effects analysis revealed that having a hobby was longitudinally associated with fewer depressive symptoms, and higher levels of self-reported health, happiness and life satisfaction. Third, our pooled effect sizes from meta-analysis confirmed the associations between hobbies and the outcomes, with life satisfaction having the strongest and most consistent association. No gender differences were found in meta-analysis. These results provide evidence that the associations between hobby and the health outcomes are applicable in different countries and settings. However, we found that there may be differences in the associations according to world happiness index score and life expectancy. In particular, the associations between hobby engagement and self-reported health and life satisfaction may be stronger in countries with higher world happiness index score and life expectancy.

This study has numerous policy and practical implications in public health. The universal health benefits of hobbies suggest that removing differences in hobby engagement across demographic groups and between countries should be the priority; not only could it help relieve the burden of the healthcare system that many countries have been experiencing, but it also has the potential to extend ‘the third age’ period where older adults can enjoy hobbies for enjoyment and self-development. In this instance, further work is required to identify, compare and contrast the enablers and barriers of hobby engagement across different countries. Further, results from this study can also be used as evidence when formulating and developing schemes to integrate psychosocial interventions into health services or public health strategies (e.g. through social prescribing schemes) to reduce morbidity, mortality and healthcare burden and enhance ageing experiences amongst older adults.

Data

ELSA. ELSA started in 2002/03 and follows over 11,000 participants aged 50 years and above every two years³⁵. In this study, to be in line with the other datasets, we extracted a sample of adults aged 65 years of above who responded in Waves 7 (2014/15; response rate=78.3%-81.4%), 8 (2016/17; response rate=82.4%), and 9 (2018/19; response rate=79.5%) where hobby engagement and outcome variables were measured. We only considered respondents providing data across all measures, which left an analytical sample of 10,876 observations from 4,267 participants (2.5 per person, ranging from 2 to 3). The study received ethical approval from the National Research Ethics Service Committee and all participants provided informed consent.

JAGES. JAGES is a large-scale population-based longitudinal cohort study about ageing established in 2010, mainly collected through self-administered mail surveys, targeting older people aged 65 and older who do not receive long-term care insurance benefits³⁶. JAGES has conducted joint survey with municipalities that are the public insurers of long-term care insurance every 3-4 years: Wave 1 (2010/11) to Wave 4 (2019/2020). This study used data from Wave 2, 3 and 4 (30 to 64 municipalities [response rate: 52.4% to 71,1%]). Of them, the sample with complete data on hobby engagement and health outcomes in at least two waves were recruited. Therefore, the sample of 125,901 observations from 57,051 participants (2.4 person, ranging from 2 to 3) were included in the final analysis. The study received ethical approval from Nihon Fukushi University, Chiba University and the National Center for Geriatrics and Gerontology, and all participants provided informed consent.

HRS. HRS is a nationally representative study of more than 37,000 individuals over the age of 50 in the US³⁷. The study was initiated by the National Institute on Aging and conducted by the Institute for Social Research at the University of Michigan to track the Baby Boom generation’s transition from work to retirement. The initial HRS cohort was interviewed for the first time in 1992 and followed-up every two years, with other studies and younger cohorts merged with the initial sample. Together, these studies create a fully representative sample of individuals over the age of 50 in the United States. Further details on study design are reported elsewhere³⁷. We used data from HRS waves at which participation in a hobby was measured (2008-2018). At each wave, a rotating random 50% subsample of participants were invited to an enhanced interview and given a Leave-Behind Psychosocial and Lifestyle Questionnaire to complete and return by mail, which included questions on participation in community arts groups and mental health³⁸. Participants were eligible to complete this psychosocial questionnaire every four years. Response rates in each year varied from 62% to 85%. We restricted the sample to participants aged 65 years and above, with complete data on hobby engagement and mental health outcomes in at least two waves, and no missing data on time-varying covariates. This resulted in a final analytical sample of 14,989 observations from 6,204 participants (2.4 observations per person, range 2-3).

