Early retirement and depressive symptoms – results from the population-based LIFE-Adult-Study

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Depressive Symptomatology in Early
Retirees Associated With Reason for
Retirement—Results From the
Population-Based LIFE-Adult-Study
Andrea E. Zuelke
1
*, Susanne Roehr
1,2
, Matthias L. Schroeter
3,4
, A. Veronica Witte
3
,
Andreas Hinz
5
, Heide Glaesmer
5
, Christoph Engel
6
, Cornelia Enzenbach
6
,
Silke Zachariae
6
, Samira Zeynalova
6
, Markus Loeffler
6
, Arno Villringer
3,4
and SteffiG. Riedel-Heller
1
1
Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany,
2
Global
Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland,
3
Department of Neurology, Max-Planck-Institute for
Human Cognitive and Brain Sciences, Leipzig, Germany,
4
University Hospital Leipzig, Clinic for Cognitive Neurology, Leipzig,
Germany,
5
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany,
6
Institute for
Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
Background: Transition from employment to retirement is regarded a crucial event.
However, there is mixed evidence on associations between retirement and mental health,
especially regarding early retirement. In Germany, cases of early retirement due to ill health—
particularly, mental ill health—are increasing. Therefore, we investigated the association
between early retirement and depressive symptoms, including information on different types
of early retirement.
Methods: We analyzed data from 4,808 participants of the population-based LIFE-Adult-
Study (age: 40–65 years, 654 retired, 4,154 employed), controlling for sociodemographic
information, social network, pre-existing health conditions, and duration of retirement.
Depressive symptoms were assessed using the Center for Epidemiologic Studies
Depression Scale. Regression analysis using entropy balancing was applied to achieve
covariate balance between retired and employed subjects.
Results: We found no overall-differences in depressive symptoms between employed
and retired persons (men: b = −.52; p = 0.431; women: b = .05; p = .950). When looking at
different types of early retirement, ill-health retirement was linked to increased depressive
symptoms in women (b = 4.68, 95% CI = 1.71; 7.65), while voluntary retirement was
associated with reduced depressive symptoms in men (b= −1.83, 95% CI = −3.22; −.43)
even after controlling for covariates. For women, statutory retirement was linked to lower
depressive symptomatology (b = −2.00, 95% CI = −3.99; −.02).
Conclusion: Depressive symptomatology among early retirees depends on reason for
retirement: For women, ill-health retirement is linked to higher levels of depressive
symptoms. Women who retire early due to ill-health constitute a risk group for
Frontiers in Psychiatry | www.frontiersin.org September 2020 | Volume 11 | Article 5654421
Edited by:
Karsten Heekeren,
University of Zurich, Switzerland
Reviewed by:
Carlos Marı
´a Alcover,
Rey Juan Carlos University, Spain
Karla Spyra,
Charite
´
–Universitätsmedizin Berlin,
Germany
*Correspondence:
Andrea E. Zuelke
andrea.zuelke@medizin.uni-leipzig.de
Specialty section:
This article was submitted to
Public Mental Health,
a section of the journal
Frontiers in Psychiatry
Received: 25 May 2020
Accepted: 04 September 2020
Published: 18 September 2020
Citation:
Zuelke AE, Roehr S, Schroeter ML,
Witte AV, Hinz A, Glaesmer H, Engel C,
Enzenbach C, Zachariae S,
Zeynalova S, Loeffler M, Villringer A
and Riedel-Heller SG (2020)
Depressive Symptomatology in Early
Retirees Associated With Reason for
Retirement—Results From the
Population-Based LIFE-Adult-Study.
Front. Psychiatry 11:565442.
doi: 10.3389/fpsyt.2020.565442
ORIGINAL RESEARCH
published: 18 September 2020
doi: 10.3389/fpsyt.2020.565442

depressive symptoms that needs specific attention in the health care and social
security system.
Keywords: Center for Epidemiologic Studies Depression Scale, depressive symptoms, mental health, early
retirement, pension, population-based study
INTRODUCTION
Retiring from employment is considered a crucial event, affecting
social relationships and roles, daily activities, and possibly various
health outcomes (1–3). However, evidence on associations
between retirement and mental health remains inconclusive (4–
7). This applies particularly to early retirement, i.e., withdrawal
from the labor force before reaching the country-specific
statutory retirement age. One possible explanation for the
mixed results on associations between early retirement and
mental health is that most existing studies focus on one specific
type of retirement (e.g., retirement due to ill-health or due to
layoffs) and/or do not assess different reasons for retirement (2,8,
9). Comprehensive investigations simultaneously considering
mental health in different subtypes of retirees are currently rare,
especially in Germany.
Knowledge on the health situation of different types of
retirees, however, is crucial e.g., for the design of effective
prevention and treatment strategies. Information on mental
health of different subgroups of retired people is also valuable
for the design of effective policy tools. Many welfare systems
currentlyrelyonfinancial incentives in order to encourage
people to stay in the labor force; however, these kinds of
incentives might not yield the desired effects if workers retire
early involuntarily, e.g., due to health impairments (10–12).
In the face of demographic changes and increased life
expectancy, policy makers in several Western countries have
implemented different strategies to reduce pathways into early
retirement in order to prolong individual careers and increase
the share of older employees in the workforce (11,13,14). This
also applies to Germany, where the statutory retirement age has
been increased to currently 65 years and 7 months for people
born in or after 1964 and will be raised further until the age of 67
years in the year 2029. Furthermore, replacement rates were
successively lowered and subsidies for private pension provisions
were introduced (15). Despite these political measures and a
noticeable increase in the average retirement age, evidence from
cross-national studies indicates that retirement transitions in
Germany still occur earlier than in other countries like e.g.,
England or Japan (16).
Ill-health was repeatedly found to be one of the main factors
raising the probability of early retirement (2,4,8,10,14,17,18).
Depression, among other mental disorders, constitutes a
particularly relevant reason for early retirement (2,17–19).
