Transition to retirement impact on health and lifestyle habits: analysis from a nationwide Italian cohort

Impact of retirement transition on health, well-being and health behaviours: critical insights from an overview of reviews

Retirement is a pivotal life course transition wich may have profound implications for health, well-being and health behaviours. Despite extensive research and theoretical debate, the impact of retirement on health remains inconclusive, with studies reporting positive, negative, or no effects. This overview of reviews synthesises evidence from 15 systematic reviews (4 meta-analyses) assessing the relationship between retirement and physical and mental health outcomes (including mortality, mental health, cognitive decline and cardiovascular diseases) and health behaviours (including physical activity, diet, smoking and alcohol consumption). The review adheres to PRIOR guidelines and assesses the quality of the literature and existing methodological challenges. Findings indicate that retirement's impact varies widely depending on socioeconomic status (SES), job characteristics, and individual lifestyle factors. Retirees with higher SES generally experience improved mental health and increased physical activity, whereas those with lower SES are more prone to declines in physical and mental health, increased sedentary behaviour, and adverse cardiovascular outcomes. Evidence on cognitive decline and mortality remains mixed. This review highlights critical methodological issues in the available literature, including inconsistent definitions of retirement, reliance on self-reported health data, and biases like reverse causality and healthy worker effect. Future research should prioritise life course longitudinal designs and cross-country comparisons informed by stronger theoretical grounding to untangle the complex relationship between retirement and health. Policy efforts should target vulnerable groups, particularly those from lower SES, by promoting physical activity, mental well-being, and social engagement during and after the transition to retirement. Tailored interventions across retirement transition could mitigate health disparities and improve overall well-being in later life.

Impact of extreme weather events on food security among older people: a systematic review

BACKGROUND

Climate change has intensified the frequency and severity of extreme weather events, disproportionately affecting vulnerable populations, including older people for which the literature is still limited. This systematic review investigated the impact of extreme weather events on malnutrition and food security among individuals aged 60 and older.

METHODS

A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted without restrictions (October 2024), and following PRISMA guidelines. Observational studies examining older adults exposed to extreme weather events (e.g., droughts, floods, heatwaves, hurricanes) and their effects on malnutrition or food security were included. The Newcastle-Ottawa Scale assessed study quality. Protocol was registered in PROSPERO (ID: CRD42024596910).

RESULTS

From 1,709 articles, six observational studies involving 265,000 participants (aged 60 years and over) were included. These studies spanned multiple geographies, with a concentration in the United States. Findings revealed a dual impact: while some studies reported protective factors, such as social support and economic stability, others highlighted increased malnutrition risk due to disrupted food supply, economic hardship, and inadequate adaptive responses. Heterogeneity in study designs, exposure definitions, and outcome measures limited comparability.

CONCLUSION

Extreme weather events significantly impact malnutrition and food security among older adults, with outcomes influenced by socio-economic and geographical factors. Further longitudinal studies are needed to clarify causal pathways and inform targeted public health interventions to enhance resilience in aging populations.

Aging, longevity, and healthy aging: the public health approach

BACKGROUND

Population aging is one of the most significant global demographic changes of the 21st century, driven by increased life expectancy and declining fertility rates. This phenomenon presents both achievements and challenges for public health systems worldwide.

AIMS

On the one hand, advances in healthcare and socio-economic conditions have contributed to longer lives and improved quality of life for older adults. On the other hand, aging populations are increasingly affected by chronic diseases, greriatric syndromes, and multimorbidity, leading to greater healthcare demands and higher associated costs.

METHODS

This manuscript explores evidence on regards of the impact of aging on healthcare and economic systems, emphasizing the need for a paradigm shift toward healthy aging.

RESULTS

Healthy aging, as defined by the World Health Organization, focuses on the maintenance of intrinsic capacity, physical, mental, and social well-being throughout life. It highlights the importance of preventive healthcare, proper nutrition, and regular physical activity in delaying the onset of chronic conditions and maintaining functional independence. Furthermore, the manuscript addresses the challenges faced by healthcare infrastructures and pension systems as they adapt to aging populations, with particular attention to the strain caused by workforce shortages and the rising need for long-term care.

DISCUSSION

A coordinated public health approach is essential to promote healthy aging and mitigate the economic and societal impacts of population aging.

