Is poor mental health a risk factor for retirement? Findings from a longitudinal population survey

A new roadmap for an age-inclusive workforce management practice and an international policies comparison

Background

Worldwide, the worker population age is growing at an increasing rate. Consequently, government institutions and companies are being tasked to find new ways to address age-related workforce management challenges and opportunities. The development of age-friendly working environments to enhance ageing workforce inclusion and diversity has become a current management and national policy imperative. Since an ageing workforce population is a spreading worldwide trend, an identification and analysis of worker age related best practices across different countries would help the development of novel palliative paradigms and initiatives.

Methods

This study proposes a new systematic research-based roadmap that aims to support executives and administrators in implementing an age-inclusive workforce management program. The roadmap integrates and builds on published literature, best practices, and international policies and initiatives that were identified, collected, and analysed by the authors. The roadmap provides a critical comparison of age-inclusive management practices and policies at three different levels of intervention: international, country, and company. Data collection and analysis was conducted simultaneously across eight countries: Canada, France, Germany, Italy, Japan, New Zealand, Slovenia, and the USA.

Results and conclusions

The findings of this research guide the development of a framework and roadmap to help manage the challenges and opportunities of an ageing workforce in moving towards a more sustainable, inclusive, and resilient labour force.

Economic inactivity and mental-physical multimorbidity

Economic inactivity and multimorbidity, including mental–physical multimorbidity, have increased in recent years, adversely impacting individuals and the economy, and widening health inequalities. There is an under-recognition of their relationship although they share important risk factors. The substantial challenges of each cannot be addressed without understanding the other. This requires access to better health and work data, and greater cooperation between clinicians, researchers and policy-makers. The central role of occupational health expertise is highlighted.

Psychometric properties of the rehabilitation treatment beliefs questionnaire for psychosomatic rehabilitation

PURPOSE

Treatment beliefs play a crucial role for patient satisfaction and the treatment outcome in psychosomatic rehabilitation. The aim of this study was the development and the psychometric evaluation of an indication-specific questionnaire of beliefs about psychosomatic rehabilitation.

MATERIALS AND METHODS

The study was conducted at a psychosomatic rehabilitation clinic. The primary item list comprised k = 125 items. After a descriptive item analysis, we conducted an exploratory factor analysis. Furthermore, we tested reliability via McDonald's Omega and construct validity by analyzing correlations of the scales with related constructs.

RESULTS

Of the N = 264 participants, 50% were female and the mean age was 50.4 (SD = 9.8) years. K = 85 items were suitable for factor analysis, which resulted in k = 30 items constituting six scales, explaining of 57% the overall variance. The corrected item-total correlations were between r = 0.48 and r = 0.83. Internal consistency ranged from ω = 0.81 to ω = 0.86.

CONCLUSION

The newly developed questionnaire assesses specific treatment beliefs about inpatient psychosomatic rehabilitation. The psychometric properties of the six scales are acceptable. Further studies should confirm the psychometric results, such as the factorial structure of the questionnaire.IMPLICATIONS FOR REHABILITATIONTreatment beliefs are known to play an important role for the adherence, therapy outcome and satisfaction in psychosomatic rehabilitation.We developed and tested a indication-specific questionnaire assessing treatment beliefs in psychosomatic rehabilitation.The questionnaire can be used to explore patient's rehabilitation-related treatment beliefs, predict treatment outcomes, and to develop interventions attempting to modify these.

Personal and Work-Oriented Characteristics Distinguishing Older Nurses' Partial or Complete Actual Retirement Behavior over Three Years

To retain nurses and prevent worsening the nursing shortage, a key opportunity is to better understand the drivers of complete and partial retirement of older nurses. This study investigates the characteristics that distinguish older nurses' partial and complete actual retirement behavior, from those continuing to work, over a three-year period. A quantitative longitudinal design comprising 217 female Australian nurses aged 50 years or over, from two samples working at Time 1 (2012 and 2016), responding three years later (Time 2). Multinomial regression found two different patterns of drivers for each of completely retiring and partly retiring respectively. Age was the only variable distinguishing both partly and completely retired nurses from nurses who were not retired. The further variables distinguishing completely retired nurses were not being prosperous, having impaired work ability, being partnered, not stressed at work and working part-time. The only variable beyond age distinguishing partly retired nurses was having a casual contract. Offering flexible work options in terms of working hours and contracts that suit the nurse's lifestyle and supporting nurses with health impairments to continue working are options that may lessen the number of nurses completely retiring and instead either remaining at work or partly retiring.

Changes in retirement plans in the English older population during the COVID-19 pandemic: The roles of health factors and financial insecurity

Over the course of 2020 and 2021, the COVID-19 pandemic disrupted lives globally. In the UK, unemployment rate continued to increase during and post-lockdown periods, and job security and financial wellbeing deteriorated. It is important to understand whether individual decisions related to retirement plans have changed systematically as a result of the pandemic, especially among older adults who experienced greater rates of pandemic unemployment. Using the English Longitudinal Study of Ageing, this article examines changes in retirement plans of older adults during the COVID-19 pandemic and estimates the impact of health and financial circumstances on these changes. In June/July 2020, 5% of 2095 participants reported planning earlier retirement, while 9% reported planning later retirement. We found that poor self-rated health and financial insecurity were associated with intentions to postpone retirement. Additional risk of later retirement associated with poor health was detected among those experiencing financial insecurity. In November/December 2020, 7% of 1845 participants reported planning earlier retirement, while 12% reported planning later retirement. We found that poor health was predictive of a lower relative risk of later retirement, while depressive symptomology and financial insecurity predicted a higher relative risk of later retirement. The findings imply a contextual role of health factors in, and a persistent influence of financial insecurity on, retirement planning in the older population.

Prospective Drivers of Nurses' Partial or Complete Retirement Seven Years Later: Work Ability and Physical Functioning Going against the Tide of Age

In the context of a nursing shortage in many developed countries, one option for retaining the expertise of older nurses in the workforce is to better manage the retirement of nurses. This study will investigate life course predictors of actual retirement behavior, whether partial or complete, for older working nurses over a seven-year span. Data were analyzed from a quantitative, longitudinal survey of 178 Australian nurses aged 45 years and older working at Time 1 (2012), who responded seven years later (Time 2). Age predicted both forms of retirement behavior, confirming the strength of social normative pressures toward retirement. Moving against this social normative tide toward retirement were the predictors of partial retirement such as job satisfaction, physical functioning and work ability. In turn, working part-time was the only predictor, beyond age, of complete retirement. Nurse and health service managers could support nurses to stand against the tide of social normative pressures (until such social norms change) by managing the nurses' physical functioning and work ability, including by more explicitly managing the impacts of chronic diseases in the workplace, not least so as to retain their nurses in the context of nurse shortages.