According to data from the German pension insurance, claims
to disability pension due to psychiatric disorders have been
increasing continuously during the last years from 20.1% in
1996 to 42.7% of all claims in 2018 (20). Currently, depressive
episodes constitute the 3
rd
most important reason for sick leave
days (21). On average, sick leave due to mental ill health lasts
26.1 days. Evidence from Germany revealed that sick leave due to
depression is a significant predictor for early retirement (22).
This highlights the crucial role of mental health in maintaining
work ability and prolonging individual careers. Studies from
Scandinavian countries found depression and depressive
symptoms to be associated with disability pension due to
mental ill-health, but also with retirement due to somatic
causes and non-illness-based retirement (17,18). Depression
often occurs as a recurring disease, which is one reason why it
can severely disrupt labor force participation (23). Representative
data from Germany estimate a share of 60-75% of all cases of
depression being recurring depressive disorders (24).
Disability benefits can be granted for those workers having
contributed to the statutory pension insurance who have become
unable to pursue gainful employment due to ill health or
disability. These benefits are only granted if employment
capacity cannot be regained through e.g., means of medical
rehabilitation and if the applicant is unable to perform any
kind of paid work he or she can reasonably follow (25).
Receiving a disability pension therefore comes with many
preconditions. In 2018, 43% of all applications were denied
(20). However, receipt of disability pensions is at least somewhat
selective, since not all workers in Germany contribute to the
statutory pension insurance; moreover, some people—although
maybe suffering from ill-health—might rather look for a less
demanding occupation, reduce working hours or leave the
working environment through other exit routes, e.g., by becoming
ahomemaker.
Aside from health reasons, prematurely leaving the work
force can occur voluntarily or due to other reasons, e.g., layoffs
or corporate reorganization. Voluntariness of the transition from
employment to retirement has been found a crucial factor
impacting mental health of retirees, with people retiring
involuntarily experiencing higher levels of depressive symptoms
and other mental health problems than employees retiring
voluntarily or because they reached the statutory retirement age
(7,26–28). This is likely because involuntary early retirement
severely affects personal retirement plans and comes with financial
losses and increased uncertainty (29,30). Moreover, the
skills and experiences of older workers might not easily be
transferrable to other occupations, reducing the chance for
reemployment (7).
By comparison, people who describe their retirement status as
“voluntary”can be expected to report better mental health. As
retirement was actively chosen, the transition was likely
Abbreviations: ANOVA, analysis of variance; CASMIN, Comparative Analysis of
Social Mobility in Industrial Nations; CES-D, Center for Epidemiologic Studies
Depression Scale; CI, confidence interval; LSNS-6, Lubben Social Network Scale;
SD, standard deviation.
Zuelke et al. Early Retirement and Depressive Symptoms
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anticipated and planned, i.e., people deciding to retire voluntarily
should be more open to the new experiences and changes that
retirement can entail than people who continue to work until the
statutory retirement age (26,31). Several studies investigating the
reasons for early retirement found the wish to enjoy life while
still being in good health an important factor (32,33). Moreover,
voluntarily leaving the labor force prematurely requires some
sort of personal wealth and assets to rely upon. Therefore, it is
reasonable to assume that people actively choosing to retire early
can draw upon personal resources for retirement. Several studies
found voluntary early retirement to be linked to improved
mental health and health satisfaction, although the association
tended to diminish over time (7,29,34).
Although the statutory retirement age in Germany currently
amounts to 65 years, certain exceptions apply for employees who
entered the labor market early in life and contributed to the
statutory pension insurance for at least 45 years, offering the
possibility to retire at the age of 63 at full benefit receipt. Special
regulations also apply to certain occupational groups, allowing
e.g., police officers, soldiers or miners to retire at an earlier age.
As outlined above, different reasons for retirement have been
found to relate differently to mental health. Therefore, statutory
early retirees should be carefully differentiated from those who
retired due to specific reasons.
Evidence on possible gender differences concerning the
association between mental health and early retirement remains
inconclusive, partly because previous studies often exclusively
focused on men’s retirement (35). Drawing on traditional societal
norms emphasizing the role of employment for men’s identities,
it has been suggested that prematurely exiting the labor force
might be an especially stressful experience for men, resulting in
higher levels of psychological distress than in women who retire
early (36). However, given the higher labor force attachment of
younger cohorts of women and the changing of gender roles, it
has to be questioned whether this assumption still holds true.
Possible gender differences might prevail regarding both reasons
for retirement and mental health in retirement (28). Previous
studies on reasons for retirement found caring duties for a spouse
or other family members to be more important for women’s
retirement decision than men’s(37,38). While the overall-rates of
retirement due to disability have been decreasing in Germany
during the last decades, the share of women receiving a disability
pension has increased continuously, partly due to the increased
labor force participation of women (39). Lastly, the overall-
prevalence of depression is consistently reported higher in
women than in men (40). These factors highlight the need for
gender-specific information on the association of early retirement
and mental health.
Against this background, it can be assumed that different
reasons for retirement relate differently to mental health. We
therefore hypothesize that a) ill-health related retirement is
linked to increased depressive symptomatology, while b)
voluntary early retirement is associated with less depressive
symptoms. Involuntary early retirement is assumed to be
linked to increased depressive symptomatology c). For early
retirement due to reaching the statutory retirement age, i.e.,
where none of these reasons apply, we suspect no association
with depressive symptoms d). To investigate possible gender
differences in the association of early retirement and depressive
symptoms, all analyses were conducted separately for men and
women e).
MATERIALS AND METHODS
Participants
Data were drawn from the LIFE-Adult-Study, a population-
based cohort study conducted by the Leipzig Research Center
for Civilization Diseases; 10,000 randomly selected citizens of
Leipzig, Germany aged between 18 and 79 years completed the
baseline examination between 2011 and 2014.
The LIFE-Study aims to investigate the prevalence, genetic
predispositions, and modifiable lifestyle factors of major
civilization diseases such as cardiovascular diseases, dementia,
or depression. The baseline assessment consisted of physical
examinations, structured interviews, and questionnaires which
were administered to all participants. Pregnancy and insufficient
command of the German language were exclusion criteria. For a
detailed description of the study aims and concept, please see
(41). The study included an age- and sex-stratified random
sample of 10,000 community-dwelling German-speaking
residents of the city of Leipzig who were randomly drawn
from lists provided by the local registry office. These residents
were sent an invitation letter, informing them about the aims and
design of the study, and a response form. Residents who did not
respond were sent a reminder invitation. Non-responders were
searched in public phone directories and contacted by phone.