SHARE. The Survey of Health, Ageing and Retirement (SHARE is the largest pan-European social science panel study providing internationally comparable longitudinal micro data on the population aged 50 and over and currently includes eight waves with data collection starting in 2004. SHARE contains an original sample as well as a refreshment sample to account for sample size reduction due to panel attrition. SHARE has original core questionnaires as well as retrospective questionnaires (SHARELIFE, in Waves 3 and 8). In Waves 3 and 8, respondents answering the retrospective questionnaire were asked to answer a reduced core questionnaire with fewer information, justifying the use of Waves 5, 6 and 7 in this study. Data information for these three waves is available for twelve countries. Data was not available over these three waves for Croatia, Greece, Hungary, Israel, Luxembourg, the Netherlands, Poland and Portugal. The analytical sample by country, including non-response at baseline, is 2,524 in Austria; 2,304 in Belgium; 2,664 in Czech Republic; 1,006 in Denmark; 3,584 in Estonia, 2,705 in France, 966 in Germany; 1,915 in Italy; 1,272 in Slovenia; 2,099 in Spain; 1,315 in Sweden and 1,776 in Switzerland. The study received ethical approval from the Ethics Council of the Max Planck Society and all participants provided informed consent.

CHARLS. The China Health and Retirement Longitudinal Study (CHARLS) is a nationally representative sample of Chinese residents aged 45 and above³⁹. The baseline survey started in 2011 and has been followed up every two years (in 2013 and 2015). Multistage probability sampling was used for sample selection. The baseline included 17,708 individuals, and the response rates were over 80% in all three waves (wave 1= 80.5%, wave 2=82.6% and wave 3=82.1%). The study only considered participants who responded to all measures, with a final analytical sample of 3,440 observations from 1,611 participants (2.1 observations per person, range 2-3). The study received ethical approval from the Biomedical Ethics Review Committee of Peking University, and all participants provided informed consent.

Measures

Hobby and mental health. Our measures of hobby and mental health are given in Table S5, which presents the exact question-wording and item responses across datasets. The analysis will focus on four types of mental health: (a) self-reported health, (b) life satisfaction, (c) happiness, and (d) depressive symptoms. The measure items and response categories vary somewhat by country, reflecting the cultural differences across 16 nations. Therefore, to ensure the data were comparable, we harmonised and recoded all variables, and standardised the outcome variables. We created a binary indicator of hobby engagement (yes, no) in each country. Nonetheless, care needs to be taken in comparing the proportion of hobby engaged and levels of various mental health outcomes across countries.

Time-varying covariates. Nine time-varying variables that might confound observational associations between hobby and mental health were identified for the analysis. These included demographic characteristics: age (a continuous variable), partnership status (living with a partner/spouse vs not living with a partner/spouse), number of people living in the household (a continuous variable); socio-economic position (SEP): employment status (working vs not working), household income (a continuous variable), housing tenure (home-owner vs not a home-owner); and health profiles: long-standing mental/physical conditions (yes vs no), difficulties with daily activities (ADLs) (with difficulties vs without difficulties), and difficulties with instrumental activities of daily living (IADLs) (a continuous variable).

Statistical analysis

Due to data access restrictions, data were analysed separately for each country using fixed-effects regression, a longitudinal data method that controls for all time-invariant variables. For this reason, fixed-effects regression is considered to be more robust than traditional regression models such as OLS regressions in exploring how changes in the predictor are associated with the changes in the outcomes. Listwise deletion was applied to handle missing data. The proportion of missingness was as follows: Austria (20.6%), Belgium (39.6%), China (69.7%; mainly due to missingness in household wealth, hobby and life satisfaction), Czech Republic (34.8%), Denmark (56.6% ), England (15.1%), Estonia (20.8%), France (21.2%), Germany (69.1%), Italy (51.3%), Japan (54.0%), Slovenia (54.8%), Spain (53.8%), Sweden (62.5%), Switzerland (19.3%), and the US (15.7%). In our main analysis, we present coefficients and 95% confidence intervals (CIs) to show the relationship between hobby engagement and the outcomes across countries after adjustment for time-varying covariates.