Understanding the effect of retirement on health behaviors in China: Causality, heterogeneity and time-varying effect

Retirement is an important turning point during the course of life, but few studies have examined the effects of retirement on a broad range of health behaviors in China. We use the longitudinal data of the China Health and Nutrition Survey (CHNS) from 2004 to 2015 to conduct empirical analysis. Fuzzy discontinuity regression was used to assess the association between retirement and health behaviors in the entire sample and subgroups based on gender and education. A time-varying effect model was used to measure the anticipatory effect, immediate effect and lag effect of retirement. We observed that the transition to retirement was associated with healthier lifestyle habits, such as reduced smoking and alcohol consumption and increased exercise motivation. However, the transition was associated with worse sedentary behavior. No significant statistical association was found between retirement and sleep duration. Men and those with higher education levels are more likely to experience the impact of retirement. The anticipatory effect suggests that as the statutory pension age is predictable, workers adjust their behaviors 4 and 5 years before retirement. The lagged effect indicates that it takes time to develop new habits; thus, retirees change their behaviors 2-3 years after retirement. The paper discusses possible reasons for our findings and proposes several policy implications from the perspectives of the government and society to facilitate the realization of healthy aging.

Associations of sickness absence and disability pension due to mental and somatic diagnoses when aged 60-64 with paid work after the standard retirement age; a prospective population-based cohort study in Sweden

Background

The proportion of people working beyond age 65 is increasing. We aimed to explore whether sickness absence (SA) and disability pension (DP) due to mental, somatic, or both diagnoses when aged 60–64 were associated with being in paid work when aged 66–71.

Methods

This prospective population-based cohort study included all 98,551 individuals who in 2010 turned 65 years, lived in Sweden, and were in paid work at some point when aged 60–64. Data from three nationwide registers were used with 2010 as baseline, with SA or/and DP as the exposure variables (2005–2009) and paid work as the outcome variable (2011–2016). Logistic regression was conducted to calculate odds ratios (OR) with 95% confidence intervals (CI) for the association between exposures and outcome, controlling for sociodemographic factors. The analyses were also stratified by sex.

Results

Nearly half were in paid work during follow-up. Those with SA due to mental diagnoses had lower likelihood of being in paid work among both sexes (women OR: 0.76; 95% CI: 0.69–0.84; men 0.74; 0.65–0.84), while this association was smaller for SA due to somatic diagnoses (women 0.87; 0.84–0.91; men 0.92; 0.89–0.96). SA due to both mental and somatic diagnoses was associated with a lower likelihood of paid work for men (0.77; 0.65–0.91), but not women (0.98; 0.88–1.09). Regardless of diagnosis group and sex, DP had the strongest association with not being in paid work (women mental DP 0.39; 0.34–0.45; women somatic DP 0.38; 0.35–0.41; women mental and somatic DP 0.28; 0.15–0.56; men mental DP 0.36; 0.29–0.43; men somatic DP 0.35; 0.32–0.38; men mental and somatic DP 0.22; 0.10–0.51). Combined SA and/or DP demonstrated ORs in-between the diagnosis groups of SA and DP alone (e.g., mental SA and/or DP women and men combined 0.61; 0.57–0.65).

Conclusions

SA and DP were negatively associated with being in paid work after the standard retirement age of 65. The association was especially strong for DP, irrespective of diagnosis group. Moreover, compared to somatic diagnoses, SA due to mental diagnoses had a stronger association with not being in paid work. More knowledge is needed on how mental SA impedes extending working life.

Retirement Confidence: Development of an Index

Older workers who are confident about the changes accompanying retirement report higher well-being. We have developed an index to measure retirement confidence – the Retirement Confidence Index (RCI). A six-stage approach was used to develop the index items, including (i) a literature review to catalogue retirement confidence components; (ii) a consultation with a panel of experts to review the proposed indicators and combine components according to their meaning; (iii) normalisation of the selected components to make them comparable; (iv) weighting of the top-level dimensions using experts’ judgement; (v) linear aggregation of the dimension scores according to their corresponding relative weight; and (vi) correlation of the composite score with a self-report measure of retirement confidence. Based on the review of the literature, a list of nine sub-components (financial literacy, financial attitude and behaviour, financial control, financial anxiety, physical health, mental health, social connectedness, goal setting for retirement and future uncertainties) was compiled. Subsequently, these components were grouped into four broad dimensions. Correlations between these dimensions (social, financial awareness and skills, health and well-being, and retirement awareness and planning dimensions) and the corresponding self-reported measures were as high as r = 0.555, r = 0.603, r = 0.591 and r = 0.569, reflecting 30.8%, 36.3%, 34.9% and 32.3% shared variance with the corresponding self-reported indices, respectively. The Retirement Confidence Index provides the foundation for future research to measure retirement confidence, with the aim of identifying deficient RCI dimensions and directing efforts to targeted policies to ensure older workers are confident about retirement.

Employment and retirement impacts on health and wellbeing among a sample of rural Australians

Background

In Australia, it is projected that one in four individuals will be at the nominal retirement age of 65 or over by 2056; this effect is expected to be especially pronounced in rural areas. Previous findings on the effects of retirement on wellbeing have been mixed. The present study explores the effects of employment and retirement on health and wellbeing among a sample of rural Australians.

Methods

Australian Rural Mental Health Study participants who were aged 45 or over (N = 2013) were included in a series of analyses to compare the health and wellbeing of individuals with differing employment and retirement circumstances. Self-reported outcome variables included perceived physical health and everyday functioning, financial wellbeing, mental health, relationships, and satisfaction with life.

Results

Across the outcomes, participants who were employed or retired generally reported better health and wellbeing than those not in the workforce. Retired participants rated more highly than employed participants on mental health, relationships, and satisfaction with life. There was also a short-term benefit for perceived financial status for retired participants compared to employed participants, but this effect diminished over time.

Conclusions

While retirement is a significant life transition that may affect multiple facets of an individual’s life, the direction and magnitude of these effects vary depending on the retirement context, namely the pre-retirement and concurrent circumstances within which an individual is retiring. Personal perceptions of status changes may also contribute to an individual’s wellbeing more so than objective factors such as income. Policies that promote rural work/retirement opportunities and diversity and address rural disadvantage are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10876-9.

Health- and Age-Related Workplace Factors as Predictors of Preferred, Expected, and Actual Retirement Timing: Findings from a Swedish Cohort Study

To address the challenges of demographic aging, governments and organizations encourage extended working lives. This study investigates how individual health- and age-related workplace factors contribute to preferred, expected and actual retirement timing, as well as to the congruency between preferences vs. expectations, and preferences vs. actual retirement. We used data from a representative Swedish longitudinal sample comprising 4058 workers aged 50-64, with follow-up data regarding actual retirement timing available for 1164 respondents. Multinomial logistic regression analyses suggest that later preferred, expected, and actual retirement timing were, to different extent, influenced by better health, an age-friendly workplace and feeling positive regarding the future at work. Emotional exhaustion, age-related inequalities at work and experiencing aging as an obstacle increased the likelihood of preferring to retire earlier than one expected to, over retiring at the time one expected to. Those with better health and positive work prospects were less likely to prefer retiring earlier than they expected to, and more likely to being "pulled toward working until 65 and beyond", compared to being "pulled toward early retirement". Experiencing aging as an obstacle decreased the chances of being "pulled toward working until 65 and beyond". The results provide insights on how to facilitate extended working lives.