For residents who refused to participate, residents of the same
age and sex were randomly drawn from the registry office’s lists
and invited to participate. The study was approved by the
responsible ethics board of the Medical Faculty of the University
of Leipzig. All participants provided written informed consent to
participate prior to enrolment.
Of the initial sample, we excluded cases younger than 40 and
older than 65 years (n = 3,561) in order to exclude cases that had
already left the labor market due to old-age retirement or who
were too young to be reasonably compared to early retirees;
however, there was only one observation younger than 40 years
in early retirement. Observations were further excluded if they
were neither in employment or retirement (e.g., homemakers,
unemployed, on maternal leave; n = 772) or if information was
missing on social network (n = 308), net equivalent income
(n = 92), job status (n = 10), severe preexisting health conditions
(n = 71), type of retirement (n = 5), or depressive symptoms (n =
373). The final sample thus consisted of 4,808 individuals.
Measures
Depressive Symptoms
Depressive symptoms were assessed using the German version of
the Center for Epidemiologic Studies Depression Scale [CES-D
(42)]. This self-report scale consists of 20 items, assessing
symptoms such as depressed mood, hopelessness, or insecurity
Zuelke et al. Early Retirement and Depressive Symptoms
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during the last week, using a 4-point-Likert-scale (0 = never/
almost none of the time; 3 = most or all of the time). Possible
scores range from 0 to 60 points, with higher values indicating
higher levels of current depressive symptomatology. Reference
values from comparable population-based samples suggest a cut-
off value of ≥23 points as an indicator for risk of depression (43).
Early Retirement
We investigated observations up to 65 years of age since this
represents the legal retirement age in Germany to date. The age
of 65 has long served as a benchmark in the German retirement
system and is also often chosen for research conducted in other
countries as an indicator for “on-time”or statutory retirement,
making it feasible to embed our results in a wider international
context. Due to certain exceptions in the German pension system
(see Background), a certain amount of statutory early retirees is
likely to be included in the sample, despite the focus on other
subtypes of early retirement. This category is to be differentiated
from voluntary early retirement: while statutory early retirees
worked in their respective jobs until the statutory retirement age,
voluntary early retirees exit the labor market prematurely. These
early retirees usually rely upon personal assets like e.g., private
pension insurance plans in old age or made additional voluntary
contributions to the statutory pension insurance during their
employment career, allowing for an early withdrawal from the
labor force.
In LIFE-Adult, different types of retirement were identified by
asking the question “which of the following best describes your
situation?”if participants indicated having retired, with the
following response categories: retirement due to reaching the
statutory retirement age; early retirement due to ill-health;
voluntary early retirement; involuntary retirement due to
operational circumstances; involuntary retirement due to other
reasons. We combined the last two options, resulting in the
categories: employed; statutory retirement; retirement due to ill-
health; voluntary early retirement; involuntary early retirement.
Other Covariates
We included gender, age, and marital status (married or living in a
partnership vs. single, divorced, or widowed) as covariates.
Moreover, we included education as measured by the CASMIN-
scale [Comparative Analysis of Social Mobility in Industrial
Nations (44)], net equivalent income, and job status (high/
middle/low) as sociodemographic characteristics. Categorization
of jobs was conducted using a scoring algorithm for the
measurement of socioeconomic status in epidemiological studies
which is based on the International Socio-Economic Index of
Occupational Status [ISEI; (45)]. Further, we included information
on participants’social network using the short form of the Lubben
Social Network Scale (LSNS-6). The LSNS-6 is a measure widely
used for the assessment of social engagement and perceived social
support, containing questions like: “how many relatives/friends do
you see or hear from at least once a month?; how many relatives/
friends do you feel close to such that you could call on them for
help?”. Scores range from 0 to 30, with higher values indicating
higher levels of social engagement. To control for pre-existing
health conditions, we included information on lifetime diagnoses
of diabetes, myocardial infarction, or stroke, since these conditions
were repeatedly found to increase the propensity of early
retirement (46–48). Other conditions reported to be related to
early retirement (cancer, arthritis, multiple sclerosis) were not
investigated due to high numbers of missing values. If participants
described themselves as retired, information on duration of
retirement was included in the analyses.
Statistical Analyses
Comparisons between groups were conducted using Chi²-tests
and one-way ANOVA as appropriate. We investigated the
association of different types of early retirement and depressive
symptoms by means of multivariate linear regression, calculating
separate models for men and women, with a p-value < 0.05
indicating significance. Analyses were conducted using Stata 16.0
(SE). A weighting factor provided within the LIFE-data was used
to adjust the age- and gender distribution to the German
population in 2011 (1
st
year of baseline assessment). To
precisely identify the links between different types of early
retirement and depressive symptoms, we first matched retired
and employed cases on a set of covariates, namely: age, gender,
partnership status, education, job level, net equivalent income,
social network size, and pre-existing health conditions. We used
entropy balancing to reweigh a matrix of control observations,
i.e., employed participants (49). Weighting control observations
is performed to achieve maximum comparability between
treatment- (i.e., retired) and control observations, even in cases
where treatment- and control group differed in covariates before
the treatment. This method is more effective than other matching
approaches like e.g., propensity score matching since control
observations are re-weighted to fulfill pre-specified assumptions
like equal means and variances of covariates as in the treatment
group (50). Unlike other matching techniques, this algorithm
allows to use all available observations in the sample without
discarding cases that cannot be matched to a control observation
(49). Entropy balancing is a non-parametric approach that takes
selection of observations based on time-invariant unobserved
variables into account (51). To ensure robustness of our findings,
we repeated our analyses using propensity score matching,
leading to highly comparable results (not shown).
