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Retirement and Depression in Mexican Older Adults: Effect Modifiers in a

Cohort Based on the Study on AGEing and Adult Health (SAGE), 2002–2010

Article in Journal of Population Ageing · September 2019

DOI: 10.1007/s12062-018-9230-x

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Journal of Population Ageing
https://doi.org/10.1007/s12062-018-9230-x

Retirement and Depression in Mexican Older Adults: Effect

Modifiers in a Cohort Based on the Study on AGEing
and Adult Health (SAGE), 2002–2010

Laura Juliana Bonilla-Tinoco 1 & Julián Alfredo Fernández-Niño 2 &

Betty Soledad Manrique-Espinoza 3 & Martin Romero-Martínez 3 & Ana Luisa Sosa 4

Received: 13 April 2018 / Accepted: 1 October 2018/

# Springer Nature B.V. 2018

Abstract
World population is experiencing a demographic transition, which introduces changes
in the workforce structure, such as increasing retirement. At the same time, retirement
produces several life-style modifications that significantly influence well-being and can
lead to depression. Thereby, this study aimed to estimate the association between
retirement and depression incidence in Mexican older adults from a
population-based cohort and to evaluate its potential effect modifiers. The
cohort was assembled using SAGE-Mexico waves 0 and 1 (baseline and
follow-up, respectively), and included individuals who at wave 0 were 53+
years and not depressed, and those who had a follow-up. Retirement was
assessed in wave 0 by creating three categories: working; retired; and can’t
retire; covariates were also ascertained in wave 0. Incidence of depression was
measured in wave 1 by means of self-report of a medical diagnosis of depres-
sion and of the use of an algorithm based on the Composite International
Diagnostic Interview. Log-binomial regression models were used to estimate
risk ratios (RR) adjusted for all the covariates; additionally, interaction terms
were constructed to explore a potential effect modification given by marital
status, income quintile, health insurance tenure and multimorbidity. The analytic
sample consisted of 820 participants; the 8-year depression incidence was
12.20%; and being retired increased the risk of depression in those older adults
who did not have a permanent partner (RR: 4.52; CI 95% 1.30–15.76). The
results obtained in this study indicate that the association between retirement
and depression in Mexican older adults depends on the context surrounding the
retirement transition.

Keywords Retirement . Depression . Incidence . Aged . Cohort studies

* Julián Alfredo Fernández-Niño

aninoj@uninorte.edu.co

Extended author information available on the last page of the article

 L. J. Bonilla-Tinoco et al.

Introduction

Currently, world population is experiencing an accelerated ageing, which translates into

a demographic transition (United Nations Population Fund 2012). This phenomenon is
caused, mainly, by: 1) the decline in fertility rates; and 2) the rise in life expectancy,
given by a major survival at older ages in high-income countries and by lower child
mortality rates in low and middle-income countries (Organización Mundial de la Salud
(OMS) 2015; United Nations Population Fund 2012). According to the United Nations
Population Fund, older adults —people over 60 years of age— represented 11.5% of
world population in 2012, but this number is expected to increase to 22% by 2050
(United Nations Population Fund 2012). In Latin America, it has been estimated that
the average annual growth of general population is 1.3%, while that of the elderly is
3.4% (Vega et al. 2009). Similarly, in Mexico, the proportion of older adults rose from
6.8 to 7.6% in the 2000–2005 period (Garay et al. 2012), and is expected to be 20–24%
in 2050 (Organización Mundial de la Salud (OMS) 2015).
The above-mentioned demographic transition has become a subject of great interest
due to the multiple social, health and economic challenges at the individual and
population levels that come with it. For example, in the public health field, countries
will have to deal with the change in the epidemiologic profile, given by a greater
relevance of the non-communicable diseases, which in turn increases the need of health
care (United Nations Population Fund 2012). In addition, population ageing introduces
another change relative to the workforce structure given by an increasing retirement as
people age, which also has social, economic and health consequences (Butterworth
et al. 2006; Denton and Spencer 2009; R. Lee et al. 2010). Retirement, which can be
understood as the voluntary or involuntary “withdrawal from the paid labor force”
(Denton and Spencer 2009) that may be accompanied by the receipt of a pension
(Denton and Spencer 2009; Scherer 2002), does not have a standardized definition
because is a “fuzzy” concept that can have several meanings depending on the context
and labor legislation of each country (Bowlby 2007; Denton and Spencer 2009; Scherer
2002). However, it is clear that retirement has a major frequency in the elderly due to
the policies encouraging it (mandatory retirement and, sometimes, even early retire-
ment); the health-related problems, such as diseases or disability; and the natural
decline of physical and cognitive skills (Bloom et al. 2010; R. Lee et al. 2010).
Furthermore, retirement is considered a “milestone” that indicates the moving from
midlife to later adulthood and that comes with several important life-style modifications
(Kim and Moen 2001a, b). These latter comprise changes in roles, relationships, income,
health and daily routines, and have a significant impact on the individual’s well-being;
hence, they representing psychological challenges the older adults need to overcome in
order to have a satisfactory retirement transition (Kim and Moen 2001b; Osborne 2012).
Conversely, if older adults do not successfully adjust to the described modifications,
retirement might lead to psychological distress and depression through the disturbance
of social networks; the decline in social contact; the generation of role-loss feelings, that
diminishes morale; the loss of the identity-structure shaped by the job; and the loss of the
work life-structure (Dave et al. 2008; Kim and Moen 2002; Osborne 2012).
In addition, it has been described that the influence of retirement on an individual’s
well-being, and therefore on the presence of depression, might be influenced by the
economic status, the social networks and the personal resources of the retiree (Kim and
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