Insights into the Sustainable Return to Work of Aging Workers with a Work Disability: An Interpretative Description Study

Purpose A sustainable return to work (S-RTW) following prolonged work disability poses particular challenges as workers age. This article provides a synthesis of the factors and issues involved in a S-RTW process for aging workers following such a disability. Methods Using interpretive description methods, a critical review was conducted of the literature specifying return-to-work factors and issues for aging workers with regard to four major causes of work disability (musculoskeletal disorders, common mental disorders, cancer or other chronic diseases). The initial review concerned the 2000-2016 literature, and was subsequently updated for November 2016-December 2018. To further explore and contextualise the results of this literature review, four focus groups were held with stakeholders, representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. Results Fifty-five articles were reviewed and 35 stakeholders participated in the focus groups. Returning to work and staying at work appear to be particularly challenging for aging workers, who face notable issues and stigma concerning their ability to meet work demands, as well as their mobilisation and engagement in these processes. Such findings echo in many ways the main assertions of the literature on aging at work, except those regarding the transformation of capacities with aging, which is not mentioned in relation to workers with a work disability. The influence of healthcare and compensation systems on the S-RTW of aging work-disabled workers has also received little attention to date. Conclusions The results underscore that aging workers with a disability are frequently vulnerable in terms of their health or their jobs. Intersectoral efforts are needed to remedy this situation to keep them at work.

Subjective cognitive complaints and permanent work disability: a prospective cohort study

PURPOSE

Work disability (WD) is a medico-legal concept that refers to disability benefits (DB) granted due to diseases. We assessed whether subjective cognitive complaints (SCC)-presenting as self-rated difficulties of concentration, memory, clear thinking, and decision making-predict permanent WD in knowledge-intensive occupations.

METHODS

In this prospective cohort study with up to 7-year follow-up, we combined the SCC questionnaire results with reliable registry data on the DBs of 7161 professional/managerial employees (46% females). We excluded employees who were on long-term sickness absence (SA) or had received a DB at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome variable was a granted DB. The cumulative incidence function illustrates the difference between SCC categories, and the Fine-Gray model estimates the predictors of WD during the 8-year follow-up.

RESULTS

The annual incidence of DB was 0.15% in the entire cohort: 0.18% among the females, and 0.12% among the males (p = 0.795). The most common primary reasons for permanent WD were mental (36%) and musculoskeletal (20%) disorders. SCC predicted DB in both genders when controlling for age and prior SA. Hazard ratios were 2.9 with a 95% confidence interval 1.4-6.0 for the females and 3.7 (1.8-7.9) for the males.

CONCLUSION

Subjective cognitive complaints predict permanent WD in knowledge-intensive occupations. This finding has implications for supporting work ability and preventing work disability among employees with cognitively demanding tasks.

Gender differences in resources related to depressive symptoms during the early years of retirement: A Swedish population-based study

OBJECTIVES

To examine levels of depressive symptoms during the early years of retirement in men and women and to investigate potential gender differences in associations with self-reported health, financial insecurity, social network and psychological resources.

METHODS

Data was drawn from the first wave in the Health, Aging and Retirement Transitions in Sweden-study (HEARTS) including a total sample of 1148 retirees, aged 60 to 66. Level of depressive symptoms and associations with health, financial insecurity, social network and psychological resources were investigated in regression analyses in the total sample and in bivariate correlation analyses in the subgroup at risk of depression as defined by a cut-off ≥9 on the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

Mean CES-D scores were similar in men and women in the entire sample. The CES-D identified 144 individuals at risk of depression (men 14%, women 11%, n.s.). Although the pattern of related resources was similar in men and women, a greater proportion of the variance was explained in the male group (51% vs 37%). Health, quality of social network, social support and competence satisfaction were all correlated with depressive symptoms in men in the high risk group, but no associations were seen in women.

CONCLUSIONS

Similar levels of depressive symptoms were observed in women and men in the retirement transition. However, the relevance of the selected resources may be greater in men. Research on the management of depressive symptoms in the transition between midlife and aging needs to take gender into consideration.

The Analysis of Predictors of Retirement Preferences over Time

Due to rapid demographic ageing and to sustain its pension system, the Netherlands recently initiated a pension reform that increased the retirement age, with the intention to increase labour force participation among older workers. However, there is little evidence on the preferences of workers concerning their retirement age, and on how these preferences have changed over time. To identify personal and work-related determinants of the preference toward earlier or later retirement, and how these determinants and preferences have changed over time. We use data from three consecutive measurements (waves) of a large Dutch panel. Ordered logit regression is used to investigate the predictors of retirement preferences. Analyses are performed for two groups; all workers and a subsample of workers aged 50 years or older. Furthermore, the analyses are performed for each wave separately and for the combined dataset. A preference for later retirement is primarily related to university education, high job satisfaction, and high income. Age is only positively related to later retirement among older workers. Earlier retirement is preferred by female workers and workers living with a partner. The preference toward an earlier retirement age has increased over time. The preferences toward retirement can be primarily explained by personal characteristics, job satisfaction, and net income. Furthermore, with the increase in the retirement age defined by current legislation, the preference for an earlier retirement age has increased over time.

Depressive Symptomatology in Early Retirees Associated With Reason for Retirement-Results From the Population-Based LIFE-Adult-Study

BACKGROUND

Transition from employment to retirement is regarded a crucial event. However, there is mixed evidence on associations between retirement and mental health, especially regarding early retirement. In Germany, cases of early retirement due to ill health-particularly, mental ill health-are increasing. Therefore, we investigated the association between early retirement and depressive symptoms, including information on different types of early retirement.

METHODS

We analyzed data from 4,808 participants of the population-based LIFE-Adult-Study (age: 40-65 years, 654 retired, 4,154 employed), controlling for sociodemographic information, social network, pre-existing health conditions, and duration of retirement. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Regression analysis using entropy balancing was applied to achieve covariate balance between retired and employed subjects.

RESULTS

We found no overall-differences in depressive symptoms between employed and retired persons (men: b = -.52; p = 0.431; women: b = .05; p = .950). When looking at different types of early retirement, ill-health retirement was linked to increased depressive symptoms in women (b = 4.68, 95% CI = 1.71; 7.65), while voluntary retirement was associated with reduced depressive symptoms in men (b= -1.83, 95% CI = -3.22; -.43) even after controlling for covariates. For women, statutory retirement was linked to lower depressive symptomatology (b = -2.00, 95% CI = -3.99; -.02).