RESULTS
Descriptive Analyses
Among the 4,808 observations, 654 (13.6%) had already left the
labor force (men vs. women: 39.8/60.2%). This group included
104 (15.9%) cases of early statutory retirement, 196 (30.0%) cases
of ill-health retirement, 294 (45.0%) observations who had
retired voluntarily and 60 (9.2%) cases of involuntary early
retirement. The proportion of women was slightly higher in all
subtypes of retirement (61.5, 55.1, 62.6, and 63.3%, respectively).
For men, depressive symptoms were lowest in voluntary early
retirees (mean = 7.8, SD = 5.7) and highest in the ill-health
retirement subgroup (mean = 12.0, SD = 7.4; see Table 1). For
women, the respective values were lowest in statutory early
Zuelke et al. Early Retirement and Depressive Symptoms
Frontiers in Psychiatry | www.frontiersin.org September 2020 | Volume 11 | Article 5654424

TABLE 1 | Sample description of employed and retired respondents, by subgroup (men).
Variable Employed
(unmatched)
Employed
(matched)
Statutory early
retirement
Ill-health
retirement
Voluntary
retirement
Involuntary
retirement
F/chi²
(unmatched)
P-value
(unmatched)
F/chi²
(matched)
P-value
(matched)
Age, mean (SD) 51.0 (6.6) 62.2 (2.8) 64.4 (2.2) 59.2 (6.1) 63.9 (1.3) 63.7 (2.2) 189.28 P<0.001 129.20 P<0.001
Partnership % 81.0 89.8 85.0 71.6 94.5 90.1 20.04 P<0.001 6.72 P<0.001
Job status low % 9.2 17.9 2.5 19.3 19.1 22.7 30.33 P<0.001 1.13 P = 0.339
Job status middle % 83.5 76.2 90.0 78.4 76.4 77.3
Job status high % 7.4 5.9 7.5 2.3 4.5 0.0
Education low % 3.2 4.4 0.0. 4.5 6.4 4.5 18.80 P = 0.016 1.93 P = 0.053
Education middle % 60.4 59.0 42.5 71.6 61.8 68.2
Education high % 36.4 36.7 57.5 23.9 31.8 27.3
Net equivalent income, mean (SD) 2,236.8 (1,947.9) 1,565.9 (570.5) 1,642.5 (593.9) 1,377.1 (724.6) 1,435.1 (484.7) 1,424.4 (582.6) 10.69 P<0.001 11.67 P<0.001
Social resources (LSNS-6-score),
mean (SD)
17.0 (5.3) 16.1 (5.7) 14.7 (5.9) 14.4 (6.0) 16.8 (6.1) 18.1 (4.8) 6.85 P<0.001 14.11 P<0.001
Stroke % 0.6 1.7 2.5 10.2 1.8 0.0 71.74 P<0.001 4.24 P = 0.002
Diabetes % 5.6 14.9 30.0 23.9 10.0 13.6 77.66 P<0.001 2.82 P = 0.0255
Myocardial infarction % 1.2 6.9 7.5 8.0 5.5 0.0 68.15 P<0.001 0.44 P = 0.7625
Pension duration, years 1.4 (1.7) 5.6 (6.0) 2.1 (2.1) 3.1 (2.4) 38.38 P<0.001 38.38 P<0.001
Depressive symptoms (CES-D-
score), mean (SD)
9.1 (5.5) 9.7 (5.1) 9.7 (5.1) 12.0 (7.4) 7.8 (5.7) 9.6 (4.7) 7.52 P<0.001 27.93 P<0.001
n 1,894 40 88 110 22
n = 2,154; table presents results for unmatched and matched controls (employed respondents); age reported in years; education assessed according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations)-classification
categories low, middle, and high; social resources assessed by the Lubben Social Network Scale (LSNS-6); CES-D, Center for Epidemiologic Studies Depression Scale; stroke, diabetes, and myocardial infarction: lifetime diagnoses; p-values
based on Chi
2
-tests and one-way ANOVA, as appropriate.
TABLE 2 | Sample description of employed and retired respondents, by subgroup (women).
Variable Employed
(unmatched)
Employed
(matched)
Statutory early
retirement
Ill-health
retirement
Voluntary
retirement
Involuntary
retirement
F/chi²
(unmatched)
P-value
(unmatched)
F/chi²
(matched)
P-value
(matched)
Age, mean (SD) 50.6 (6.4) 62.1 (2.9) 64.2 (1.7) 58.2 (6.2) 63.2 (1.8) 63.1 (3.5) 302.72 P<0.001 163.55 P<0.001
Partnership % 75.0 72.2 82.8 59.3 81.0 81.6 20.77 P<0.001 4.05 P = 0.005
Job status low % 4.8 8.5 12.5 13.0 6.5 5.3 28.79 P<0.001 1.20 P = 0.294
Job status middle % 87.1 88.8 79.7 83.3 90.8 89.5
Job status high % 8.1 2.7 7.8 3.7 2.7 5.3
Education low % 2.1 3.7 0.0 4.6 4.3 2.6 20.96 P = 0.007 0.54 P = 0.811
Education middle % 62.1 72.5 76.6 71.3 66.8 71.1
Education high % 35.8 23.8 23.4 24.1 28.8 26.3
Net equivalent income, mean (SD) 1,966.9 (995.4) 1,316.2 (544.3) 1,546.2 (717.3) 1,260.7 (520.3) 1,466.2 (482.4) 1,174.2 (349.7) 32.75 P<0.001 21.80 P<0.001
Social resources (LSNS-6-score),
mean (SD)
17.3 (5.0) 15.9 (5.2) 17.3 (4.5) 15.1 (5.0) 16.5 (4.4) 15.3 (4.0) 7.24 P<0.001 9.23 P<0.001
Stroke % 0.7 6.2 1.6 10.2 1.6. 5.3 84.28 P<0.001 1.30 P = 0.272
Diabetes % 3.6 16.0 10.9 18.5 12.5 13.2 80.96 P<0.001 0.438 P = 0.688
Myocardial infarction % 0.3 1.8 0.0 5.6 1.1 2.6 51.17 P<0.001 1.28 P = 0.280
Pension duration, years 1.5 (1.8) 7.6 (7.6) 2.1 (1.8) 3.6 (2.9) 627.17 P<0.001 627.17 P<0.001
Depressive symptoms (CES-D-
score), mean (SD)
10.8 (7.4) 13.1 (7.1) 9.2 (5.8) 17.5 (11.2) 11.0 (5.3) 11.4 (7.7) 21.83 P<0.001 59.67 P<0.001
n 2,260 64 108 184 38
n = 2,654; table presents results for unmatched and matched controls (employed respondents); age reported in years; education assessed according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations)-classification
categories low, middle, and high; social resources assessed by the Lubben Social Network Scale (LSNS-6); CES-D, Center for Epidemiologic Studies Depression Scale; stroke, diabetes, and myocardial infarction: lifetime diagnoses; p-values
based on Chi
2
-tests and one-way ANOVA, as appropriate.