CONCLUSIONS

This paper underscores the need for integrated health policies and multidisciplinary care models to ensure that longer life expectancy is accompanied by better quality of life for older individuals.

Transition to retirement impact on food consumption frequency: results from a longitudinal analysis within the Survey of Health, Ageing and Retirement in Europe (SHARE)

OBJECTIVES

It has been suggested that major life course transitions, such as retirement, can greatly impact lifestyles. However, the evidence is scant and inconclusive, especially with reference to the effects on dietary habits. We investigated the long-term effects of retirement on the frequency of food consumption using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE).

DESIGN AND PARTICIPANTS

We used data from a SHARE-based cohort, including European individuals from 28 countries aged 50 and older who were employed at baseline and retired during follow-up time (2004-2020).

MEASUREMENTS

Dietary habits were assessed through self-reported frequencies of consumption for fruit and vegetables, dairy products, meat and fish, legumes and eggs. A dietary score (dichotomised as ≥5 or <5) was also estimated. Generalised estimating equation models calculated relative risks (RR) of daily (for fruit, vegetables and dairy products) and 3-6 times per week (for meat, fish, legumes and eggs) consumptions before and after retirement, adjusting for selected variables.

RESULTS

The cohort included 8,998 individuals with a mean follow-up time of 9 years. Baseline daily consumption frequencies were 73.7% for fruit and vegetables and 65.9% for dairy products, while 3-6 times per week frequencies were 39.8% for meat and fish and 26.1% for legumes and eggs. An increase in 3-6 times a week consumption of meat and fish (RR 1.07, 95% CI 1.01-1.13) and legumes and eggs (RR 1.09, 95% CI 1.01-1.17) was observed 10 or more years post-retirement. Daily consumption of fruit and vegetables, and dairy products remained stable. The RR of a dietary score ≥5 post-retirement was 1.11 (95% CI 1.06-1.16, 10 or more years after).

CONCLUSIONS

Retirement positively appears to influence overall dietary habits, particularly by improving the consumption frequency of protein-rich foods, while the stability in fruit, vegetables, and dairy consumption suggests that well-established habits persist despite life transitions.

Effect of retirement on the body mass index in China: a nationwide study based on the regression discontinuity design

INTRODUCTION

Retirement represents a significant life transition and is associated with individual health outcomes. Previous studies on the health effects of retirement have yielded inconsistent conclusions. This study aimed to estimate the impact of retirement on the body mass index (BMI) and BMI-defined overweight and obesity.

METHODS

Between 2012 and 2015, this study included 88,471 public sector participants from the Chinese Hypertension Survey (CHS) while excluding those working in the private sector. By utilizing the fuzzy regression discontinuity design (FRDD), this research evaluated the direct impact of retirement on the BMI, as well as on the overweight and obesity rates. Additionally, the study examined variations in the effects of retirement among groups stratified by sex and educational attainment.

RESULTS

The fully adjusted model suggested that retirement did not have a significant impact on the BMI or overweight and obesity rates of the overall population. Notably, retirement significantly impacted the male participants, resulting in an increase in their BMI of 2.18 (95% CI 0.23-4.13), but did not affect the BMI of the female participants. Furthermore, individuals with lower educational backgrounds experienced more pronounced BMI changes upon retirement.

CONCLUSIONS

On average, retirement has no significant impact on the BMI and overweight and obesity rates. Retirement leads to an increase in the BMI among men but does not affect that in women. When considering adjustments to existing retirement policies, the differential health effects of retirement across various populations should be taken into account.

Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study

BACKGROUND

Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process.

OBJECTIVE

The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention.

METHODS

The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops.

RESULTS

Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed.

CONCLUSIONS

The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention.

Retirement, Social Engagement, and Post-Retirement Changes in Cognitive Function

OBJECTIVES

This study examines whether social engagement at the time of retirement is associated with better cognitive function and slower cognitive decline.

METHODS

Data come from 10 waves of the Health and Retirement Study, linked with data from the Consumption and Activities Mail Survey (CAMS). Respondents included those who had transitioned from working full-time to partial or full retirement. Social engagement was measured across 5 social activities and grouped into 4 categories.

RESULTS

In fully adjusted regression models, higher frequency of participation in social activities was associated with higher cognitive function at the time of retirement but not with slower cognitive decline after retirement. An increase in social activities after retirement was not associated with better cognitive function or slower cognitive decline.