Moen 2001b). This means that the association between retirement and the presence of
depression in older adults varies according to the degree of availability of these
resources, so that they might act as modifiers of this relation. Thus, economic factors
such as retirement income and pension receipt might affect adjustment to retirement
through the financial strains and lifestyle limitations that retired people might experi-
ence (Kim and Moen 2001b; Mein et al. 2003). Marital status and family and friendship
networks may modulate the retirement-depression association because being married
and having friends offer support to adapt to a new role and to deal with uncertainty
(Kim and Moen 2001a, 2001b). Finally, some individual features such as educational
level, overall health, self-efficacy and self-esteem also influence in retirement adjust-
ment (Kim and Moen 2001a). Among these factors, it is worth highlighting that sex
plays a very important role in moderating retirement effect on well-being, given the
differences in how they experience retirement and in their labor-force participation
(Kim and Moen 2001b).
Considering that retirement is a complex process with multiple changes that have the
potential to worsen the psychological well-being of older adults (Kim and Moen 2001b,
2002; Osborne 2012), the relationship between depression and retirement in older
adults is currently one of the health issues that raises more interest among researchers.
Moreover, there are some other reasons as to why the research on this topic is
increasing. Firstly, depression is the most frequent mental disorder in older adults,
which can be evidenced by its estimated prevalences of up to 30% in any of its
presentation forms (Vega et al. 2009). Secondly, depression in older adults is an
important public health problem due to its impact on mortality and morbidity; on
physical and cognitive functioning; on the suicide risk; and on the health-services
demand (Fiske et al. 2009; Vega et al. 2009).
There are several investigations in the literature about the relation between retire-
ment and depression in older adults, although their results are somehow diverse and
even contradictory (Kim and Moen 2001b, 2002). This way, one can found studies
concluding that retirement is harmful for mental and physical health of older adults
(Buxton et al. 2005; Dave et al. 2008; Mosca and Barrett 2016); studies that report that
retirement is beneficial for older adult’s mental health (Mojon-Azzi et al. 2007;
Westerlund et al. 2010); studies whose conclusions indicate that the effect of retirement
depends on the context (J. Lee and Smith 2009; Mandal and Roe 2008; Rhee et al.
2016); and studies that do not find evidence of the beneficial effect of retirement
(Olesen et al. 2015). The described heterogeneity can be partly explained by the fact
that retirement does not have a standardized definition, which allows the usage of
several definitions that hinders the comparability of existent investigations; by the
presence of multiple effect modifiers whose prevalence varies according to the context;
and by the culturally different meaning of retirement of older adults (Shiba et al. 2017).
Given the previously described and that evaluating and understanding the potential
effects of retirement on health has become a priority objective in the health, political
and economic sectors (Mandal and Roe 2008; Mosca and Barrett 2016; Westerlund
et al. 2010), two aims were established for the present study. The first was to estimate
the association between retirement and depression incidence in Mexican older adults
from a population-based cohort and the second one, to evaluate the potential effect
modifiers of this relationship (sex, marital status, income quintile, health insurance
tenure and multimorbidity).
 L. J. Bonilla-Tinoco et al.