CONCLUSION

Depressive symptomatology among early retirees depends on reason for retirement: For women, ill-health retirement is linked to higher levels of depressive symptoms. Women who retire early due to ill-health constitute a risk group for depressive symptoms that needs specific attention in the health care and social security system.

Modelling changes in anxiety and depression during low-intensity cognitive behavioural therapy: An application of growth mixture models

OBJECTIVES

Research largely supports the clinical effectiveness of low-intensity cognitive behavioural therapy (LICBT) for mild-to-moderate anxiety and depression, delivered by psychological well-being practitioners (PWPs). Knowledge regarding the predictors of treatment response, however, is relatively limited. The primary aim of this study was to model the heterogeneity in longitudinal changes in anxiety and depression throughout LICBT provided by PWPs in Northern Ireland (NI), and to explore associations between pre-treatment variables and differences in treatment response.

METHODS

Growth mixture modelling (GMM) techniques were employed to examine changes in psychological status in clients (N = 253) over the first six sessions of treatment, to identify divergent early response trajectories. A series of pre-treatment variables were used to predict class membership using chi-square tests and binary logistic regression models.

RESULTS

There was one class representing improvement and one representing no improvement for both anxiety and depression. Class membership was predictive of treatment outcome. Pre-treatment variables associated with less improvement included unemployment, risk of suicide, neglect of self or others, using medication, receiving previous or concurrent treatments, a longer duration of difficulties, and comorbidities.

CONCLUSIONS

Findings indicate most of the sample populated an 'improvers' class for both depression and anxiety. Pre-treatment variables identified as predictive of poor treatment response may need to be considered by practitioners in potential triage referral decision policies, supporting cost-effective and efficient services. Further research around predictors of clinical outcome is recommended.

PRACTITIONER POINTS

Most of the sample belonged to an 'improvers' class. Several pre-treatment variables predicted poor treatment response (unemployment, suicide risk, neglect, medication, previous or concurrent treatments, longer duration of difficulties, and comorbidities). Few studies have utilized GMM to determine predictors of outcome following LICBT Regarding pre-treatment variables, the possibility of self-report bias cannot be excluded. The time period was relatively short, although represented the optimum number of sessions recommended for LICBT. The lack of a control group and random allocation were the main limitations.

Exploring socioeconomic and mental health trajectories during times of economic recession: a qualitative study with primary health care users and professionals

Background: The 2008 economic recession has been shown to affect populations' mental health due to deterioration of socioeconomic and living conditions. Concurrently, mental health problems may have constituted a vulnerability to wider social inequalities during this period.Aims: To explore perceptions and experiences of primary health care users and professionals regarding the relationship between mental health and socioeconomic position during the economic recession in Portugal.Method: Data were collected in three primary health care centres in Lisbon Metropolitan Area. Focus groups and semi-structured interviews were conducted with users and professionals, respectively. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis.Results: Two themes were obtained. The first comprised the relationship between changes in socioeconomic conditions (unemployment, precarious work conditions and financial hardship) and poor mental health. The second involved the consequences of experiencing mental health problems during the recession, namely disability, need of sick leave and early retirement.Conclusions: This study provided a comprehensive overview of the bidirectional relationship between socioeconomic conditions and mental health, emphasizing the need to develop policies to address the drivers of poor mental health during times of economic downturn and tackle the barriers faced by people with mental disorders to promote their full social inclusion.

Work stress among older employees in Germany: Effects on health and retirement age

Background

Policy makers in aging societies aim for the extension of work lives by increasing the official retirement age. Despite these efforts, many people stop working before reaching this retirement age. The main reason for early retirement is poor health. Health in turn is influenced by exposure to the work environment. Furthermore, health and work stress are influenced by education, which may lead to different effects for the lowly and the highly educated.

Objective

This study examines the relationship between work stress and retirement age. It investigates whether this relationship is mediated by health and moderated by education. Three dimensions of health are taken into account: self-rated health (SRH), depressive symptoms, and high cardiovascular risk diseases (HCVR).

Methods

A German subsample of the longitudinal Survey of Health, Aging and Retirement in Europe (SHARE) was linked with register data of the German Public Pension Scheme (SHARE-RV). The sample followed 302 individuals aged 50 to 65 years at baseline from 2004 to 2014. The data contains information on work stress, measured by job control and effort–reward–imbalance (ERI), health, and age of retirement. Multi-group structural equation modeling was applied to analyze the direct and indirect effects of work stress on retirement age via health. Work stress was lagged so that it temporally preceded health and retirement age.

Results

Lower job control and poorer SRH lead to a lower retirement age. Health does not operate as a mediator in the relationship between work stress and retirement age. Education moderates the relationship between work stress and health: high ERI leads to better SRH and better physical health of higher educated persons. Low job control increases the risk of depressive symptoms for persons with less education.

Conclusions

Improving stressful working conditions, particularly improving job control, can prolong the working lives of employees and postpone retirement.

Retirement and depressive symptoms: A 10-year cross-lagged analysis

The effect of retirement on depressive symptoms remains a subject of scientific inquiry, given the fact that previous studies have found mixed results. Moreover, the possible effect of depressive symptoms on the propensity to retire remains relatively understudied. Given the sheer number of retirees, and the significance of depressive symptoms for individuals' well-being and ability to work, as well as for societies at large, we used a large longitudinal dataset to examine the reciprocal effects of retirement on depressive symptoms, and of depressive symptoms on the propensity to retire. Using six waves of the Health and Retirement Study (HRS) data collected over a period of 10 years (N = 6584), we tested cross-lagged models of the reciprocal relationships between retirement and depressive symptoms. The analysis revealed that retirement results in increased depressive symptoms, and that depressive symptoms increase the likelihood of retirement. No sex differences in the lagged associations were found. We conclude that depressive symptoms are a risk factor for retirement, and practitioners should try and identify older workers suffering from depression prior to the retirement transition. Similarly, as retirement increases depressive symptoms, the transition should be treated as an important and sometimes risky milestone, where adequate preparation is required.

Intersections of discrimination due to unemployment and mental health problems: the role of double stigma for job- and help-seeking behaviors

PURPOSE

The everyday lives of unemployed people with mental health problems can be affected by multiple discrimination, but studies about double stigma-an overlap of identities and experiences of discrimination-in this group are lacking. We therefore studied multiple discrimination among unemployed people with mental health problems and its consequences for job- and help-seeking behaviors.

METHODS

Everyday discrimination and attributions of discrimination to unemployment and/or to mental health problems were examined among 301 unemployed individuals with mental health problems. Job search self-efficacy, barriers to care, and perceived need for treatment were compared among four subgroups, depending on attributions of experienced discrimination to unemployment and to mental health problems (group i); neither to unemployment nor to mental health problems (group ii); mainly to unemployment (group iii); or mainly to mental health problems (group iv).

