Department of Public Health, Experimental and Forensic Medicine, Università degli Studi di Pavia, Pavia, Italy.
Ca' della Paglia College, Fondazione Ghislieri, Pavia, Italy.
Epidemiol Psychiatr Sci. 2023 May 11;32:e34. doi: 10.1017/S2045796023000239.
AIMS: Depression is among the main contributors to older adults' mental health burden. Retirement, one of the major life transitions, has been claimed to influence mental health substantially. Following up on a previous meta-analysis, the study aims to assess from a longitudinal perspective short- and long-term impacts of transitioning to retirement on depression risk and suicidality in older adults across Europe. METHODS: We conducted a longitudinal study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected between 2004 and 2020 in 27 European countries plus Israel. To estimate relative risks (RR) and 95% confidence intervals (95% CIs) for depression and suicidality at seven time intervals before and after retirement, we fitted adjusted generalized estimating equation models for repeated measures. RESULTS: We included 8,998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). Compared to the year of retirement, the risk of depression was 11% lower in the following year (RR 0.89; 95% CI 0.81-0.99), 9% lower after 2 years (RR 0.91; 95% CI 0.82-1.00) and after 3 years (RR 0.91; 95% CI 0.81-1.01). Significant estimates remained among females, married individuals, those with an intermediate or higher level of education, former manual workers and those who retired at or before their country's median retirement age. A significant increase in depressive symptoms emerged from the tenth year after retirement among former non-manual workers (RR 1.21; 95% CI 1.05-1.40) and late retirees (RR 1.37; 95% CI 1.16-1.63). No heterogeneity emerged among strata. As for suicidality, we reported an increase in risk only 5 years or more after retirement, namely +30% 5-9 years after retirement (RR 1.30; 95% CI 1.04-1.64) and +47% 10 or more years after retirement (RR 1.47; 95% CI 1.09-1.98). Sensitivity analyses excluding subjects who reported a diagnosis of depression over the study period and those retirees who declared to receive a disability pension confirmed the results obtained in the overall analysis. CONCLUSIONS: Longitudinal adjusted data suggest an independent effect of retiring associated with a reduction in depression and suicidality risk in the short run, with its effect decreasing in the long run. Such trends are particularly evident among selected subgroups of elderly populations. If greater flexibility in pensionable age may help prevent depression late in life, the transition to retirement is to be accompanied by targeted health promotion interventions. In an ageing society, welfare policies should be evaluated, considering their long-term impact on mental health.
目的:抑郁症是导致老年人心理健康负担的主要因素之一。退休是人生的重大转折之一,据报道会对心理健康产生重大影响。在之前的一项荟萃分析之后,本研究旨在从纵向角度评估欧洲老年人退休后短期和长期的退休对抑郁风险和自杀的影响。
方法:我们使用 2004 年至 2020 年在欧洲 27 个国家和以色列收集的欧洲健康、老龄化和退休调查(SHARE)的数据进行了纵向研究。为了估计退休前后七个时间间隔的抑郁和自杀风险的相对风险(RR)和 95%置信区间(95%CI),我们为重复测量拟合了调整后的广义估计方程模型。
结果:我们纳入了 8998 名在基线时就业并在随访时退休的个体(中位随访时间:9 年;最长:16 年)。与退休当年相比,退休次年的抑郁风险降低 11%(RR 0.89;95%CI 0.81-0.99),第 2 年降低 9%(RR 0.91;95%CI 0.82-1.00),第 3 年降低 9%(RR 0.91;95%CI 0.81-1.01)。女性、已婚人士、中等或以上教育程度、前体力劳动者和在本国中位数退休年龄或之前退休的人群中,显著估计值仍然存在。在退休 10 年后,前非体力劳动者(RR 1.21;95%CI 1.05-1.40)和延迟退休者(RR 1.37;95%CI 1.16-1.63)的抑郁症状显著增加。各层之间没有出现异质性。至于自杀,我们只报告了退休 5 年或更长时间后风险增加,即退休后 5-9 年增加 30%(RR 1.30;95%CI 1.04-1.64),退休后 10 年或更长时间增加 47%(RR 1.47;95%CI 1.09-1.98)。排除研究期间报告抑郁诊断的受试者和宣布领取残疾抚恤金的退休人员的敏感性分析证实了总体分析中获得的结果。
结论:纵向调整数据表明,退休与抑郁和自杀风险降低有关,这种关联在短期内独立存在,随着时间的推移,这种关联的效应会降低。这些趋势在老年人群体的某些特定亚组中尤为明显。如果在可领取养老金的年龄方面有更大的灵活性,可能有助于预防晚年的抑郁,那么退休过渡应伴随着有针对性的健康促进干预。在老龄化社会中,应评估福利政策,考虑其对心理健康的长期影响。
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