Methods

Study Population

The Study on AGEing and adult health (SAGE) is a multi-country and longitudinal
study with nationally representative samples of adults 50 years and older. Participant
countries are China, India, Russian Federation, Ghana, Mexico and South Africa; six
low and middle-income countries. SAGE began in 2002/04 with the World Health
Survey, also known as SAGE-Wave 0 (World Health Organization 2003), which
included people aged 18 years and older from 70 countries. On the other hand, SAGE
Wave 1 data (Naidoo 2011) was obtained during the 2007/10 period by re-interviewing
Wave 0 samples from four of the six SAGE countries. Samples from both waves were
drawn using a multi-stage cluster sampling design and data was obtained using
individual and household questionnaires. Methodology of waves 0 and 1 has been
described in detail elsewhere (Kowal et al. 2012; World Health Organization 2005).
In the case of Mexico, the wave 0 sample consisted of 38.746 participants and from
these, 11.009 were 50+; the individual and household response rates were 100 and 96%,
respectively. Mexico’s Wave 1 was collected on 2009/10 and had the lowest response
rates (51 and 59% at the individual and household levels), yielding a final sample of
5.448 people aged 50+ (Kowal et al. 2012; World Health Organization 2005).
For the present study, we built a cohort based on SAGE waves 0 and 1, so that wave 0
would be the baseline and wave 1, the follow-up. We analyzed data from all individuals
who: 1) were 53 years old in wave 0, thus they would be 60 years old (older adults) in wave
1; 2) didn’t have depression at baseline (diagnostic history or a depressive episode 12 months
before the wave 0 interview); and 3) were re-contacted in wave 1. These criteria yielded a
sample of 1.248 adults, of whom 820 had complete data in all considered variables.

Measures

Depression

In order to exclude depressed people from the baseline, depression was also ascertained
in wave 0. It was evaluated by means of a self-reported history of depression medical
diagnostic and of the presence of a depressive disorder in the last 12 months according
to the diagnostic criteria for research of the Classification of Mental and Behavioral
Disorders from the International Statistical Classification of Diseases-10th revision
(ICD-10) (World Health Organization 1992). This last criteria have been used previ-
ously to determine whether a person has a depressive episode or subclinical depressive
symptoms (Ayuso-Mateos et al. 2010). According to this order, a person was said to
have depression in wave 0 if he/she had either one of the two conditions mentioned
above: a depression diagnosis given by a physician at some point in life or a depressive
disorder (depressive episode or subclinical depressive symptoms) in the previous
12 months according to the ICD-10 criteria. Individuals classified as having depression
in wave 0 (the baseline) were excluded from this study in order to guarantee the
assembled cohort would start from a group of people without the event under study,
so that a maximum approach to the causality criteria could be reached and the majority
of depression cases from wave 1 would be incident.
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

With regard to the incidence of depression in wave 1, it was assessed through self-
report of a new medical diagnostic of depression and by using an algorithm that is
based on the World Mental Health Survey version of the Composite International
Diagnostic Interview (WHO –WMH CIDI), that has been previously used
(Arokiasamy et al. 2015). This algorithm is based on questions from the SAGE
questionnaire that ascertain depressive symptoms in the 12 months previous to the
interview and it consists of the construction of two sets: set A, which encompasses
questions about the core symptoms of depression; and set B, which considers items
related to other depressive symptoms. A person is said to have a possible major
depressive episode in the past 12 months if scores 2 or more in set A and 4 or more
in set B. To sum up, a participant is classified as having incident depression in wave 1 if
reports a new medical diagnostic of depression or if meets the diagnostic thresholds of
the described algorithm.