Zuelke et al. Early Retirement and Depressive Symptoms
Frontiers in Psychiatry | www.frontiersin.org September 2020 | Volume 11 | Article 5654425

retirees (mean = 9.2, SD = 5.8) and highest for ill-health retirees
(mean = 17.5, SD = 11.2; see Table 2). Mean age was significantly
lower among employed than among retired subjects (men:
mean = 51.0, SD = 6.6; women: mean = 50.6, SD = 6.4).
Overall, 81.5% of men and 75.1% of women were married or
living with a partner, with the lowest proportion among ill-health
retirees, respectively (men: 71.6%, women: 59.3%). Men
reporting involuntary early retirement more often belonged to
the lowest job-status category (22.7%). Among women, this
proportion was highest among ill-health retirees (13.0%).
Regarding social networks, ill-health retirees had the lowest
mean levels of social support (men: mean = 14.4, SD = 6.0;
women: mean = 15.1, SD = 5.0), compared to employed and
other retirement subgroups. Observations also differed in terms
of education. While 57.5% of early statutory retired men had a
high level of education, this proportion was 23.9% among ill-
health, 31.8% among voluntary early retirees, and 27.3%
among involuntary early retirees (employed: 36.4%). Among
women, these educational differences were less pronounced
(proportion of women with a high level of education in
employment, statutory, ill-health, voluntary, and involuntary
early retirement: 35.8, 23.4, 24.1, 28.8, 26.3%, respectively). For
men, ill-health retirees had the lowest mean incomes (1,377.1,
SD: 724.6), followed by involuntary, voluntary, and statutory
retirees and highest values for employed men (mean = 2,236.8,
SD = 1,947.9). In the female subsample, mean net equivalent
income was lowest among involuntary early retirees (1,174.2,
SD = 349.7), followed by ill-health, voluntary, and early statutory
retirees and highest values for employed women (1,966.9, SD =
995.4). Regarding pre-existing health conditions, a lifetime
diagnosis of stroke was most often found in men retired due to
ill-health (10.2%, respectively). Statutory early retired men
(30.0%) and ill-health retired women (18.5%) had the highest
prevalences for diabetes, while a lifetime diagnosis of myocardial
infarction was most frequently found in ill-health retirees (men:
8.0%, women: 5.6%). Average duration of retirement was highest
for ill-health retirees (men: mean = 5.6 years, SD = 6.0; women:
mean = 7.6, SD = 7.5).
Descriptive sample statistics are provided in Tables 1,2for
men and women, respectively. Results are presented for
unmatched, i.e., before entropy balancing, and matched controls,
the last four columns reporting information on significance of
differences between early retirement subtypes and unmatched/
matched control observations, respectively.
Multivariate Analyses
Tables 3,4report the results of multivariate linear regression
models, stratified by gender. The results of a model comparing
employed and retired observations without differentiating for
early retirement reasons are shown in model 1. No association
between retirement and depressive symptoms was detected in
either men or women (men: b = −.52, p = 0.431; women: b = .05,
TABLE 3 | Multivariate linear regression, association of depressive symptomatology (CES-D), and early retirement, men.
Men (n = 2,154)
Model 1 Model 2
Coeff. 95% CI P-Value Coeff. 95% CI P-value
Employed Ref. Ref.
Retired −.52 −1.83 .78 0.431
Statutory early retirement .20 −1.66 2.06 0.831
Ill-health retirement 1.34 −.90 3.58 0.240
Voluntary retirement −1.83 −3.22 −.43 0.010
Involuntary retirement .28 −1.80 2.36 0.795
Age −.17 −.33 −.01 0.034 −.10 −.25 .05 0.187
Partnership (Ref.: single) .40 0.671 .69 −1.10 2.48 0.447
Job status low Ref. Ref.
Job status middle −.57 −2.10 .96 0.463 −.78 −2.26 .71 0.306
Job status high 2.48 −1.04 6.01 0.167 2.41 −1.10 5.92 0.178
Education low Ref. Ref.
Education middle −.56 −2.29 1.17 0.523 −.60 −2.30 1.11 0.491
Education high −1.97 −3.99 .06 0.057 −1.99 −4.01 .03 0.053
Net equivalent income −.00 −.00 .00 0.154 −.00 −.01 .00 0.123
Social resources −.28 −.38 −.19 0.000 −.27 −.37 −.17 0.000
Stroke .21 −5.43 5.85 0.941 −.27 −5.90 5.36 0.926
Diabetes −.15 −1.39 1.09 0.810 −.55 −1.75 .66 0.376
Myocardial infarction 1.03 −1.31 3.38 0.387 1.09 −1.24 3.41 0.361
Pension duration, years .12 −.13 .37 0.359 .04 −.23 .31 0.768
R² 0.1510 0.1718
Coeff., coefficient; CI, confidence interval; education assessed according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations)-classification categories low, middle,
and high; social resources assessed by the Lubben Social Network Scale (LSNS-6); CES-D, Center for Epidemiologic Studies Depression Scale; stroke, diabetes, myocardial infarction:
lifetime diagnoses; significant associations presented in bold type.