RESULTS

In multiple regressions among all participants, higher levels of discrimination predicted reduced job search self-efficacy and higher barriers to care; and attributions of discrimination to unemployment were associated with increased barriers to care. In ANOVAs for subgroup comparisons, group i participants, who attributed discrimination to both unemployment and mental health problems, reported lower job search self-efficacy, more perceived stigma-related barriers to care and more need for treatment than group iii participants, as well as more stigma-related barriers to care than group iv.

CONCLUSIONS

Multiple discrimination may affect job search and help-seeking among unemployed individuals with mental health problems. Interventions to reduce public stigma and to improve coping with multiple discrimination for this group should be developed.

Domains and determinants of retirement timing: A systematic review of longitudinal studies

BACKGROUND

To date, determinants of retirement timing have been studied separately within various disciplines, such as occupational health and economics. This narrative literature review explores the determinants of retirement timing in countries, and relevant domains among older workers from both an economic and occupational health perspective.

METHODS

A literature search was conducted using 11 databases. Longitudinal studies on determinants of retirement timing were included. Study inclusion criteria were as follows: full-text article written in English or Dutch, conducted in humans, main outcome was time until retirement (i.e. retirement date or retirement age), and longitudinal design. Next, the included articles were screened for hypotheses on retirement timing and these articles with hypotheses were subjected to a quality assessment. Determinants for retirement timing were classified into multiple domains by three researchers.

RESULTS

The literature search identified 20 articles. The determinants of retirement timing were classified into eight domains: demographic factors, health factors, social factors, social participation, work characteristics, financial factors, retirement preferences, and macro effects. In total, we identified 49 determinants, ranging from one (social, and retirement preferences) to 21 determinants (work characteristics) per domain.

CONCLUSIONS

The findings suggest that there is a wide range of determinants that influence retirement timing in modern industrialized countries and that these determinants differ between countries. We recommend that researchers include determinants from various domains when studying retirement timing, while taking into account a country's context.

Secular trends in work disability and its relationship to musculoskeletal pain and mental health: a time-trend analysis using five cross-sectional surveys (2002-2010) in the general population

OBJECTIVES

International evidence suggests that rates of inability to work because of illness can change over time. We hypothesised that one reason for this is that the link between inability to work and common illnesses, such as musculoskeletal pain and mental illness, may also change over time. We have investigated this in a study based in one UK district.

METHODS

Five population surveys (spanning 2002-2010) of working-age people aged >50 years and ≤65 years were used. Work disability was defined as a single self-reported item 'not working due to ill-health'. Presence of moderate-severe depressive symptoms was identified from the Mental Component Score of the Short Form-12, and pain from a full-body manikin. Data were analysed with multivariable logistic regression.

RESULTS

The proportion of people reporting work disability across the surveys declined, from 17.0% in 2002 to 12.1% in 2010. Those reporting work disability, one-third reported regional pain, one-half widespread pain (53%) and two-thirds moderate-severe depressive symptoms (68%). Both factors were independently associated with work disability; their co-occurrence was associated with an almost 20-fold increase in the odds of reporting work disability compared with those with neither condition.

CONCLUSIONS

The association of work disability with musculoskeletal pain was stable over time; depressive symptoms became more prominent in persons reporting work disability, but overall prevalence of work disability declined. The frequency and impact of both musculoskeletal pain and depression highlight the need to move beyond symptom-directed approaches towards a more comprehensive model of health and vocational advice for people unable to work because of illness.

Permanence in the labour market and life satisfaction in old age

Population aging is a global trend that has drawn attention to policies to encourage a productive life and delayed retirement. Thus, it is necessary to expand our understanding of the effects of work on health indicators and well-being in old age. The purpose of this study was to determine the association of permanency in the labor market with sociodemographic and medical factors and life satisfaction in elders. We used the database from Study FIBRA-RJ including elderly (aged > 65) clients of a private health care plan who resided in northern districts of the municipality of Rio de Janeiro. Among the 626 participants, 82 (13,1%) maintained paid jobs. Multiple logistic regression showed that the odds of remaining working among the elderly were higher for men; and those with 9 years of studies or more, and those with high income; and those with no disabling clinical conditions and with higher satisfaction with life. This study confirms that work activities in old age are associated with better social and physical health conditions. Moreover, we observed that the maintenance of work activities was associated with higher life satisfaction, independent of socioeconomic and clinical characteristics in old age.

Early Retirement: A Meta-Analysis of Its Antecedent and Subsequent Correlates

Early or voluntary retirement (ER) can be defined as the full exit from an organizational job or career path of long duration, decided by individuals of a certain age at the mid or late career before mandatory retirement age, with the aim of reducing their attachment to work and closing a process of gradual psychological disengagement from working life. Given the swinging movements that characterize employment policies, the potential effects of ER-both for individuals and society-are still controversial. This meta-analysis examined the relationships between ER and its antecedent and subsequent correlates. Our review of the literature was generated with 151 empirical studies, containing a total number of 706,937 participants, with a wide range of sample sizes (from N = 27 to N = 127,384 participants) and 380 independent effect sizes (ESs), which included 171 independent samples. A negligible ES value for antecedent correlates of early retirement (family pull, job stress, job satisfaction, and income) was obtained (which ranged from r = -0.13 to 0.19), while a fair ES was obtained for workplace timing for retirement, organizational pressures, financial security, and poor physical and mental health, (ranging from r = 0.28 to 0.25). Regarding ER subsequent correlates, poor ESs were obtained, ranging from r = 0.08 to 0.18 for the relationships with subsequent correlates, and fair ESs only for social engagement (r = -0.25). Examination of the potential moderator variables has been conducted. Only a reduced percentage of variability of primary studies has been explained by moderators. Although potential moderator factors were examined, there are several unknown or not measurable factors which contribute to ER and about which there are very little data available. The discussion is aimed to offer theoretical and empirical implications suggestion in order to improve employee's well-being.

Health, lifestyle and employment beyond state-pension age

Background

The factors influencing one’s choice to retire vary, with financial and health considerations being some of the main factors impacting or associated with people’s timing of retirement. The aim of the study is to investigate the differences in current health and health-related behaviours, such as smoking, drinking and exercising, between people who kept on working beyond state-pension age and those who retired before or at state-pension age.

Methods

Data from six waves (2003, 2008–2012) of the Scottish Health Survey (SHeS) are used. Descriptive analyses were used to characterise the population. Multivariate logistic regression was undertaken to analyse the relationship between retirement groups and gender, age, deprivation, marital status, housing tenure, general health, longstanding illness, cigarette smoking status, amount of exercise and mental health, using Stata.