Retirement

To assess the principal exposition in wave 0, two questions were used: the first one
asking about the current job; if the respondent said he/she was not working for pay, a
second question about the main reason for it was asked. Based on these, three categories
were created: 1) workers: included people who responded being working at the time the
interview was done; 2) retired people: referred to people that reported being retired as the
main reason for not being working at the moment; and 3) people who can’t retire during
the study period. This last category consisted of homemakers, adults not working due to
disability or illness and individuals who don’t have the need to work, can’t find a job or
study. Moreover, individuals were also included in the third category of exposure if, in
wave 1, responded that had never worked in their life. This wave 1 response was taken
into account to assess the baseline exposition because it made reference to having ever
worked in the lifetime, so a person who responded negatively to this item could not
count as having the possibility to retire as he/she never even worked.

Covariates

Health Related Variables Multimorbidity was assessed based on the self-report of the
medical diagnosis of a series of chronic conditions listed in the individual questionnaire
(arthritis, angina, asthma, schizophrenia or psychosis and diabetes). A person
was classified as having multimorbidity if reported having two or more of those
conditions, according to the World Health Organization (WHO) definition
(Fernández-Niño and Bustos-Vázquez 2016). Similarly, the evaluation of func-
tional limitations was done by means of the Health State Descriptions module
of the individual questionnaire, which is based on the International Classifica-
tion of Functioning, Disability and Health (ICF). This section contains ques-
tions regarding the degree of difficulty in the previous 30 days for performing a
series of activities from the mobility, self-care, pain and discomfort, cognition,
interpersonal activities, vision, sleep and energy, and affect domains (World
Health Organization 2011). An adult was said to have a functional limitation if
he/she reported to have a severe or extreme difficulty to do any of the activities
from the listed domains.
 L. J. Bonilla-Tinoco et al.

Socioeconomic and Demographic Variables Socioeconomic status was measured as the

relative wealth of the household level in wave 0. It was estimated from 15 items
ascertaining the household ownership of goods (car, T.V., washing machine, bicycle,
refrigerator, DVD player, etc.). Each of those questions was coded as 0 if there was
none of these goods in the household and as 1 if there was any, in order to carry out a
tetrachoric matrix. Then, a factor analysis was performed and the first factor was
retained and used to predict a continuous wealth index; the retained factor explained
22% of the variance of the items. Finally, the predicted continuous variable was divided
into quintiles, where the first quintile was the poorest and the fifth, the wealthiest.
Other covariates included in the analyses were sex; age in years, grouped in
53–59, 60–69, 70–79 and 80+ years; marital status, defined as having a
permanent partner (married or cohabiting) or not (widowed, divorced, single
and separated); educational level, categorized in no schooling, complete ele-
mentary education, complete high school and complete college studies; health insurance
tenure and area of residence (rural or urban). All covariates were assessed in wave 0 and
were selected for the analysis given their confounding potential according to the
literature review. Figure 1 shows the Directed Acyclic Graph (DAG) constructed from it.

Statistical Analysis

Firstly, an exploratory analysis was conducted in which the principal exposition and all
the covariates were ascertained in wave 0 and depression cases, in wave 1; additionally,

Fig. 1 Directed Acyclic Graph (DAG) of the association between retirement and depression in Mexican older
adults. The green and blue nodes with symbols in the inside represent the principal exposure and the outcome,
respectively. White nodes indicate adjusted confounders and blue nodes depict mediation variables, which are
part of the causal pathways (green arrows) between retirement and depression. Finally, the green node of “role”
is the mediator by which sex has a causal effect on retirement; and the grey node represents a collider. Black
arrows show that no backdoor path is opened and that not selection bias is present due to adjusting for a collider
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