Zuelke et al. Early Retirement and Depressive Symptoms
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p = 0.950). Higher age and a larger social network were linked to
lower depressive symptoms in both genders, whereas living in a
partnership was associated with lower depressive symptoms only
in women (b = −3.37; 95% CI: −5.33, −1.40). Women reporting a
lifetime diagnosis of diabetes had increased depressive symptoms.
The analyses did not reveal a link between a lifetime-diagnosis of
myocardial infarction or stroke and depressive symptomatology.
For both men and women, no association between sociodemographic
factors (education, net equivalent income, job level) and depressive
symptoms could be demonstrated.
Model 2 presents the results of a multivariate regression model
differentiating between reasons for early retirement, i.e., statutory
retirement, retirement due to ill-health, voluntary, and involuntary
early retirement (reference group: employment). Men who retired
voluntarily showed lower depressive symptoms (b = −1.83, 95% CI =
−3.22; −.43), while no significant differences were detected for other
groups of retirees in respect to depressive symptoms. A larger social
network was linked to lower depressive symptoms. Results in the
female subsample followed a different pattern. While women in
statutory retirement showed lower levels of depressive symptoms
(b = −2.00; 95% CI = −3.99; −.02), women reporting retirement due
to ill-health had increased depressive symptoms (b = 4.68; 95% CI =
1.71; 7.65). Living in a partnership and a larger social network were
associated with lower depressive symptomatology in women, while a
lifetime diagnosis of diabetes was linked to increased depressive
symptoms. No other associations between covariates and depressive
symptoms were revealed in either men or women.
DISCUSSION
Overall, no differences between early retirees and men and
women in employment regarding depressive symptoms were
detected. However, on further investigation of different reasons
for retirement, a more complex picture emerged. Possible
interpretations of our findings are discussed below.
Voluntary early retirement was linked to lower depressive
symptoms in men, but not in women. The negative association
between voluntary early retirement and depressive symptoms in
men might point toward the importance of voluntariness, i.e.,
whether a true choice to retire was present. This finding is
supported by earlier studies, stating that voluntary retirement
is protective for mental health, compared to other kinds
of retirement (7,26,29,34). For men retiring voluntarily,
the expected benefits from retirement might outweigh the
advantages of employment. Considering the higher proportion
of women reporting voluntary early retirement, the non-significant
association in women seems surprising at first. However, the
female sample of voluntary early retirees might be more diverse
than captured by our assessments. As e.g., ill-health retirement
benefits come with many preconditions (see Background), certain
women might not apply for the respective benefits or leave the
labor market early for other reasons, e.g., to become a homemaker,
and describe their decision as voluntary. This interpretation is in
line with previous studies suggesting that different self-definitions
of employment status between older men and women contribute to
TABLE 4 | Multivariate linear regression, association of depressive symptomatology (CES-D) and early retirement, women.
Women (n = 2,654)
Model 1 Model 2
Coeff. 95% CI P-value Coeff. 95% CI P-value
Employed Ref. Ref.
Retired .05 −1.39 1.48 0.950
Statutory early retirement −2.00 −3.99 −.02 0.047
Ill−health retirement 4.68 1.71 7.65 0.002
Voluntary retirement −.65 −2.00 .69 0.340
Involuntary retirement −.66 −3.49 2.16 0.645
Age −.32 −.51 −.12 0.002 −.15 −.36 .07 0.179
Partnership (Ref.: single) −3.37 −5.33 −1.40 0.001 −3.07 −4.95 −1.19 0.001
Job status low Ref. Ref.
Job status middle .54 −1.16 2.24 0.532 .42 −1.34 2.19 0.638
Job status high 2.45 −1.27 6.18 0.197 2.35 −1.19 5.89 0.193
Education low Ref. Ref.
Education middle −2.26 −5.45 .94 0.166 −2.53 −6.01 .95 0.154
Education high −3.05 −6.11 .66 0.115 −3.13 −6.75 .50 0.091
Net equivalent income −.00 −.00 .00 0.077 −.00 −0.00 .00 0.159
Social resources −.34 −.47 −.20 0.000 −.31 −.45 −.18 0.000
Stroke 2.95 −2.48 8.38 0.286 2.79 −2.56 8.14 0.306
Diabetes 2.58 .59 4.57 0.011 2.18 .25 4.11 0.027
Myocardial infarction 2.59 −.34 5.52 0.084 2.20 −.73 5.13 0.142
Pension duration, years −.02 −.17 .16 0.978 −18 −.38 .02 0.071
R² 0.1697 0.2039
Coeff., coefficient; CI, confidence interval; education assessed according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations)-classification categories low, middle,
and high; social resources assessed by the Lubben Social Network Scale (LSNS-6); CES-D, Center for Epidemiologic Studies Depression Scale; stroke, diabetes, myocardial infarction:
lifetime diagnoses; significant associations presented in bold type.
Zuelke et al. Early Retirement and Depressive Symptoms
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gender differences in the association of retirement and depressive
symptoms (9). Moreover, women still engage in care work more
often than men even at higher ages and in retirement (52).
Findings from German panel data and the Australian HILDA-
Survey, reporting that caregiving duties have a stronger influence
on women’s decision to retire than on men’s(37,38), underscore
this interpretation. This could have contributed to the non-
significant association of voluntary retirement and depressive
symptoms in women.
Early retirement due to ill-health, on the other hand, was
linked to higher levels of depressive symptoms only in women.
One possible explanation for this finding is health selection into
ill-health retirement, since women experience higher overall-
levels of depression than men in the general population.
Furthermore, the causes for disability retirement might be
gender-specific: Evidence from German pension insurance data
revealed that mental disorders accounted for 36.3% of men’s ill-
health retirement cases, with 6.9% of these cases due to
addictions; in women, mental disorders made up 48.7% of all
disability pensions, with only 1.9% of these cases related to
addictions. Disability retirement due to diseases of the
circulatory system, on the other hand, were more prominent in
men (13.6% of all cases) than in women [5.6%; (53)].
