Academic journal article Scandinavian Journal of Work, Environment & Health

Trajectories of Mental Health before and after Old-Age and Disability Retirement: A Register-Based Study on Purchases of Psychotropic Drugs

Academic journal article Scandinavian Journal of Work, Environment & Health

Trajectories of Mental Health before and after Old-Age and Disability Retirement: A Register-Based Study on Purchases of Psychotropic Drugs

Article excerpt

Laaksonen M, Metsä-Simola N, Martikainen P, Pietiläinen 0, Rahkonen 0, Gould R, Partonen T, Lahelma E. Trajectories of mental health before and after old-age and disability retirement: a register-based study on purchases of psychotropic drugs. Scand J Work Environ Health. 2012;38(5):409-417. doi:10.5271/sjweh.3290

Objectives Retirement from paid work is a major life event facing increasingly large numbers of people in the coming years. We examined trajectories of mental health five years before and five years after old-age and disability retirement using data on purchases of psychotropic drugs.

Methods The study included all employees from the City of Helsinki, Finland, retiring between 2000-2008 due to old age (N=4456) or disability (N=2549). Purchases of psychotropic drugs were analyzed in 20 3-month intervals before and after retirement using graphical methods and growth curve models.

Results Old-age retirement was unrelated to purchases of psychotropic drugs. Among disability retirees, psychotropic medication tripled before retirement. The average increase was 0.95 [95% confidence interval (95% CI) 0.73-1 . 16] daily defined doses (DDD) 5-1 .5 years before retirement; from 1 .5 years until retirement it was 5.68 DDD (95% Cl 5.33-6.03) for each 3-month interval. After disability retirement, purchases of antidepressants decreased on average by 0.40 DDD (95% CI 0.57-0.23) for each 3-month interval, those of hypnotics and sedatives increased by 0.30 DDD (95% Cl 0.12-0.47), and no changes were seen for other psychotropic drugs. The changes before and after retirement were largest among those who retired due to mental disorders and those whose retirement had been granted as temporary.

Conclusions While no overall decrease in psychotropic medication after retirement was observed, purchases of antidepressants decreased after disability retirement. Long-term trajectories suggest that disability retirement might be prevented if mental health problems were tackled more efficiently earlier in the pre-retirement period.

Key terms disability pension; health trajectory; medication; register data; register linkage; registry.

Retirement from paid work is a major life event facing increasingly large numbers of people in the coming years in various European populations and the US (1). The transition to retirement has profound implications on an individual's daily activities, social relationships, and material living conditions, and may have consequences for health and well-being.

Health status before retirement and anticipation concerning it after retirement are among the most important factors affecting the timing of retirement among ageing employees (2). Early retirement due to disability is common, and in many western countries the proportion of people who continue to work up to their statutory retirement age has been decreasing (3). Mental disorders, particularly depression, have become increasingly prevalent reasons for disability retirement (3, 4).

The evidence on the possible effect of retirement on mental health is inconsistent (5-10). Furthermore, previous studies suffer from methodological drawbacks that make such an effect difficult to demonstrate. Most studies have been cross-sectional or two-wave panel studies comparing retirees to those continuing in employment, and selection out of employment due to poor health is likely to have a profound effect on the results. Studies using designs that can more effectively catch the effect of retirement on mental health and, that of mental health on retirement, are few. Multi-wave panel surveys from the US Health and Retirement Study have reported an increase in mental health problems after retirement (6, 11). French studies based on annually repeated surveys among predominantly old-age retirees found a reduction in depressive symptoms (12) and sleep disturbances (13) around the time of retirement. A Finnish study examining annual changes before and after the year of retirement found that, among old-age retirees and those retiring due to mental illnesses, antidepressant purchases diminished between the year before retirement and the year after retirement (14). …

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