descriptive statistics of all variables were obtained: central tendency and dispersion
measures for quantitative variables, and proportions and CI 95% for categorical variables.
For the bivariate analysis, crude risk ratios (RR) were estimated and Fisher’s exact test
was used to evaluate the association between each categorical predictor and the incidence
of depression; this test was chosen given that there was a scarce sample in some cases.
Secondly, before performing the multivariable analysis, a sensitivity analysis was
conducted to verify the presence of significant differences between follow-up losses and
participants. Given that that retirement, age, sex, educational level, health insurance,
area of residence, income quintile and functional limitations were significantly different
between the two groups, propensity score was obtained in order to adjust for the
probability of being a follow-up loss, albeit it generated highly collinear models when
included along with the other covariates. Due to this situation, the elected solution was to
adjust the significantly different covariates in the multiple regression models.
Third, log-binomial regression was performed in the multivariable analysis, which
allowed the estimation of adjusted RR. A first model for the incidence of depression in
wave 1 was constructed using retirement in wave 0 as the main predictor and adjusting
for all the previously mentioned covariates. Finally, interactions terms were constructed
between the main exposure (retirement) and marital status, income quintiles, health
insurance tenure and multimorbidity to explore a potential effect modification.
Lastly, all analyses were stratified by sex due to the expected differential effect, and
every assumption of regression was verified in all models (including multicollinearity),
as well as the goodness of fit. All estimations were adjusted by sampling design and
considered statistically significant at a p value <0.05; however, an alpha of 0.20 was
chosen as the significance level for the interaction terms. Analyses were performed
using Stata 12 (Stata Corporation, College Station, TX, USA).

Results

Exploratory Analysis

Assembling the cohort using waves 0 and 1 from SAGE-Mexico and applying the
inclusion and exclusion criteria yielded a sample of 1.248 older adults, although only
820 participants (65.71%) had complete data in all considered variables. It is worth
highlighting that, in wave 0, 354 individuals were excluded for having depression and
from these, 53 only had a self-reported depression, 242 only met the ICD-10 criteria
and 59 had both a self-reported diagnosis of depression and met the ICD-10 criteria.
Figure 2 depicts the conformation of the study sample. With regard to the baseline
characteristics of this analytical sample, it was found that 60.61% were women;
14.63% (CI 95% 12.37–17.23) reported to be retired. In addition, the median age
was 63 years (IQR: 58–70); 62.32% of older adults had a permanent partner; 25.24 and
55.61% had no formal schooling and elementary studies, respectively; 57.20% of
people had health insurance; and 78.29% lived in an urban area. Regarding the health
status, 4.02% had multimorbidity (CI 95% 2.87–5.61) and 38.05% (CI 95% 34.78–
41.43) of older adults reported having functional limitations in at least one of the
evaluated activities. Table 1 shows sociodemographic and health characteristics in the
total sample and by sex. For the whole sample, the 8-year depression incidence was
 L. J. Bonilla-Tinoco et al.

Wave 0 Wave 1 Follow-up

29.448 excluded for being 7.005 did not had follow-up 428 had incomplete data in
<53 years in Wave 1 considered variables
n= 38.746 individuals
Wave 0 (Baseline)

n= 9.298 n= 8.607 n= 1.602 n= 1.248 n= 820

Analytic
sample

691 excluded for incomplete 354 had depression in Wave

data 0 (the baseline)

Depression according to:

Self-report of medical diagnosis

(only): 53
ICD-10 criteria (only): 242
Both self-report and ICD-10
criteria: 59

Fig. 2 Flow chart of the cohort conformation. Central boxes show the yielded sample after applying the
inclusion and exclusion criteria in every step. Depression criteria according to which depressed people in wave
0 were excluded are also specified

12.20% (CI 95% 10.12%–14.62%). With respect to the bivariate analysis, only sex was
associated with depression incidence among older adults (p < 0.001) and when running
the sexstratified bivariate analysis, crude RR’s of retirement showed a tendency to
increase the risk of depression compared to working, but they were not significant
neither in men, nor in women (Table 2).

Association between Retirement and Incident Depression

In the multivariable analysis (Table 3), incident depression was only significantly
associated with sex (model 1), so that female sex increased the risk of depression
2.12 times compared to men (RR: 2.12; CI 95% 1.25–3.61; p < 0.01). On the other
hand, retirement did not show a significant association with depression incidence in the
sample (RR: 1.47; CI 95% 0.74–2.93; p = 0.27); and this lack of association remained
in the sex stratified models (RR: 1.55; CI 95% 0.57–4.24; p = 0.39 for male older
adults, and RR: 1.40; CI 95% 0.50–3.96; p = 0.52 for female older adults). However,
when including an interaction term between retirement and marital status (model 2), a
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

Table 1 Sociodemographic and health-related characteristics of the Mexican older adults from SAGE Waves
0 and 1, 2002–2010