Results

Reporting poor self-rated health or having a long-standing illness was associated with increased odds of retiring before state pension age (SPA) in groups with a medium deprivation profile in almost all the survey years. For the least deprived there was little evidence of an association between poor health and extended-working-life, while significant associations were observed for the most deprived. An increasing trend was observed for both genders in the number of people extending their working life. Similar associations between reporting poorer self-rated health and extended working lives were observed for men and women. Distinct gender differences were observed for the associations with reporting poor mental health and no exercise. In the adjusted models, both were significantly associated with retiring at or before SPA in almost every year for women, whereas no significant associations were observed (except in 1 year) for men.

Conclusions

This study shows an increasing trend in the number of people extending their working lives and demonstrates significant associations between health and lifestyle behaviours and employment status past SPA. The results suggest that good health – both physically and mentally – along with either a need or a want to stay in employment could be important reasons for continuing to work beyond SPA.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4957-5) contains supplementary material, which is available to authorized users.

Comparison the effects of poor health and low income on early retirement: a systematic review and meta-analysis

The main aim of this study was to estimate the effects of poor health and low income on early retirement. For this purpose systematic review and meta-analysis were conducted. Web of Science, PUBMED and Scopus databases were searched systematically. Finally 17 surveys were added in meta-analysis. These studies were conducted in 13 countries. At the end a Meta regression was done to show the effects of welfare system type on effect sizes of poor health and low income. The results of this study showed that poor health had effect on the risk of early retirement. (Poor health pooled effect sizes: 1.279 CI: (1.15 1.41), low income pooled effect sizes: 1.042 CI: (0.92 1.17), (poor health pooled marginal effects: 0.046 CI: (-0.03 0.12), low income pooled marginal effects: -0.002 CI: (-0.003 0.000). The results of this study showed that association between poor health and early retirement was stronger in comparison with low income and early retirement.

What types of social interactions reduce the risk of psychological distress? Fixed effects longitudinal analysis of a cohort of 30,271 middle-to-older aged Australians

BACKGROUND

Research on the impact of social interactions on psychological distress tends to be limited to particular forms of support, cross-sectional designs and by the spectre of omitted variables bias.

METHOD

A baseline sample with 3.4±0.95 years follow-up time was extracted from the 45 and Up Study. Change in the risk of psychological distress (Kessler Psychological Distress Scale) was assessed using fixed effects logistic regressions in relation to the number of times in the past week a participant: i) spent time with friends or family they did not live with; ii) talked to friends, relatives or others on the telephone; iii) attended meetings at social clubs or religious groups; and the count of people outside their home, but within one hour travel-time, participants felt close to. Separate models were fitted for men and women, adjusting for age, income, economic and couple status.

RESULTS

An increase in the number of social interactions was associated with a reduction in the risk of psychological distress, with some gender differences. Interactions with friends or family were important for women (adjusted OR 0.85, 95%CI 0.74, 0.98, p=0.024), whereas telephone calls were effective among men (adjusted OR 0.83, 95%CI 0.72, 0.96, p=0.011). Strong effects for the number of people that can be relied on were observed for men and women, but attendance at clubs and groups was not. No age-specific effects were observed.

LIMITATIONS

No indicator of positive mental health.

CONCLUSIONS

Policies targeting greater social interactions in middle-to-older age may help protect mental health.

Impact of 9/11-related chronic conditions and PTSD comorbidity on early retirement and job loss among World Trade Center disaster rescue and recovery workers

BACKGROUND

The economic impact of the 9/11 terrorist attacks has rarely been studied. We examined the association between 9/11-related chronic health conditions with or without post-traumatic stress disorder (PTSD) and one important aspect of the economic impact, retirement, and job loss before age 60.

METHODS

A total of 7,662 workers who participated in the World Trade Center Health Registry surveys were studied. Logistic regression models examined the association of 9/11-related health and labor force exit.

RESULTS

Workers with chronic conditions were more likely to experience early retirement and job loss, and the association was stronger in the presence of PTSD comorbidity: the odds ratios for reporting early retirement or job loss were increased considerably when chronic conditions were comorbid with PTSD.

CONCLUSIONS

Disaster-related health burden directly impacts premature labor force exit and income. Future evaluation of disaster outcome should include its long-term impact on labor force. Am. J. Ind. Med. 59:731-741, 2016. © 2016 Wiley Periodicals, Inc.

Does long-term experience of nonstandard employment increase the incidence of depression in the elderly?

Objectives:

Our prospective study aimed to elucidate the effect of long-term experience of nonstandard employment status on the incidence of depression in elderly population using the Korean Longitudinal Study of Ageing (KLoSA) study.

Methods:

This study used the first- to fourth-wave cohorts of KLoSA. After the exclusion of the unemployed and participants who experienced a change in employment status during the follow-up periods, we analyzed a total of 1,817 participants. Employment contracts were assessed by self-reported questions:standard or nonstandard employment. The short form of the Center for Epidemiologic Studies Depression Scale (CES-D) served as the outcome measure. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models to evaluate the association between standard/nonstandard employees and development of depression.

Results:

The mean age of the participants was 53.90 (±7.21) years. We observed that nonstandard employment significantly increased the risk of depression. Compared with standard employees, nonstandard employees had a 1.5-fold elevated risk for depression after adjusting for age, gender, CES-D score at baseline, household income, occupation category, current marital status, number of living siblings, perceived health status, and chronic diseases [HR=1.461, 95% CI= (1.184, 1.805) ]. Moreover, regardless of other individual characteristics, the elevated risk of depression was observed among all kinds of nonstandard workers, such as temporary and day workers, full-time and part-time workers, and directly employed and dispatched labor.

Conclusions:

The 6-year follow-up study revealed that long-term experience of nonstandard employment status increased the risk of depression in elderly population in Korea.

Retirement Policies and Support for Emergency Service Personnel: The Transition to Retirement

L’objectif principal de cette étude a été d’examiner les politiques et les procédures pour soutenir les employés prenant leur retraite de leur travail aux services d’urgence. On a mené des entrevues avec les participants qui connaissaient bien les politiques et les procédures actuelles d’un grand ambulance (n = 8) et le service d’incendie (n = 6) en Irlande. Quatre thèmes principaux ont été révelés: (1) «Je ne pense pas que ce soit un bon travail d’etre ambulancier d’urgence quand on a 65 ans»; (2) “ils se sentent véritablement un tout petit peu isolé”; (3) l’amélioration du «choc culturel»; et (4) «Je continue a m’avancer en espérant que tout aille pour le mieux. » Les conclusions indiquent que la retraite est un changement majeur de la vie, et mettent en évidence la nécessité pour une préparation de pré-retraite plus structurée et efficace. Les éléments uniques au personnel des services d’urgence comprennent: le stress physique et émotionnel intense impliqué dans les services d’urgence; une forte identification avec ce service; et un manque de clarté sur les règles et les droits, exigeant meilleure renseignements et préparation pour prendre sa retraite.

