Trajectories of Antidepressant Medication before and after the Onset of Unemployment by Subsequent Employment Experience

Abstract

BackgroundThe unemployed more often suffer from depression than the employed. We examined whether mental health deterioration occurs already before unemployment implicating health selection, or whether it mostly occurs after becoming exposed to the experience rendering causal explanations more likely.MethodsWe used nationally representative Finnish register data to examine changes in depressive morbidity as measured by antidepressant medication in 1995–2009 over four years before and since a new onset of unemployment (N = 28 000) at the age of 30–60 compared to the employed (N = 124 136). We examined separately those who became continuously long-term unemployed, intermittently unemployed and unemployed with eventual re-employment in the second, third or fourth year since the year of onset. Annual repeated measurements were analysed using generalised estimation equations.ResultsAmong the employed antidepressant medication increased slowly but steadily over the study period and it was mainly at a lower level than among the unemployed. In the four years leading to unemployment there was excess increase in medication that was generally stronger among those with longer duration of the eventual unemployment experience. During unemployment medication decreased in all groups except among the intermittently unemployed. By the first year of re-employment antidepressant medication reached a level similar to that among the employed and afterwards followed no consistent trend.ConclusionsThe associations of unemployment and re-employment with depressive morbidity appear to be largely driven by health selection. The question of potential causal associations remains unresolved for intermittent unemployment in particular.

Work status, retirement, and depression in older adults: An analysis of six countries based on the Study on Global Ageing and Adult Health (SAGE)

“…Considering previous studies, the findings herein contrast with other research that have found that retirement (compared to remain working) was associated with a higher risk of depression, so that the timing ( Buxton, Singleton, & Melzer, 2005 ), the duration ( Olesen, Rod, Madsen, Bonde, & Rugulies, 2015 ) and the wilfulness ( Mosca & Barrett, 2016 ) of retirement were key features that influenced the mental health of older adults. Contrarily, our results are similar to those presented in other investigations where a protective association between retirement (versus working) and depression has been reported ( Mandal and Roe, 2008 , Westerlund et al, 2010 ) or where at least there was not an increase of depressive symptoms given by partial ( Szinovacz & Davey, 2004 ) and statutory retirement ( Leinonen, Mäki, & Martikainen, 2017 ).…”

“…Nonetheless, the present study adheres to the growing body of literature that suggests retirement has a protective effect on mental health when it is voluntary or includes a pension, features that are not always specified, making it difficult to synthesize the evidence. Theoretically, some authors have proposed that retirement may increase depression, especially when: 1) it occurs sooner than expected, 2) it is perceived as forced, and 3) it is abrupt rather than gradual ( Leinonen et al, 2017 ). Based on this theory, a “good retirement” (right timing, gradual, voluntary, and well paid) should not be related to depression.…”

Use of sequence analysis for classifying individual antidepressant trajectories to monitor population mental health

“…We found that unemployment was associated with decreasing use of antidepressants similar to other studies, which have found that unemployment status correlates with decreasing antidepressant use [38]. This effect is thought to be driven by health selection, whereby mental health status deteriorates before unemployment, and then improves during unemployment [39,40], perhaps due to relief of work related stressors. Living alone had stronger associations with antidepressants in another study (OR 1.81; 95%CI 1.46-2.23) [25] than in the current study (OR ranged from 1.10 to 1.28 for 'decreasing', 'increasing' and 'most of the time' groups), which may be explained by the differences in sample .…”

Distinctive use of newer and older antidepressants in major geographical areas: A nationally representative register-based study

“…These studies, however, did neither examine long-term trends in antidepressant use nor distinctive antidepressant classes, which may have masked some associations. Furthermore, a recent study concluded that the differences by employment status may arise from health selection (Leinonen et al 2017), which means that those with mental health problems are more likely to become selected into unemployment than vice versa.…”