Lago di Como, February 2006

Transcription

1 1 and Martin J Prince 1 1 Institute of Psychiatry, London Lago di Como, February 2006

2 1 Background to depression and 2 Study methods and measures 3 What does it all mean? 4 What does it all mean?

3 Why was this worth doing? is an important source of morbidity (and mortality) throughout the life course. Poor mental health may affect decisions Poor conditions may affect mental health Organisationally based studies have shown a link between early and mental health

4 What did we measure? EURO-D scale - validated in the EURODEP study of depression in Europe, current depression. Reasons for and feeling about. Demographic variables. Physical health and functioning. Self reported past history of depression. Analysis is based on those who said they had retired.

5 Female Male Italy Spain Greece France Switzerland Austria Density Sweden Denmark Germany The Netherlands

6 Analysis decisions Exclude all those who retired age 40 after age 79 The women who retired age 40 often gave as the sole reason to spend more time with my family. Missing depression Age less than 50 already excluded from the previous graph.

7 Who retired early? Sex Women Men % % Marital status Alone Cohab Married % % %

8 Who retired early? (continued) Feelings about Neither Both Concern Relief % % % % Education Low Medium High % % %

9 Did age at matter? Predicting score on the EURO D (from 0 12) Adjusted for sex (female higher risk of depression), age (older higher), country (Mediterranean higher), past history (higher), education (more lower), marital status (unmarried higher) Effect 95% ci 60+ Reference So the early retirers score about half a point more on the EURO D This is a relatively large effect, for comparison the largest other effect is past history at 1.2 followed by sex at 0.57.

10 But why did they retire? Reason Alone At all Pension Own health Incentive Redundancy Family Enjoy life Other s health None of above 275 Pension means pension from any source Pens + enjoy 113 Pens + own hlth 109 Family + enjoy 72 Pens + fam + enjoy 56 Pens + fam 52 Pens + incent 44 Incent + enjoy 39 Incent + redund 32 Incent + own hlth 30 Family means spend more time with family or synchrony with spouse There are 9468 in total

11 Reasons for and feelings about Adding reasons for and feeling about Effect 95% ci Pension Incentive Redundant Own health Other s health Family Enjoy myself Felt concerned Felt relief Both Neither Reference

12 Reasons for and feelings about (continued) is no longer a source of variation. No obviously important interactions Men and women do not differ in the effect on depression score of age at, feelings about or reasons given for The effect of age at does not differ according to reasons given for The effect of age at is not different for different levels of education Models similar if use log link, proportional odds or transform outcome.

13 What does it all mean? Strengths Variety of social structures Large sample Women Limitations Retrospective about circumstances of Most people retired because their pension was due or because of an incentive Most people felt relief It is not retiring early but the circumstances and your feelings which predict depression A substantial number retire because of their own health

14 Past history of depression Poor man s longitudinal study onset of depression an impefect measure Final digit Frequency Classify as depressed versus the others (never depressed and those with onset after ). Model with and without current depression.

15 Italy Spain Greece France Switzerland Austria Density Sweden Denmark Germany The Netherlands first episode of depression

16 Can we retrodict who was depressed? More likely to be Female Younger, but possible memory effects From The Netherlands or France Currently depressed Better educated Retired older, but possible artefact of shortened period at risk OR 95% ci 60+ Reference Unmarried

17 Reasons for and feelings about OR 95% ci Pension Incentive Redundant Own health Other s health Family Enjoy myself Felt concerned Felt relief Both Neither 1.00

18 Reasons for and feelings about (continued) Models fairly similar if currently depressed are excluded from the dataset so not just reporting issues. still a source of variation Basic model Full model OR 95% ci OR 95% ci 60+ Reference

19 What does it all mean? Strengths Variety of social structures Large sample Limitations Imperfect measurement of previous depression and timing of onset History of depression does not predict early History of depression does predict on grounds of own health and (inversely) retiring to be with family