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Previous research suggests that the characteristics of both patients and physicians can contribute to the overuse of antibiotics. Until now, patients’ psychosocial characteristics have not been widely explored as a potential contributor to the overuse of antibiotics. In this study, the relationship between a patient’s psychosocial characteristics (self-reported in postal surveys in 2003) and the number of antibiotics they were prescribed (recorded in Finnish national registry data between 2004–2006) were analyzed for 19,300 working-aged Finns. Psychosocial characteristics included life satisfaction, a sense of coherence, perceived stress, hostility, and optimism. In a structural equation model, patients’ adverse psychosocial characteristics were not related to increased antibiotic prescriptions in the subsequent three years. However, these characteristics were strongly associated with poor general health status, which in turn was associated with an increased number of subsequent antibiotic prescriptions. Furthermore, mediation analysis showed that individuals who used healthcare services more frequently also received more antibiotic prescriptions. The current study does not support the view that patients’ adverse psychosocial characteristics are related to an increased number of antibiotic prescriptions. This could encourage physicians to actively discuss treatment options with their patients., CC BY 4.0This article belongs to the Special Issue Antimicrobial Prescribing and Antimicrobial Use in Healthcare SettingsCorrespondence: sade.stenlund@utu.fiThis research was funded by a personal grant for S.S. (Säde Stenlund) from the Signea nd Ane Gyllenberg Foundation, grant number 5723. K.C.A. is funded by a Social Sciences and Humanities Research Council Partnership Development Grant, grant number 890-2019-0015, and a University of British Columbia Grant for Catalyzing Research Clusters, grant number n/a. L.C.M. received salary support from the BC Children’s Hospital Research Institute. D.S. is funded through a personal grant from the Magnus Ehrnrooth Foundation, grant number 182282, and the Swedish Cultural Foundation in Finland, grant number n/a.

Background The bidirectional relationship between health behavior and subjective well-being has previously been studied sparsely, and mainly for individual health behaviors and regression models. In the present study, we deepen this knowledge focusing on the four principal health behaviors and using structural equation modeling with selected covariates. Methods The follow-up data (n = 11,804) was derived from a population-based random sample of working-age Finns from two waves (2003 and 2012) of the Health and Social Support (HeSSup) postal survey. Structural equation modeling was used to study the cross-sectional, cross-lagged, and longitudinal relationships between the four principal health behaviors and subjective well-being at baseline and after the nine-year follow-up adjusted for age, gender, education, and self-reported diseases. The included health behaviors were physical activity, dietary habits, alcohol consumption, and smoking status. Subjective well-being was measured through four items comprising happiness, interest, and ease in life, and perceived loneliness. Results Bidirectionally, only health behavior in 2003 predicted subjective well-being in 2012, whereas subjective well-being in 2003 did not predict health behavior in 2012. In addition, the cross-sectional interactions in 2003 and in 2012 between health behavior and subjective well-being were statistically significant. The baseline levels predicted their respective followup levels, the effect being stronger in health behavior than in subjective well-being. Conclusion The four principal health behaviors together predict subsequent subjective well-being after an extensive follow-up. Although not particularly strong, the results could still be used for motivation for health behavior change, because of the beneficial effects of health behavior on subjective well-being., CC BY 4.0© 2021 Stenlund et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.sade.stenlund@utu.fi