DISCUSSION

These findings do not offer evidence that higher frequency of social engagement or increases in social engagement after retirement protect against post-retirement cognitive decline.

The relationships between race, employment, and self-rated health among older South Africans: exploring the mediating role of generalized anxiety

Objective

This study explores the impact of race and employment status on self-rated health among older adults in South Africa. It reveals new insights by examining the mediating role of generalized anxiety. The findings highlight the importance of addressing these factors to improve the wellbeing of older adults.

Methods

Drawing from Wave 5 of the National Income Dynamics Study-Coronavirus Rapid Mobile Survey, a cross-sectional survey encompassing a nationally representative cohort of South African adults, this research employs a sophisticated blend of logistic regression and structural equation modeling techniques.

Results

The study reveals that race is strongly linked to self-rated health. Individuals of Colored and White backgrounds have lower odds of favorable self-rated health. Retirement has a positive impact on self-rated health. Generalized anxiety mediates the complex relationship between race and self-rated health.

Conclusions

Addressing the imperative need to mitigate racial disparities in self-rated health and advance equitable healthcare access for older adults, targeted interventions are undeniably warranted.

It Has To Be My Way-Reducing Sedentary Time in the Transition to Retirement

BACKGROUND

Sedentary behavior is highly prevalent in older adults transitioning to retirement. Sedentary time is all of the time spent in sedentary behavior, and prolonged sedentary time is associated with an increased risk of noncommunicable diseases. The aim of this study was to explore perceptions among older adults transitioning from working life to retirement regarding self-management strategies for reducing sedentary time and adhering to the reduced sedentary time.

METHODS

Twenty-eight older adults, age 60-75 years, participated in one of four focus group interviews. Qualitative content analysis was used to analyze the data.

RESULTS

The analysis resulted in the theme "It has to be my way," and the three categories "Activities scattered with joyfulness," "Support for changes in everyday life," and "Health affects willingness and ability, and is affected by adherence."

CONCLUSIONS

Interpreted from the perspective of self-determination theory, self-management strategies for reducing sedentary time should be adaptable as every individual is unique, indicating a need for autonomy. Sedentary time was said to be reduced by activities that evoked joyfulness, and joyfulness was considered to increase adherence. Support for changes to one's everyday life was considered necessary. The support that was mentioned primarily involved targeting cognitive determinants such as self-efficacy and attitudes. This new knowledge can be included when designing self-management interventions; however, more research is needed in order to evaluate whether self-management strategies targeting autonomous motivation and affective determinants, such as affective judgment and cognitive determinants, can reduce sedentary time in those who are in the transition to retirement.

Experiences in healthcare for weight management - a qualitative interview study of retired individuals with obesity and low or high education

BACKGROUND

Overweight and obesity are global health concerns, especially significant for older adults at higher risk for chronic diseases. The transition to retirement, altering daily routines, highlights the need for adequate weight management support. Since obesity is a challenging topic in healthcare and socioeconomic inequalities exist in access and utilization, we examined how retired individuals with obesity and low or high education describe their experiences of unmet needs, mismatches, and successes within the healthcare service system for weight management.

METHODS

This qualitative interview study is part of the Helsinki Health Study. The participants (N = 20, with a body mass index of at least 30 kg/m2) were selected from a cohort of retired former employees of the City of Helsinki. Half of the interviewees had low education, and the other half had high education. Women and men were equally represented. The interviews were conducted in 2023 and the data were analyzed using inductive thematic analysis.

RESULTS

Three main themes were formed: Deficiencies in engaged care, Services are mismatched with needs, and Facilitating conditions for individual successes. The first main theme had two sub-themes: Condescending attitude and Ignoring weight during the appointment. The second main theme had one sub-theme: Inadequate personnel resources. The third main theme had one sub-theme: Individual opportunities to acquire information and treatment. Educational differences were most clearly reflected in the sub-themes. Participants with low education more often described experiencing a condescending attitude towards them when seeking care and had had difficulties in obtaining time for appointments due to inadequate resources. Participants with high education described broader experiences related to individual opportunities to acquire information and treatment within the healthcare service system than participants with low education.