Baseline variables Total (n = 820) n (%) Men (n = 323) n (%) Women (n = 497) n (%)

Presence of depression a 100 (12.20) 23 (7.12) 77 (15.49)

Retirement
Working 199 (24.27) 147 (45.51) 52 (10.46)
Retired 120 (14.63) 77 (23.84) 43 (8.65)
Can’t retire 501 (61.10) 99 (30.65) 402 (80.89)
Age (years)
53–59 264 (32.20) 98 (30.34) 166 (33.40)
60–69 331 (40.37) 137 (42.41) 194 (39.03)
70–79 190 (23.17) 71 (21.98) 119 (23.94)
80+ 35 (4.27) 17 (5.26) 18 (3.62)
Permanent partner 511 (62.32) 265 (82.04) 246 (49.50)
Educational level
No formal schooling 207 (25.24) 67 (20.74) 140 (28.17)
Elementary 456 (55.61) 190 (58.82) 266 (53.52)
Secondary 111 (13.54) 44 (13.62) 67 (13.48)
College 46 (5.61) 22 (6.81) 24 (4.83)
Has health insurance 469 (57.20) 187 (57.89) 282 (56.74)
Urban area 642 (78.29) 254 (78.64) 388 (78.07)
Income quintile
1 119 (14.51) 35 (10.84) 84 (16.90)
2 137 (16.71) 56 (17.34) 81 (16.30)
3 162 (19.76) 65 (20.12) 97 (19.52)
4 251 (30.61) 102 (31.58) 149 (29.98)
5 151 (18.41) 65 (20.12) 86 (17.30)
Multimorbidity 33 (4.02) 8 (2.48) 25 (5.03)
Functional limitations 312 (38.05) 105 (32.51) 207 (41.65)

Results are presented by columns

a This is the only variable measured in wave 1 (incident cases)

significant effect on the risk of depression was found, so that retirement increased the risk
of depression 4.52 times compared to working among those who did not have a
permanent partner (CI 95% 1.30–15.76; p = 0.02). Additionally, the point estimate of
the risk of depression among retired older adults with permanent partner suggested a
protective behavior of retirement, although it was not significant (RR: 0.591; CI 95%
0.20–1.74; p = 0.34). When running the sex-stratified models with the described interac-
tion term, the retirement-depression association remained statistically and marginally
significant in men and women without permanent partner, respectively (RR: 21.21; CI
95% 2.57–175.37; p < 0.01 for men and RR: 3.67; CI 95% 0.78–17.24; p = 0.10 for
1
This estimation can be obtained from multiplying the RR of depression in the retired without permanent
partner by the RR of the interaction term “Retired-With permanent partner” shown in model 2 (Table 3). The
described RR’s of depression in the retired group from the model with interaction terms are equivalent to make
a stratification by marital status of model 1.
 L. J. Bonilla-Tinoco et al.

Table 2 Bivariate association between incidence of depression and sociodemographic and health-related
characteristics of Mexican older adults from SAGE Waves 0 and 1 (2002–2010), according to sex

8-year probability of depression according to baseline characteristics

Baseline variables Women (n = 77) Men (n = 23)

na (%) p cRRb (CI 95%) na (%) p cRRb (CI 95%)