Contrary to our hypothesis, no association between involuntary
early retirement and depressive symptoms was detected in our
sample. However, there is evidence from studies on unemployment
and mental health, suggesting that unemployed people experience
lowerlevelsofmentalhealthproblemsifthereasonforjoblossis
perceived as exogenous, e.g., in cases of plant closures or layoffs [for
a review, please see (54)]. If the reason for losing one’sjobisnot
perceived as individual failure but rather as a result of a company’s/
employer’s decision, involuntary early retirement might show no
association with depressive symptoms. Moreover, the probability
of health selection is rather small in cases of layoffs. However,
our sample only contained a small number of involuntary early
retirees, therefore, interpretation of these results should be made
with caution.
Statutory early retirement was linked to lower depressive
symptomatology only in women, suggesting that retirement
due to reaching the statutory retirement age is beneficial for
women’s mental health. For these women, retirement might be
perceived as a relief and a possibility to engage in other roles or
enjoy a greater amount of leisure time. This corroborates findings
from the US-American Health and Retirement Survey, reporting
improved mental health in women following retirement (7). On the
other hand, no association of statutory retirement and depressive
symptoms was found in men. However, our study investigated men
and women up to the age of 65, i.e., where statutory retirement was
a rather recent event. Therefore, we cannot conclude whether these
gender differences in mental health among statutory early retirees
persist throughout retirement or whether an association of
depressive symptoms and statutory retirement might emerge at a
later time-point for men.
Social networks, as captured by the number of family and
non-family contacts, were smaller in all subgroups of early
retirees, compared to those in employment, a finding that is
consistent with previous studies (27,55). Larger social networks
were linked to lower depressive symptoms both in men and
women, corroborating previous studies reporting a protective
effect for social networks and support (27). Retirement can bring
about more time for leisure activities that can be enjoyed with
friends, but our finding could also point toward the potentially
buffering effect of friendships and social resources in times of
meaningful transitions and change, e.g., the transition to
retirement. A partnership, however, was only protective for
female retirees, highlighting the importance of marriage and
partnership for the mental health of women. This finding
underscores previous studies reporting greater importance of
marriage/partnership for female retiree’s mental health (35,56,57).
The non-significant impact of income on the association of
early retirement and depressive symptoms detected in our
sample seems surprising at first sight. However, this factor
draws upon information on net equivalent income at the time
of the interview which is only one indicator of peoples’economic
situation; another indicator could be e.g., net assets, which give a
hint about savings people accumulated over their lifetime and
can rely on when exiting the workforce (58). In the face of
increasing life expectancy and, therefore, longer periods of
retirement, being able to rely on personal assets for retirement
is crucial (23). Certain longitudinal studies found associations
between changes in income after retirement and mental health
(59). Unfortunately, however, this information was not available
since our study relied on cross-sectional data.
In line with findings from other investigations (59,60), no
association between level of education and depressive symptoms
was found in our sample. This implies that the association of
different types of retirement and depressive symptoms is rather
independent of educational attainments. It has to be pointed out,
however, that average levels of education were rather high in our
sample and only a small fraction of observations belonged to the
lowest education category.
Similar results were found for job status, with no impact on
the association between early retirement and depressive
symptoms in either men or women. However, job-level is a
rather general descriptor of (previous) employment; possibly,
there might be differences between certain occupations or job
characteristics which provide different levels of resources for
mental health. Further investigations on the mental health of
retirees from different occupations might provide useful insights.
Chandola et al. (61), using data from the Whitehall II study,
found different trajectories of mental health between employment
grades over time (improved mental health for retirees from high-
grade jobs, but no similar trend for low-grade jobs), but no
baseline differences between the respective groups. According to
these findings, possible links between socioeconomic position and
depressive symptoms might only emerge over a longer time span
following retirement.
Strengths and Limitations
A major strength of our study lies in the use of a large, population-
based sample, which might likely be less selective than samples
from previous studies. Furthermore, our data included information
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on distinct reasons for early retirement, i.e., statutory, voluntary,
involuntary, or ill-health-related retirement, allowing for nuanced
statements about the links between retirement and depressive
symptoms. Due to the extensive set of covariates included in the
LIFE-Adult-Study, we were able to control for a number of
important factors that possibly impact the relationship between
retirement and depressive symptoms. We addressed possible
heterogeneity between employed and retired subjects by using
advanced techniques of covariate balancing, namely: entropy
balancing, which should make our findings robust against
selection bias, a problem shared by many comparable studies in
the field. Further, we were able to provide information on the
association of retirement status and depressiveness for both
genders. Many previous studies primarily focused on men’s
retirement and mental health, often assuming a stronger labor
market attachment in men or presuming single-earner households.
However, since labor force participation of women has increased
continuously in the last decades and gender roles are not fixed but
changing over time, providing information on women’smental
health in retirement is crucial for a comprehensive understanding
of the association between retirement and depressiveness.
Certain limitations need to be kept in mind when interpreting
our findings. A sizeable proportion of observations had to be
discarded due to missing values in the variables of analysis.
Although we controlled for several possible confounders in our
analyses, other factors possibly impacting the link between early
retirement and depressive symptoms were not available in the
LIFE-Adult assessment. This applies e.g., to the health- and
employment status of spouses/partners or care obligations for
a spouse or other family members, factors found to have a
significant impact especially on women’s health in retirement
(36,38). Moreover, there were no information available on which
diagnoses lead to ill-health retirement, a factor that could have
shed light on the observed gender differences in the ill-health
retirement subsample. Bearing in mind that depression
diagnoses increase the risk of disability pensions, it is likely
that a certain amount of ill-health retirees in our sample left the
labor market due to depression. Therefore, health selection is
likely to have contributed to our findings.
Since our study relied on cross-sectional data, we cannot draw
conclusionsastoacausalrelationship between depressive
symptoms and early retirement status or about the course of
depressive symptoms post-retirement. Several studies have
pointed out that the relationship between retirement and
depressive symptoms is reciprocal, i.e., depressive symptoms
increase the likelihood of retirement intentions (62) and actual
retirement transitions (18,63,64),butretirementcanalso
increase depressive symptoms (9) or psychological distress
(36). Since the LIFE-Adult-Study has a longitudinal cohort
design with an extensive follow-up-period, longitudinal
investigations of the association between early retirement and
depressive symptoms will be feasible in the near future.
