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失业、退休与美国老年人的心理健康。

Job loss, retirement and the mental health of older Americans.

作者信息

Mandal Bidisha, Roe Brian

机构信息

The Ohio State University, Columbus, OH, USA.

出版信息

J Ment Health Policy Econ. 2008 Dec;11(4):167-76.

PMID:19096091
Abstract

BACKGROUND

Millions of older individuals cope with physical limitations, cognitive changes, and various losses such as bereavement that are commonly associated with aging. Given increased vulnerability to various health problems during aging, work displacement might exacerbate these due to additional distress and to possible changes in medical coverage. Older Americans are of increasing interest to researchers and policymakers due to the sheer size of the Baby Boom cohort, which is approaching retirement age, and due to the general decline in job security in the U.S. labor market.

AIMS OF THE STUDY

This research compares and contrasts the effect of involuntary job loss and retirement on the mental health of older Americans. Furthermore, it examines the impact of re-employment on the depressive symptoms.

METHODS

There are two fundamental empirical challenges in isolating the effect of employment status on mental health. The first is to control for unobserved heterogeneity--all latent factors that could impact mental health so as to establish the correct magnitude of the effect of employment status. The second challenge is to verify the direction of causality. First difference models are used to control for latent effects and a two-stage least squares regression is used to account for reverse causality.

RESULTS

We find that involuntary job loss worsens mental health, and re-employment recaptures the past mental health status. Retirement is found to improve mental health of older Americans.

DISCUSSION

With the use of longitudinal data from the Health and Retirement Study surveys and the adoption of proper measures to control for the possibility of reverse causality, this study provides strong evidence of elevating depressive symptoms with involuntary job displacement even after controlling for other late-life events. Women suffer from greater distress levels than men after job loss due to business closure or lay-off. However, women also exhibit better psychological well-being than men following retirement. The present study is the first to report that the re-employment of involuntary job-loss sufferers leads to a recapturing of past mental health status. Additionally, we find that re-entering the labor force is psychologically beneficial to retirees as well.

IMPLICATIONS FOR HEALTH CARE PROVISION

It is well established that out-of-pocket expenditures on all forms of health care for seniors with self-diagnosed depression significantly exceeds expenditures for seniors with other common ailments such as hypertension and arthritis in the U.S. Thus, our research suggests that re-employment of older Americans displaced from the labor force will be cost-effective with regard to personal mental health outcomes.

IMPLICATIONS FOR HEALTH POLICIES

That re-employment of involuntary job loss sufferers leads to a recapturing of past mental health status illuminates one potential policy trade off - increased resources dedicated to job training and placement for older U.S. workers could reap benefits with regard to reduced private and public mental health expenditures.

IMPLICATIONS FOR FURTHER RESEARCH

Further research could more clearly assess the degree to which the mental health benefits of employment among older Americans would warrant the expansion of job training and employment programs aimed at this group.

摘要

背景

数以百万计的老年人应对身体机能受限、认知变化以及诸如丧亲之痛等各种与衰老相关的损失。鉴于衰老过程中对各种健康问题的易感性增加,工作岗位的变动可能会因额外的压力以及医疗保险的可能变化而加剧这些问题。由于婴儿潮一代规模庞大且即将退休,以及美国劳动力市场工作安全感普遍下降,美国老年人越来越受到研究人员和政策制定者的关注。

研究目的

本研究比较并对比非自愿失业和退休对美国老年人心理健康的影响。此外,还考察了再就业对抑郁症状的影响。

方法

在分离就业状况对心理健康的影响方面存在两个基本的实证挑战。第一个挑战是控制未观察到的异质性——所有可能影响心理健康的潜在因素,以便确定就业状况影响的正确程度。第二个挑战是验证因果关系的方向。使用一阶差分模型来控制潜在影响,并使用两阶段最小二乘回归来解释反向因果关系。

结果

我们发现非自愿失业会恶化心理健康,而再就业能恢复过去的心理健康状况。研究发现退休会改善美国老年人的心理健康。

讨论

通过使用来自健康与退休研究调查的纵向数据,并采取适当措施控制反向因果关系的可能性,本研究提供了有力证据,表明即使在控制了其他晚年事件之后,非自愿工作岗位变动也会加剧抑郁症状。因企业倒闭或裁员而失业后,女性比男性遭受更大的痛苦。然而,退休后女性的心理健康状况也比男性更好。本研究首次报告非自愿失业者的再就业会导致恢复过去的心理健康状况。此外,我们还发现重新进入劳动力市场对退休人员在心理上也有益处。

对医疗保健提供的启示

在美国,自我诊断为抑郁症的老年人在各种医疗保健方面的自付费用明显超过患有高血压和关节炎等其他常见疾病的老年人。因此,我们的研究表明,让从劳动力市场上被取代的美国老年人重新就业在个人心理健康结果方面具有成本效益。

对卫生政策的启示

非自愿失业者的再就业会导致恢复过去的心理健康状况,这揭示了一个潜在的政策权衡——为美国老年工人增加用于职业培训和就业安置的资源,可能会在减少私人和公共心理健康支出方面带来好处。

对进一步研究的启示

进一步的研究可以更清楚地评估美国老年人就业对心理健康的益处能在多大程度上证明扩大针对这一群体的职业培训和就业项目是合理的。

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