The impact of retirement on health: quasi-experimental methods using administrative data

Background

Is retirement good or bad for health? Disentangling causality is difficult. Much of the previous quasi-experimental research on the effect of health on retirement used self-reported health and relied upon discontinuities in public retirement incentives across Europe. The current study investigated the effect of retirement on health by exploiting discontinuities in private retirement incentives to test the effect of retirement on health using a quasi-experimental study design.

Methods

Secondary data (1997–2009) on a cohort of male manufacturing workers in a United States setting. Health status was determined using claims data from private insurance and Medicare. Analyses used employer-based administrative and claims data and claim data from Medicare.

Results

Widely used selection on observables models overstate the negative impact of retirement due to the endogeneity of the decision to retire. In addition, health status as measured by administrative claims data provide some advantages over the more commonly used survey items. Using an instrument and administrative health records, we find null to positive effects from retirement on all fronts, with a possible exception of increased risk for diabetes.

Conclusions

This study provides evidence that retirement is not detrimental and may be beneficial to health for a sample of manufacturing workers. In addition, it supports previous research indicating that quasi-experimental methodologies are necessary to evaluate the relationship between retirement and health, as any selection on observable model will overstate the negative relationship of retirement on health. Further, it provides a model for how such research could be implemented in countries like the United States that do not have a strong public pension program. Finally, it demonstrates that such research need-not rely upon survey data, which has certain shortcomings and is not always available for homogenous samples.

Gender, mental health, physical health and retirement: A prospective study of 21,608 Australians aged 55-69 years

OBJECTIVES

We examined retirement transitions by gender, and different associations between retirement, physical function and mental health.

METHODS

Data for 21,608 participants aged 55-69 from the 45 and Up Study were used. Generalised estimating equations were used to investigate longitudinal associations between retirement with psychological distress (Kessler score, K10) and physical dysfunction across two time points, by gender separately.

RESULTS

Retirement in men was associated with a 25% relative increase in mean physical dysfunction score (p<0.001) and a 2% relative increase in mean K10 score (p=0.004), although men with high physical dysfunction score had a 6% increase in mean K10 score (p=0.005) if retired. For women, retirement was associated with a 17% increase in mean physical dysfunction score (p<0.001), with no association observed with the K10 score. Results were adjusted for demographic and health covariates.

CONCLUSION

Retirement is associated with physical dysfunction over time. Retirement is not associated with psychological distress among women, but retirement is associated with psychological distress among men who have a high level of physical dysfunction. The findings point to the importance of attending to the physical and mental health needs, around the retirement period, particularly for men with poor physical health.

Risk factors for early disability pension in patients with epilepsy and vocational difficulties - Data from a specialized rehabilitation unit

PURPOSE

The purpose of this study was to assess the risk factors for early disability pension (EDP) in adult patients with epilepsy in a specialized epilepsy rehabilitation setting.

METHODS

In a retrospective study, 246 patients with epilepsy and employment difficulties leading to referral to an inpatient rehabilitation unit were evaluated with a questionnaire on admission and after a mean of 2.5years after discharge. Patients already receiving EDP at baseline were excluded. Epilepsy-related, demographic, and employment-related data as well as cognitive functioning and psychiatric comorbidity were assessed as risk factors for EDP at follow-up and analyzed using logistic regression models.

RESULTS

Seventy-six percent of the patients had uncontrolled epilepsy, and 66.7% had psychiatric comorbidity. At follow-up, 33.7% received an EDP. According to multivariate logistic regression analysis, age>50years (odds ratio (OR) 5.44, compared to age<30years), application for an EDP prior to admission (OR 3.7), sickness absence>3months in the previous year (OR 3.30, compared to sickness absence<3months), and psychiatric comorbidity (OR 2.79) were significant risk factors for an EDP at follow-up, while epilepsy-related factors and cognitive impairment showed an effect only in the univariate analyses.

CONCLUSIONS

Potential risk factors for EDP in patients with epilepsy were evaluated using multivariate analysis. Knowledge of such factors may help to develop appropriate criteria for rehabilitation candidacy and interventions to reduce the risk for EDP. This might lead to an amelioration of both psychosocial burden of patients and economic burden on society.

Depressive symptoms and early retirement intentions among Danish eldercare workers: Cross-sectional and longitudinal analyses

Background

Depression increases the risk of disability pension and represents a health related strain that pushes people out of the labour market. Although early voluntary retirement is an important alternative to disability pension, few studies have examined whether depressive symptoms incur early voluntary retirement. This study examined whether depressive symptoms and changes in depressive symptoms over time were associated with early retirement intentions.

Methods

We used a cross-sectional (n = 4041) and a prospective (n = 2444) population from a longitudinal study on employees of the Danish eldercare sector. Depressive symptoms were measured by the Major Depression Inventory and the impact of different levels of depressive symptoms (severe, moderately severe, moderate, mild and none) and changes in depressive symptoms (worsened, improved, unaffected) on early retirement intentions were analysed with multinomial logistic regression.

Results

In the cross-sectional analysis all levels of depressive symptoms were significantly associated with retirement intentions before the age of 62 years. Similar associations were found prospectively. Depressive symptoms and worsened depressive symptoms in the two year period from baseline to follow-up were also significantly associated with early retirement intentions before age 62. The prospective associations lost statistical significance when controlling for early retirement intentions at baseline.

Conclusions

The whole spectrum of depressive symptoms represents a health related strain that can incur intentions to retire early by early voluntary retirement. In order to change the intentions to retire early, the work related consequences of depressive symptoms should be addressed as early in the treatment process as possible.

Retirement, age, gender and mental health: findings from the 45 and Up Study

OBJECTIVES

To examine the relationships of retirement and reasons for retirement with psychological distress in men and women at the age of 45-79 years.

METHOD

Data from 202,584 Australians participating in the large-scale 45 and Up Study was used. Psychological distress was measured by the Kessler psychological distress scale. Associations between different work status and reasons for retirement with psychological distress were assessed for men and women at different ages using logistic regression.

RESULTS

Being fully retired or unemployed was associated with the high levels of psychological distress compared to being in paid work for men and women aged 45-64 (p < 0.0001), and for men aged 65-74 years (p ≤ 0.0014). At the age of 75-79 years, there was no difference in psychological distress between different work statuses. Among retirees, retirement due to ill health, being made redundant or caring duty was associated with the high level of psychological distress.

CONCLUSION

The association between work and mental health underscores the importance of policies and strategies to encourage and enable people to continue in the workforce after age 55, particularly for men. Important reasons for retirement with worse mental health outcomes include redundancy, ill health and needing to care for family or a friend. These circumstances will affect whether a person can continue working and their risk of poor mental health, and both considerations should be addressed in developing approaches for maintaining older workers or assisting them with their retirement transition.