In addition to the main analysis, we pooled our findings into novel multi-national meta-analyses using the random effect model to estimate the overall effect sizes for all outcomes. Pooled effect sizes and 95%CI were reported. Between-study heterogeneity was estimated using the algorithm of the restricted maximum likelihood and was assessed using I² and H² statistics. I² indicates the percentage of variability in the effect size that is caused by between-study heterogeneity, rather than by sampling error⁴⁰. A value of I² greater than 50% indicates heterogeneity⁴⁰. Similarly, the H² statistics describes the ratio of the observed variation and the expected variance due to sampling error⁴⁰. A value of H² greater than 1 indicates the presence of between-study heterogeneity⁴⁰. We also conduct a subgroup analysis by hobbies measures to explore whether the differences in effect sizes might have been attributed to the way questions on hobbies were asked in each cohort study (a binary measure vs index created from a list options). We further ran meta-regressions to explore the heterogeneity variance in our meta-analysis using five country-level predictors: the prevalence of hobby engagement, country wealth,²⁹ world happiness index score,²⁷ life expectancy,²⁸ and the Gini index.³⁰ Finally, we performed a set of sensitivity analyses to explore the robustness of the associations between hobby engagement and mental health:

To check that missing data did not influence our findings, we re-ran the analysis after using multiple imputation by chained equations to impute missing data on hobby engagement, mental health outcomes, and time-varying covariates across all included waves.
The main analysis only considered respondents aged 65 years and above to allow for comparison across all datasets, but this significantly restricted the sample size in the ELSA, HRS, SHARE, and CHARLS data. This might reduce statistical power. To check the robustness of our main results, we replicated the analysis using these four datasets and extended the sample to those who were aged 55 years and above.
To test for the consistency of the association between hobby engagement and mental health across different population groups, we stratified our samples by gender (female vs male).

Author Contributions

HWM, TN, JKB, JW, KK, TS and DF designed the study. HWM analysed data from ELSA, led the study, and drafted the manuscript. TN analysed data from JAGES, JKB analysed data from HRS, JW analysed data from SHARE, and QG analysed data from CHARLS. TN, JKB, JW, QG, KK, TS and DF assisted with analytical issues, contributed to the writing and made critical revisions. All authors approved the final manuscript.

Data availability

The English Longitudinal Study of Ageing can be accessed via the UK Data Service: https://beta.ukdataservice.ac.uk/datacatalogue/series/series?id=200011

The Health and Retirement Study can be accessed via the RAND Center for the Study of Aging: https://hrsdata.isr.umich.edu/data-products/rand

The Survey of Health, Ageing and Retirement in Europe can be accessed via the SHARE Research Data Center: http://www.share-project.org/data-access.html

The China Health and Retirement Longitudinal Study can be accessed via the National School of Development, Peking University: https://charls.pku.edu.cn/en/

Data of Japan Gerontological Evaluation Study are not open for public due to ethical concerns.

Code availability

All code used for these analyses is publicly available online: https://osf.io/84xzu/

Funding resources

The EpiArts Lab, a National Endowment for the Arts Research Lab at the University of Florida, is supported in part by an award from the National Endowment for the Arts (Award: 1862896-38-C-20). The opinions expressed are those of the authors and do not represent the views of the National Endowment for the Arts Office of Research & Analysis or the National Endowment for the Arts. The National Endowment for the Arts does not guarantee the accuracy or completeness of the information included in this material and is not responsible for any consequences of its use. The EpiArts Lab is also supported by the University of Florida, the Pabst Steinmetz Foundation, and Bloomberg Philanthropies. DF is supported by the Wellcome Trust (205407/Z/16/Z). JW is funded by the Belgian National Scientific Fund (FNRS) Research Associate Fellowship (CQ) n° 40010931. The Japan Gerontological Evaluation Study (JAGES) is supported by the Japan Society for the Promotion Science (JSPS) KAKENHI Grant Number (JP15H01972), Health Labour Sciences Research Grant (H28-Choju-Ippan-002), Japan Agency for Medical Research and Development (AMED) (JP18dk0110027, JP18ls0110002, JP18le0110009, JP20dk0110034, JP21lk0310073, JP21dk0110037, JP22lk0310087), Open Innovation Platform with Enterprises, Research Institute and Academia (OPERA, JPMJOP1831), and the Research Founding for Longevity Sciences from National Center for Geriatrics and Gerontology (29-42, 30-22, 20-19, 21-20).

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Psychological benefits of hobby engagement in older age: a longitudinal cross-country analysis of 93,263 older adults in 16 countries

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