Associations between depressive symptoms and being employed or retired in older adults with type 2 diabetes

Highlights

• The subpopulation of older Europeans with type 2 diabetes was studied.

• The majority of patients with depression were women.

• Patients with depression had lower employment rates.

• Women employed were more likely to have depression than the ones retired.

• Improvement of psychosocial working conditions is needed.

Abstract

Aims

Analyse the association of depression with retirement in older adults with type 2 diabetes(T2D).

Methods

Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) was used to analyse 1100 T2D aged 51–74, employed or retired. Multilevel logistic models examined the relationships of health and socio-demographic characteristics with depression.

Results

The proportion of females was significantly higher among those with depression. Around half of those aged between 51 and 64 were employed, and less than 5% among those aged between 65 and 74 years. Female, employment, more chronic diseases and not perceiving their health as healthy were associated with depression among those aged 51–64. Among women, the odds of being depressed was significantly higher among those employed than among those who had retired. Among men, being employed or retired was not significantly associated with depression.

Conclusions

Depression was associated to more limitations of daily living and chronic diseases, and worst perception of health. The majority of those with depression were women, and being retired seems to have a protective effect on women.

Introduction

Diabetes and mental illness are two morbidities that have increased in recent years around the world and in particular in Europe [1,2]. The World Health Organization estimates that the proportion of people with diabetes aged 25 years and over in the European region is around 10% (10.3% of men and 9.6% of women) [3]. Although diabetes is increasing at all ages, it remains a risk condition for older adults. If nothing is done to counteract the increasing trend of this morbidity, the number of deaths from this cause between 2005 and 2030 can double [3]. Among other factors, more deprived socio-economic status, especially those related to schooling and low-income, have contributed to the increase in prevalence, incidence and mortality due to type 2 diabetes and the female gender is the most affected by this evidence [[4], [5], [6], [7]]. It has been found that marital status plays a relevant role in men: compared to being married, being single, separated or divorced increases the mortality due to diabetes [7].

Depression has been associated with type 2 diabetes. Among patients with diabetes, the proportion of people with depression is about two-times the proportion among those who do not have diabetes [8]. Some authors found that depression was a risk factor for type 2 diabetes [9], others that the association found could be because those two disorders, depression and type 2 diabetes, share the same risk factors [8], and other authors found that having type 2 diabetes increase the risk of depression [10,11]. Most of the studies agree in indicating that among patients with type 2 diabetes, depression is associated with poor health outcomes [8,11,12].

The most general retirement age in Europe is 65, some countries have a slightly higher or lower retirement age. The employment rate of older European workers in the age group 55–64 is around 55% [13]. Employment versus retirement has been found to protect older adults in terms of mental health and well-being, although different patterns were found for men and women [[14], [15], [16], [17]]. It was found that retirement was more beneficial for women than for men, maybe because older women tend to have lower levels of work centrality, shorter working careers, lower wages, and other types of activities due to their social roles as wives, mothers, and caregivers [14]. Having diabetes has been found to increase the probability of exit from employment via retirement [18,19]. A positive correlation was also found between depression and retirement in Europe, however without evidence of a causal mechanism [20]. Psychological well-being in workers with type 2 diabetes is especially of concern since depressive symptoms can negatively affect work performance, or exit from work through unemployment or retirement [11,18].

Factors such as retirement and employment have been analyzed in the past as important determinants of mental health. We extend this literature by analyzing the association of being retired or employed on depression among people with type 2 diabetes. While the main focus of the paper is on the association between depression and employment, rather than retirement, this may not be independent of professional status. Therefore, we also contribute to the literature that assesses the effects of professional status (retirement versus employment) on psychological well-being of older adults with type 2 diabetes. Further, the paper also makes a contribution to the literature about psychological well-being and responds to the need to study this problematic on people with diabetes [11,21].

Considering only the subpopulation of older Europeans with type 2 diabetes, the aim of this study was to analyse the relationship between depression and being retired.