Prevalence and incidence of memory complaints in employed compared to non-employed aged 55-64 years and the role of employment characteristics

Objectives

To examine the association of employment status and characteristics with prevalent and incident memory complaints (MC) in 55–64-year-olds.

Methods

Subjects were participants of the Longitudinal Aging Study Amsterdam (LASA). Respondents with baseline data were selected to examine the association of employment status (n = 1525) and employment characteristics (n = 1071) with prevalent MC (i.e., MC at baseline). Respondents without MC at baseline were selected to examine the association of employment (n = 526) and employment characteristics (n = 379; working hours, job prestige, job level, psychological job demands, iso-strain) with incident MC (i.e., no MC at baseline and MC at three-year follow-up). Associations were adjusted for relevant covariates (demographics, memory performance, physical health, mental health, personality traits). Logistic regression was applied. Data were weighed according to gender and age of the Dutch population.

Results

At baseline 20.5% reported MC. At three-year follow-up, 15.4% had incident MC. No associations were found between employment status and MC. Adjusted analysis revealed that individuals with high occupational cognitive demands were more likely to have prevalent MC.

Conclusions

Middle-aged workers are equally as likely to experience MC as non-working age-peers. Among workers, those with cognitively demanding work were more likely to experience MC, independent of memory performance. Memory decline due to ageing may be noticed sooner in 55–64-year-olds performing cognitively demanding work.

Occupational stress, bullying and resilience in old age

Our working years increasingly extend into the late 60s and may soon include the 70s for some people. Thus the question whether work stress has a cumulative effect in older age, and whether older employees are more vulnerable to certain sources of work stress, such as bullying in the work place, is becoming increasingly relevant. We review some of the mechanisms, which translate cumulative stress at work into ill health, particularly in older age, and summarise what is known about the effect of age-specific stress, taking age-related bullying as an example.

Early retirement in cancer patients with or without comorbid mental health conditions: a prospective cohort study

BACKGROUND

The authors investigated whether cancer patients who have comorbid mental health disorders (MD) are at greater risk of early retirement compared with those who do not have MD.

METHODS

Individuals ages 18 to 55 years from a consecutive sample of patients who were admitted for inpatient oncologic treatment were interviewed using structured clinical interviews to ascertain MD. The patients were followed for 15 months, and the date of early retirement was documented. Rates of early retirement per 100 person-years (py) in patients with and without MD were compared using multivariate Poisson regression models.

RESULTS

At baseline, 491 patients were interviewed, and 150 of those patients (30.6%) were diagnosed with MD. Forty-one patients began full early retirement during follow-up. In patients with MD, the incidence of early retirement was 9.3 per 100 py compared with 6.1 per 100 py in mentally healthy patients. The crude rate ratio (RR) was 1.5 (95% confidence interval [CI], 0.8-2.8). The effect of MD on early retirement was modified in part by income: in patients with low income, the adjusted RR was 11.7, whereas no effect was observed in higher income groups. Patients with depression were at greater risk of retirement when they had higher income (RR, 3.4; P = .05). The effects of anxiety (RR, 2.4; P = .05), adjustment disorders (RR, 1.7; P = .21), and alcohol dependence (RR, 1.8; P = .40) on early retirement were equal across income groups.

CONCLUSIONS

Mental health conditions are risk factors for early retirement in cancer patients, although this effect differs according to the type of disorder and the patient's income level.

Is working later in life good or bad for health? An investigation of multiple health outcomes

OBJECTIVES

To examine the mutual influences between changes in work status and multiple dimensions of health outcomes (immediate memory, physical disability, and depressive symptoms) over later years.

METHODS

We used a subsample of 8,524 older adults who participated in the Health and Retirement Study from 1998 to 2008 and were 62 years or older in 1998 to examine work status and health outcomes after controlling for age and background characteristics.

RESULTS

We present results of cross-lagged auto-regressive models. Work status (level of work) predicted subsequent residual changes in immediate memory over time, whereas immediate memory predicted subsequent residual changes in work status over time, even after controlling for physical disability and depressive symptoms. Similar results were indicated for the associations between work status and physical disability and depressive symptoms over time.

DISCUSSION

Consistent with social causation and social selection traditions, the findings support bi-directional associations among changes in work status (the level of work), immediate memory, physical disability, and depressive symptoms in later years. Practical implications are discussed.

Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study

BACKGROUND

Workforce participation is a key feature of public mental health and social inclusion policies across the globe, and often a therapeutic goal in treatment settings. Understanding the reciprocal relationship between participation and mental health has been limited by inadequate research methods. This is the first study to simultaneously examine and contrast the relative effects of unemployment on mental health and mental health on employment status in a single general population sample.

METHOD

Data were from working-age respondents (20 to 55 years at baseline) who completed nine waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (N=7176). Cross-lagged path analyses were used to test the lagged and concurrent associations between unemployment and mental health over time, adjusting for sociodemographic characteristics.

RESULTS

Mental health was shown to be both a consequence of and risk factor for unemployment. Thus, the poorer mental health observed amongst people who are not working is attributable to both the impact of unemployment and existing mental health problems. While the strength of these two effects was similar for women, the results for men suggested that the effect of unemployment on subsequent mental health was weaker than the effect of mental health on subsequent risk of unemployment.

CONCLUSION

Disentangling the reciprocal links between mental health and workforce participation is central to the development and success of clinical goals and health and social policies that aim to promote either aspect. This study demonstrates that both effects are important and supports concurrent responses to prevent a cycle of disadvantage and entrenched social exclusion.

Socio-economic differences in self-reported insomnia and stress in Finland from 1979 to 2002: a population-based repeated cross-sectional survey

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.

Poor mental health influences risk and duration of unemployment: a prospective study

PURPOSE

The current paper aims to investigate the role of mental health in determining future employment status. Much of the previous longitudinal and prospective research has focused on how unemployment adversely influences mental health, while the reverse causal direction has received much less attention.

METHODS

This study uses five waves of data from 5,846 respondents in the HILDA survey, a nationally representative household panel survey conducted annually since 2001. Prospective analyses followed a group of respondents who were not unemployed at baseline across four subsequent years and investigated whether baseline mental health was associated with subsequent unemployment.

RESULTS

Baseline mental health status was a significant predictor of overall time spent unemployed for both men and women. Decomposing this overall effect identified sex differences. For women but not men, baseline mental health was associated with risk of experiencing any subsequent unemployment whereas for men but not women mental health was associated with the duration of unemployment amongst those who experienced unemployment.

CONCLUSIONS

By following a group of respondents who were not unemployed over time, we showed that poor mental health predicted subsequent unemployment. On average, men and women who experienced symptoms of common mental disorders spent greater time over the next 4 years unemployed than those with better mental health but there were sex differences in the nature of this effect. These findings highlight the importance of mental health in the design and delivery of employment and welfare policy.