1 and Martin J Prince 1 1 Institute of Psychiatry, London Lago di Como, February 2006
1 Background to depression and 2 Study methods and measures 3 What does it all mean? 4 What does it all mean?
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
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.
Female Male 0 20 40 60 80100 Italy Spain Greece 0.15 0.10 0.05 0.00 France Switzerland Austria Density Sweden Denmark Germany The Netherlands 0.15 0.10 0.05 0.00 0 20 40 60 80100 0 20 40 60 80100
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.
Who retired early? Sex Women Men % % 60+ 1909 38 3082 62 40+ 409 65 225 35 50+ 1654 45 1998 55 70+ 83 43 108 57 Marital status Alone Cohab Married % % % 60+ 1456 29 163 3 3370 68 40+ 221 35 18 3 395 62 50+ 976 27 112 3 2564 70 70+ 83 43 4 3 104 54
Who retired early? (continued) Feelings about Neither Both Concern Relief % % % % 60+ 1240 25 372 7 329 7 3043 61 40+ 150 24 48 8 95 15 341 54 50+ 772 21 268 7 313 9 2297 63 70+ 71 37 12 6 18 9 89 47 Education Low Medium High % % % 60+ 2191 51 1191 28 915 21 40+ 290 55 156 30 83 16 50+ 1582 50 1113 35 490 15 70+ 91 60 28 19 32 21
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 40+ 0.56 0.37 0.75 50+ 0.18 0.08 0.27 70+ -0.15-0.46 0.17 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.
But why did they retire? Reason Alone At all Pension 4821 5320 Own health 1467 1711 Incentive 1018 1250 Redundancy 477 598 Family 271 558 Enjoy life 206 581 Other s health 114 191 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
Reasons for and feelings about Adding reasons for and feeling about Effect 95% ci Pension -0.04-0.17 0.10 Incentive 0.13-0.02 0.29 Redundant 0.27 0.07 0.46 Own health 0.83 0.68 0.98 Other s health 0.25-0.06 0.55 Family -0.08-0.27 0.11 Enjoy myself -0.06-0.24 0.11 Felt concerned 0.91 0.74 1.09 Felt relief 0.06-0.04 0.16 Both 0.39 0.21 0.56 Neither Reference
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.
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
Past history of depression Poor man s longitudinal study onset of depression an impefect measure Final digit 0 1 2 3 4 5 6 7 8 9 Frequency 594 101 151 154 138 380 117 152 190 108 Classify as depressed versus the others (never depressed and those with onset after ). Model with and without current depression.
0 50 100 0.030 0.025 0.020 0.015 0.010 0.005 0.000 Italy Spain Greece France Switzerland Austria Density 0.030 0.025 0.020 0.015 0.010 0.005 0.000 Sweden Denmark Germany The Netherlands 0 50 100 0 50 100 first episode of depression
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 40+ 0.55 0.41 0.72 50+ 1.06 0.92 1.22 70+ 1.24 0.74 1.96 Unmarried
Reasons for and feelings about OR 95% ci Pension 0.83 0.68 1.01 Incentive 0.99 0.79 1.24 Redundant 1.16 0.88 1.51 Own health 1.50 1.22 1.85 Other s health 0.89 0.57 1.35 Family 0.65 0.48 0.88 Enjoy myself 0.91 0.69 1.18 Felt concerned 1.26 0.98 1.62 Felt relief 1.31 1.12 1.54 Both 1.67 1.30 2.12 Neither 1.00
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 40+ 0.55 0.41 0.72 0.44 0.33 0.59 50+ 1.06 0.92 1.22 0.91 0.79 1.06 70+ 1.24 0.74 1.96 1.29 0.78 2.06
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