Our study mainly included retirees who only recently
transitioned to retirement. However, the link between retirement
status and depressive symptoms might change over time as people
adjust to retirement. Engagement in leisure activities and
availability of alternative social relationships (apart from
colleagues and co-workers) have been found important indicators
of retirement adjustment (30,65–67), and previous studies found
an increase in social or physical leisure activities in retirement to be
associated with decreased depressive symptoms (68). On the other
hand, a recent meta-analysis reported a significant reduction of
social engagement and integration in early retirees over time, which
was not compensated by non-work related contacts (65). Therefore,
longitudinal analyses investigating the association of social
resources and mental health in early retirees seem worthwhile.
Previous studies investigating the impact of work-related
factors on the decision to retire early stressed the importance
of factors like job strain or high demands at work; high levels of
job strain, increasing mental demands at work and conflicts in
the workplace were found to raise the likelihood of early
retirement (14,69). The Danish SeniorWorkingLife study
identified further work-related factors impacting older workers’
retirement intentions: for lower-status and physically demanding
jobs, poor physical health, and inability to perform their current
job increased the intention to retire, while for higher-status and
predominantly sedentary jobs, more personal freedom and a
preference for leisure activities were important driving factors
(66). On the other hand, previous investigations found evidence
that positive job attributes like meaningful tasks and high levels
of control are able to increase employees’intention to prolong
their working life post retirement age (70). Unfortunately, no
such information was available in our data. However, the first
follow-up assessment of the LIFE-Adult-Study which is currently
undertaken includes several instruments addressing work-
related psychosocial factors, making respective investigations
possible in the near future.
CONCLUSION
We were able to provide detailed insights on the association
between early retirement and depressive symptoms, using data
from a large population-based study. Although the German
welfare system has been subject to major changes in the last
decades, i.e., a departure from various possibilities for premature
labor market exit toward an active ageing strategy and the
promotion of prolonged employment careers, early retirement
is still a common phenomenon. Hence, detailed information on
the reasons for early retirement and the mental health situation
of older workers and early retirees is urgently needed.
Our findings provide evidence that the group of early retired
men and women is quite heterogeneous, whereby the reason for
early labor market exit is critical for the association with
depressive symptoms. Retirement due to ill-health was linked
to higher levels of depressive symptoms for women, suggesting
that this group is at an increased risk for depressiveness.
This finding is of particular importance since many previous
studies primarily focused on men’s retirement. Further studies
investigating different reasons for early retirement in both
genders are highly desirable, since younger cohorts of women
might likely show a stronger labor force attachment than in
Zuelke et al. Early Retirement and Depressive Symptoms
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previous studies with older populations. Moreover, since care
work and other non-work responsibilities still tend to be
unequally distributed between men and women, future
investigations should further account for the individual
experience of and social roles fulfilled in early retirement and
possible links to depressiveness in both women and men.
Regarding possible prevention strategies, a strong focus
should be placed on maintaining mental health and preventing
depressive symptoms in the workforce in order to prevent cases
of ill-health related retirement. Data from German health- and
pension insurances reveal that depression increases the risk for
retirement due to a depression diagnosis, but also other cases of
early withdrawal from the labor force. Future studies investigating
specific stressors in the workplace that might be linked to
depressiveness could provide useful insights on possible
approaches for occupational health managers and political
actors. Furthermore, studies investigating subjective reasons for
retirement in different occupational groups could shed further
light on the factors driving retirement transitions and possible
relationships with mental health. This knowledge could help
inform the design of tailored workplace interventions and policy
strategies to prolong working lives and preserve mental health in
different groups of older workers.
Other approaches should address the preservation of mental
health in those women who already retired due to health reasons
in order to avoid depressive symptoms. Our findings revealed
evidence for the crucial role of social networks, therefore,
prevention strategies againstdepressivesymptomsshould
include encouragement for maintaining social contacts and
relationships in retirement. Future studies investigating social
roles and activities pursued in retirement could provide valuable
insights into this complex association. Regarding possible back-
to-work-strategies for this subgroup, job placement programs
supporting workers in their re-entry into the competitive labor
market, e.g., by the means of personal job coaches, have been
found an effective approach for workers suffering from
depression (71,72). However, further research is needed to
assess the feasibility of such programs for ill-health retirees.
DATA AVAILABILITY STATEMENT
The data analyzed in this study is subject to the following
licenses/restrictions: the dataset analyzed during the current
study is available from the corresponding author upon request.
Requests to access these datasets should be directed to Andrea.
Zuelke@medizin.uni-leipzig.de.
ETHICS STATEMENT
The studies involving human participants were reviewed and
approved by Ethics board of the Medical Faculty of the
University of Leipzig. The patients/participants provided their
written informed consent to participate in this study.
AUTHOR CONTRIBUTIONS
AZ conducted the statistical analyses, interpreted the data and
drafted the manuscript. SR supported in interpreting the data
and drafting the manuscript. MS, AW, AH, HG, ChE, SiZ, SaZ,
and CoE revised the manuscript for intellectual content, read and
approved the final version of the manuscript. ML and AV
conceptualized and designed the study, revised the manuscript
for intellectual content, read and approved the final version of
the manuscript. SRH conceptualized and designed the study,
supervised the drafting of the manuscript, supported in interpreting
the data, revised the manuscript for intellectual content, read and
approved the final version of the manuscript.
FUNDING
This publication is supported by LIFE –Leipzig Research Center
for Civilization Diseases, University of Leipzig. LIFE is funded by
means of the European Union, by the European Regional
Development Fund (ERDF) and by means of the Free State of
Saxony within the framework of the excellence initiative. This
project was funded by means of the European Social Fund and
the Free State of Saxony.
ACKNOWLEDGMENTS
We thank all members of the LIFE study center for conducting
the LIFE-Adult-Study as well as all participants for their good
collaboration. We acknowledge support from Leipzig University
for Open Access Publishing.
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Conflict of Interest: The authors declare that the research was conducted in the
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