CONCLUSIONS

The participants in this study highlighted the importance of respectful engagement with the subject of their weight and felt that these kinds of interaction skills should still be developed in healthcare personnel. The participants articulated a need for approaches that are tailored to their unique circumstances. According to the participants, long-term group intervention, provided with peer support and supported by a multidisciplinary team, could sustain their weight management.

Leisure sedentary time and elevated blood pressure: evidence from the statutory retirement policy

Objectives

The relationship between sedentary behaviors and elevated blood pressure remains inconclusive, and the socioeconomic mechanisms underlying the linkage are rarely discussed. Since retirement is often associated with behavioral changes that impact health, this study aims to provide evidence on changes in leisure sedentary time after the statutory retirement age on elevated blood pressure, along with the socioeconomic mechanisms.

Methods

We utilized data from five waves (2004-2015) of the China Health and Nutrition Survey (CHNS), focusing on males aged 55-65 employed in the formal sector. Leisure sedentary time, the independent variable, was measured based on self-reported data, while diastolic (DBP) and systolic (SBP) blood pressure were the dependent variables. Using statutory retirement policy as an exogenous variation, we employed a continuous difference-in-differences (DID) framework and a propensity score matching difference-in-differences (PSM-DID) approach to examine the relationship between changes in leisure sedentary time after the statutory retirement age and elevated blood pressure. The analysis was conducted using ordinary least squares (OLS). To address potential endogeneity, we applied the instrumental variable (IV) method via two-stage least squares (2SLS).

Results

Our findings indicate an increase in diastolic blood pressure after statutory retirement, attributed to increased leisure sedentary time. However, there was no significant increase in systolic blood pressure. Moreover, physical activity did not appear to offset this rise in blood pressure, while higher educational attainment and having family members employed in the medical field helped mitigate its negative effects.

Conclusion

This study highlights the potential adverse impact of increased leisure sedentary time on diastolic blood pressure among middle-aged men in the formal sector, while also exploring the socioeconomic factors that may alleviate these effects. These results provide a foundation for public health initiatives aimed at addressing the rising prevalence of sedentary behavior and its association with blood pressure issues.

Analysis of behavioral change techniques used in exercise and nutritional interventions targeting adults around retirement age with sarcopenic obesity in a systematic review

BACKGROUND

Sarcopenic obesity significantly burdens health and autonomy. Strategies to intervene in or prevent sarcopenic obesity generally focus on losing body fat and building or maintaining muscle mass and function. For a lifestyle intervention, it is important to consider psychological aspects such as behavioral change techniques (BCTs) to elicit a long-lasting behavioral change.

PURPOSE

The study was carried out to analyze BCTs used in exercise and nutritional interventions targeting community-dwelling adults around retirement age with sarcopenic obesity.

METHODS

We conducted an analysis of articles cited in an existing systematic review on the effectiveness of exercise and nutritional interventions on physiological outcomes in community-dwelling adults around retirement age with sarcopenic obesity. We identified BCTs used in these studies by applying a standardized taxonomy.

RESULTS

Only nine BCTs were identified. Most BCTs were not used intentionally (82 %), and those used derived from the implementation of lifestyle components, such as exercise classes ("instructions on how to perform a behavior," "demonstration of the behavior," "behavioral practice/rehearsal," and "body changes"). Only two studies used BCTs intentionally to reinforce adherence in their interventions.

CONCLUSIONS

Few studies integrated BCTs in lifestyle interventions for community-dwelling persons around retirement age with sarcopenic obesity. Future studies on interventions to counteract sarcopenic obesity should include well-established BCTs to foster adherence and, therefore, their effectiveness.

Transition to retirement impact on smoking habit: results from a longitudinal analysis within the Survey of Health, Ageing and Retirement in Europe (SHARE) project

BACKGROUND

In an ageing society, retirement impacts on behavioural risk factors and health outcomes should be carefully assessed. Scant evidence exists from longitudinal studies on the short- and long-term consequences of the transition to retirement on smoking habit.

METHODS

We conducted a longitudinal study based on the Survey of Health, Ageing and Retirement in Europe (SHARE) data from 27 European countries plus Israel collected in 2004-2020. To estimate relative risks (RR) and corresponding 95% confidence intervals (CI) for smoking status and intensity at seven time periods before and after retirement, we fitted adjusted generalised estimating equation (GEE) models for repeated measures.

