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Does retirement trigger depressive symptoms? A systematic review and meta-analysis
- A. Odone, V. Gianfredi, G. P. Vigezzi, A. Amerio, C. Ardito, A. d'Errico, D. Stuckler, G. Costa
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 30 / 2021
- Published online by Cambridge University Press:
- 01 December 2021, e77
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- Article
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Aims
Retirement is a major life transition that may improve or worsen mental health, including depression. Existing studies provide contradictory results. We conducted a systematic review with meta-analysis to quantitatively pool available evidence on the association of retirement and depressive symptoms.
MethodsWe applied PRISMA guidelines to conduct a systematic review and meta-analysis to retrieve, quantitatively pool and critically evaluate the association between retirement and both incident and prevalent depression and to understand better the potential role of individual and contextual-level determinants. Relevant original studies were identified by searching PubMed, Embase, PsycINFO and the Cochrane Library, through 4 March 2021. Subgroup and sensitivity meta-analyses were conducted by gender, study design (longitudinal v. cross-sectional studies), study quality score (QS) and considering studies using validated scales to diagnose depression. Heterogeneity between studies was evaluated with I2 statistics.
ResultsForty-one original studies met our a priori defined inclusion criteria. Meta-analysis on more than half a million subjects (n = 557 111) from 60 datasets suggested a protective effect of retirement on the risk of depression [effect size (ES) = 0.83, 95% confidence interval (CI) = 0.74–0.93], although with high statistical heterogeneity between risk estimates (χ2 = 895.19, df = 59, I2 = 93.41%, p-value < 0.0001). Funnel plot asymmetry and trim and fill method suggested a minor potential publication bias. Results were consistent, confirm their robustness and suggest stronger protective effects when progressively restricting the included studies based on quality criteria: (i) studies with the highest QS [55 datasets, 407 086 subjects, ES = 0.81, 95% CI = 0.71–0.91], (ii) studies with a high QS and using validated assessment tools to diagnose depression (44 datasets, 239 453 subjects, ES = 0.76, 95% CI = 0.65–0.88) and (iii) studies of high quality, using a validated tool and with a longitudinal design (24 datasets, 162 004 subjects, ES = 0.76, 95% CI = 0.64–0.90). We observed a progressive reduction in funnel plot asymmetry. About gender, no statistically significant difference was found (females ES = 0.79, 95% CI = 0.61–1.02 v. men ES = 0.87, 95% CI = 0.68–1.11).
ConclusionsPooled data suggested that retirement reduces by nearly 20% the risk of depression; such estimates got stronger when limiting the analysis to longitudinal and high-quality studies, even if results are affected by high heterogeneity.
As retirement seems to have an independent and protective effect on mental health and depressive symptoms, greater flexibility in retirement timing should be granted to older workers to reduce their mental burden and avoid the development of severe depression. Retirement may also be identified as a target moment for preventive interventions, particularly primary and secondary prevention, to promote health and wellbeing in older ages, boosting the observed impact.
2255 – The Mental Health Risks Economic Crisis In Spain: Evidence From Primary Care Centres, 2006 And 2010
- M. Gili, M. Roca, D. Stuckler, S. Basu, M. McKee
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- Journal:
- European Psychiatry / Volume 28 / Issue S1 / 2013
- Published online by Cambridge University Press:
- 15 April 2020, 28-E1406
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Spain has experienced one of the deepest recessions among European countries affected by the economic crisis. We investigated the effects of the recession on the frequency of mental disorders in Primary Care (PC).
A group of PC physicians selected into the study a random sample of patients attending primary care centres. These patients were administered the PRIME-MD for the assessment of mental disorders, in 2006 and again in 2010, before and during the financial crisis. Multivariate logistic regression models were used to assess the relationship of unemployment, mortgage payment difficulties, and eviction on risks of mental health disorders.
Compared with the pre-crisis period of 2006, the 2010 survey revealed substantial increases in the proportion of patients with mood, anxiety, somatoform, and alcohol-related disorders (p< 0.0001), but not in eating disorders (p = 0.172). Major depression (19.4% increase) and dysthymia (10.8), showed the greatest rise, followed generalized anxiety disorder (8.4) and panic attack disorder (7.3). Both alcohol dependence and alcohol abuse rose significantly, by 4.6% and 2.4% (OR = 11.6 and 4.5, p< 0.001), respectively. After correcting for the risks of unemployment, we observed a significant rise in attendance with depression associated with mortgage repayment difficulties (OR =2.12, p< 0.001) and evictions (OR = 2.95, p< 0.001).
Recession has significantly increased the frequency of mental health disorders, particularly among families experiencing unemployment and mortgage payment difficulties. Expanding mental health services in primary care settings to at-risk groups may help cope with rising mental health disorders in areas affected by recession.