Individual mental health patterns and the role of lifestyle among ageing adults over 20 years - the Doetinchem Cohort Study

Objective: We explored the prevalence of individual mental health patterns and the role of lifestyle factors over 20 years. Study design: We used data from the Doetinchem Cohort Study (1995–2019), a population-based study amongst adults (26–90 years) examined every five years in the Netherlands. Participants were classified in five pre-defined mental health patterns (persistent good, persistent poor, worsening, improving, varying) over 20 years (five rounds) using the MHI-5 questionnaire. BMI, sleep, smoking, alcohol consumption, and physical activity were dichotomised as healthy/unhealthy based on guidelines. The role of lifestyle at baseline (t1), 20 years later (t5), and longitudinally over 20 years (using pre-defined patterns) was explored using logistic regression. Results: Most participants had good mental health at t1 (85 %) and t5 (88 %). Over 20 years, 67 % followed a persistent good mental health pattern, 30 % a changing pattern, and 3 % a persistent poor pattern. Persistent poor and changing patterns were associated with unhealthy sleep and smoking at t1, t5, and with the 20-year unhealthy patterns. Persistent poor mental health was associated with stable unhealthy and changing sleep (OR=5.58(2.48–12.54) and OR=2.07(1.14–3.74), respectively), and with stable unhealthy and changing smoking (OR=3.35(1.58–7.11) and OR=2.53(1.40–4.57), respectively). Changing mental health was associated with changing (OR=1.54(1.26–1.88) and OR=1.64(1.30–2.07), respectively) and stable unhealthy (OR=1.80(1.23–2.64) and OR=2.24(1.60–3.14), respectively) sleep and smoking, respectively. Conclusions: Persistent good and changing mental health patterns were more common than poor mental health in adults and were associated with smoking and sleep. Clarifying the underlying mechanisms and directionality between mental health and lifestyle could improve interventions.