RESULTS

We selected a cohort of 8998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). As compared to the year of retirement, the RR of smoking was 1.59 (95% CI 1.44-1.76) at 10 years or more before retirement, 1.35 (95% CI 1.25-1.46) from 5 to 9 years before retirement, and 1.18 (95% CI 1.10-1.27) from 1 to 4 years before retirement. Smoking steadily decreased after retirement, being 0.94 (95% CI 0.87-1.01) from 1 to 4 years after retirement, 0.76 (95% CI 0.69-0.84) from 5 to 9 years, and 0.58 (95% CI 0.46-0.74) 10 years or more after retirement. In smokers, the estimated number of cigarettes smoked/day decreased from about 27 cigarettes/day at 10 years or more before retirement to 9 cigarettes/day at 10 years or more after retirement (p trend < 0.001).

CONCLUSION

Longitudinal data suggest that lifestyles might favourably change with retirement. Further studies are needed to direct healthy ageing promotion policies better.

The effect of retirement on obesity in women: Evidence from China

Introduction

Retirement has been shown to impact individual health as an important life course, and we examined the impact of retirement on the prevalence of obesity in women based on a female perspective.

Methods

We use data from the five waves of the China Family Panel Study (CFPS) data from 2010 to 2018, with the body mass index (BMI) as the obesity measure. Fuzzy regression discontinuity design (FRDD) is used to overcome the endogeneity of retirement behavior and obesity.

Results

After retirement, the obesity rate among women increased 23.8%-27.4% (p < 0.05). The mechanism is that the activity consumption has not changed significantly, but the energy intake has increased significantly. In addition, we found that the effect of retirement on female obesity was strong heterogeneity.

Conclusions

The study found that retirement will increase the probability of obesity in women.

Changes in life satisfaction during the transition to retirement: findings from the FIREA cohort study

Life satisfaction is an essential construct of well-being that is tied to behavioral, emotional, social and psychological outcomes. This study aimed to examine changes in total and domain-specific life satisfaction during the retirement transition and additionally examine whether those changes differ by gender, occupation, health and spousal working status. Aging public sector employees (n = 3543) from the Finnish Retirement and Aging Study cohort study were followed up annually before and after retirement. Total life satisfaction score (range 4-20) was computed by summing up the responses in four domains (interestingness, happiness, easiness and togetherness). The mean and mean change estimates and their 95% CI were calculated by using the linear regression models with generalized estimating equations, adjusted for age, gender, occupation, health and marital status. Total life satisfaction score improved among the entire study population during the retirement transition and remained stable thereafter. The improvement was greater among women versus men (gender * time interaction p = 0.004), among those with suboptimal health before retirement vs. those who had good (health * time p < 0.0001) and those who had no spouse vs. those who had a retired or working spouse (spousal-status * time p < 0.0001). In case of domain-specific life satisfaction scores, the greatest improvement was observed in the easiness domain. Life satisfaction improves during the retirement transition period, especially among women, those with suboptimal health and those living without a spouse. The improvement was considerably greater in the easiness domain than any other domains. Life satisfaction remained improved and stable during the post-retirement period.

Understanding the effect of retirement on health behaviors in China: Causality, heterogeneity and time-varying effect

Retirement is an important turning point during the course of life, but few studies have examined the effects of retirement on a broad range of health behaviors in China. We use the longitudinal data of the China Health and Nutrition Survey (CHNS) from 2004 to 2015 to conduct empirical analysis. Fuzzy discontinuity regression was used to assess the association between retirement and health behaviors in the entire sample and subgroups based on gender and education. A time-varying effect model was used to measure the anticipatory effect, immediate effect and lag effect of retirement. We observed that the transition to retirement was associated with healthier lifestyle habits, such as reduced smoking and alcohol consumption and increased exercise motivation. However, the transition was associated with worse sedentary behavior. No significant statistical association was found between retirement and sleep duration. Men and those with higher education levels are more likely to experience the impact of retirement. The anticipatory effect suggests that as the statutory pension age is predictable, workers adjust their behaviors 4 and 5 years before retirement. The lagged effect indicates that it takes time to develop new habits; thus, retirees change their behaviors 2-3 years after retirement. The paper discusses possible reasons for our findings and proposes several policy implications from the perspectives of the government and society to facilitate the realization of healthy aging.

Social determinants and lifestyle factors for brain health: implications for risk reduction of cognitive decline and dementia

Substantial evidence indicates a huge potential for risk reduction of cognitive decline and dementia based on modifiable health and lifestyle factors. To maximize the chances for risk reduction, it is useful to investigate associations of social determinants and lifestyle for brain health. We computed the "LIfestyle for BRAin health" (LIBRA) score for baseline participants of the Leipzig Research Centre for Civilization Diseases (LIFE) Adult Study, a population-based urban cohort in Germany. LIBRA predicts dementia in midlife and early late life populations, comprising 12 modifiable risk factors (heart disease, kidney disease, diabetes, obesity, hypertension, hypercholesterolemia, alcohol consumption, smoking, physical inactivity, diet, depression, cognitive inactivity). Associations of social determinants (living situation, marital status, social isolation, education, net equivalence income, occupational status, socioeconomic status/SES, employment) with LIBRA were inspected using age- and sex-adjusted multivariable linear regression analysis. Z-standardization and sampling weights were applied. Participants (n = 6203) were M = 57.4 (SD = 10.6, range 40-79) years old and without dementia, 53.0% were women. Except for marital status, all considered social determinants were significantly associated with LIBRA. Beta coefficients for the association with higher LIBRA scores were most pronounced for low SES (β = 0.80, 95% CI [0.72-0.88]; p < 0.001) and middle SES (β = 0.55, 95% CI [0.47-0.62]; p < 0.001). Social determinants, particularly socioeconomic factors, are associated with lifestyle for brain health, and should thus be addressed in risk reduction strategies for cognitive decline and dementia. A social-ecological public health perspective on risk reduction might be more effective and equitable than focusing on individual lifestyle behaviors alone.

Does retirement trigger depressive symptoms? A systematic review and meta-analysis

AIMS

Retirement is a major life transition that may improve or worsen mental health, including depression. Existing studies provide contradictory results. We conducted a systematic review with meta-analysis to quantitatively pool available evidence on the association of retirement and depressive symptoms.

METHODS

We applied PRISMA guidelines to conduct a systematic review and meta-analysis to retrieve, quantitatively pool and critically evaluate the association between retirement and both incident and prevalent depression and to understand better the potential role of individual and contextual-level determinants. Relevant original studies were identified by searching PubMed, Embase, PsycINFO and the Cochrane Library, through 4 March 2021. Subgroup and sensitivity meta-analyses were conducted by gender, study design (longitudinal v. cross-sectional studies), study quality score (QS) and considering studies using validated scales to diagnose depression. Heterogeneity between studies was evaluated with I2 statistics.

RESULTS

Forty-one original studies met our a priori defined inclusion criteria. Meta-analysis on more than half a million subjects (n = 557 111) from 60 datasets suggested a protective effect of retirement on the risk of depression [effect size (ES) = 0.83, 95% confidence interval (CI) = 0.74-0.93], although with high statistical heterogeneity between risk estimates (χ2 = 895.19, df = 59, I2 = 93.41%, p-value < 0.0001). Funnel plot asymmetry and trim and fill method suggested a minor potential publication bias. Results were consistent, confirm their robustness and suggest stronger protective effects when progressively restricting the included studies based on quality criteria: (i) studies with the highest QS [55 datasets, 407 086 subjects, ES = 0.81, 95% CI = 0.71-0.91], (ii) studies with a high QS and using validated assessment tools to diagnose depression (44 datasets, 239 453 subjects, ES = 0.76, 95% CI = 0.65-0.88) and (iii) studies of high quality, using a validated tool and with a longitudinal design (24 datasets, 162 004 subjects, ES = 0.76, 95% CI = 0.64-0.90). We observed a progressive reduction in funnel plot asymmetry. About gender, no statistically significant difference was found (females ES = 0.79, 95% CI = 0.61-1.02 v. men ES = 0.87, 95% CI = 0.68-1.11).

CONCLUSIONS

Pooled data suggested that retirement reduces by nearly 20% the risk of depression; such estimates got stronger when limiting the analysis to longitudinal and high-quality studies, even if results are affected by high heterogeneity.As retirement seems to have an independent and protective effect on mental health and depressive symptoms, greater flexibility in retirement timing should be granted to older workers to reduce their mental burden and avoid the development of severe depression. Retirement may also be identified as a target moment for preventive interventions, particularly primary and secondary prevention, to promote health and wellbeing in older ages, boosting the observed impact.