Retirement
Working 6 (11.54) 0.73 Ref. 11 (7.48) 0.25 Ref.
Retired 7 (16.28) 1.41 (0.51–3.88) 8 (10.39) 1.38 (0.58–3.31)
Can’t retire 64 (15.92) 1.38 (0.63–3.03) 4 (4.04) 0.54 (0.18–1.65)
Age (years)
53–59 26 (15.66) 0.23 Ref. 7 (7.14) 0.85 Ref.
60–69 36 (18.56) 1.18 (0.75–1.88) 10 (7.30) 1.02 (0.40–2.59)
70–79 12 (10.08) 0.64 (0.34–1.22) 6 (8.45) 1.18 (0.42–3.37)
80+ 3 (16.67) 1.06 (0.36–3.17) 0 (0.00) –
Marital status (permanent partner)
No 38 (15.14) 0.90 Ref. 6 (10.34) 0.27 Ref.
Yes 39 (15.85) 1.05 (0.69–1.58) 17 (6.42) 0.62 (0.26–1.50)
Educational level
No formal schooling 11 (7.86) 0.01 Ref. 7 (10.45) 0.53 Ref.
Elementary 49 (18.42) 2.34 (1.26–4.36) 11 (5.79) 0.55 (0.22–1.37)
Secondary 11 (16.42) 2.09 (0.95–4.57) 3 (6.82) 0.65 (0.18–1.37)
College 6 (25.00) 3.18 (1.30–7.79) 2 (9.09) 0.87 (0.19–3.88)
Has health insurance
No 33 (15.35) 0.99 Ref. 14 (10.29) 0.08 Ref.
Yes 44 (15.60) 1.02 (0.67–1.54) 9 (4.81) 0.47 (0.21–1.05)
Residence area
Rural 19 (17.43) 0.55 Ref. 4 (5.80) 0.80 Ref.
Urban 58 (14.95) 0.88 (0.53–1.38) 19 (7.48) 1.29 (0.45–3.67)
Income quintile
1 13 (15.48) 0.05 Ref. 4 (11.43) 0.43 Ref.
2 8 (9.88) 0.64 (0.28–1.46) 4 (7.14) 0.63 (0.17–2.34)
3 16 (16.49) 1.07 (0.54–2.08) 7 (10.77) 0.94 (0.30–2.99)
4 18 (12.08) 0.78 (0.40–1.51) 5 (4.90) 0.43 (0.12–1.51)
5 22 (25.58) 1.65 (0.89–3.06) 3 (4.62) 0.40 (0.10–1.70)
Multimorbidity
No 72 (15.25) 0.57 Ref. 21 (6.67) 0.10 Ref.
Yes 5 (20.00) 1.31 (0.58–2.95) 2 (25.00) 3.75 (1.05–13.34)
Functional limitations
No 47 (16.21) 0.62 Ref. 9 (4.13) <0.01 Ref.
Yes 30 (14.49) 0.89 (0.59–1.36) 14 (14.33) 3.23 (1.44–7.22)

a Results are presented by rows

b Crude estimates obtained with log-binomial regression without adjusting for any covariate
p-values estimated with Fisher’s exact test
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

Table 3 Log-binomial regression for incident depression in Mexican older adults from SAGE Waves 0 and 1
(2002–2010)

Variablesa Model 1 Model 2

RR CI 95% p RR CI 95% p

Retirement
Working Reference Reference
Retired 1.47 0.74 2.93 0.27 4.52 1.30 15.76 0.02
Can’t retire 1.13 0.64 1.99 0.68 2.69 0.84 8.67 0.10
Female sex 2.12 1.25 3.61 <0.01 0.44 0.25 0.78 <0.01
Age
53–59 Reference Reference
60–69 1.24 0.81 1.89 0.33 1.24 0.81 1.90 0.32
70–79 0.78 0.45 1.38 0.40 0.76 0.43 1.33 0.34
80+ 0.80 0.25 2.54 0.71 0.75 0.24 2.39 0.63
Permanent partner 0.91 0.61 1.37 0.65 3.16 0.89 11.22 0.08
Educational level
No formal schooling Reference Reference
Elementary 1.76 1.02 3.03 0.04 1.76 1.02 3.02 0.04
Secondary 1.61 0.78 3.31 0.20 1.71 0.84 3.50 0.14
College 2.03 0.86 4.81 0.11 2.27 0.97 5.28 0.06
Health insurance 0.77 0.51 1.17 0.22 0.76 0.50 1.14 0.19
Urban area 0.90 0.56 1.45 0.68 0.97 0.60 1.55 0.90
Income quintile
1 Reference Reference
2 0.66 0.33 1.32 0.24 0.67 0.33 1.34 0.26
3 0.95 0.51 1.78 0.87 0.91 0.49 1.71 0.78
4 0.63 0.33 1.20 0.16 0.61 0.32 1.15 0.13
5 1.20 0.61 2.38 0.59 1.14 0.58 2.24 0.70
Multimorbidity 1.58 0.78 3.20 0.20 1.55 0.77 3.12 0.22
Functional limitations 1.23 0.84 1.81 0.28 1.26 0.86 1.85 0.24
Interaction terms
Retired-Permanent partner – – – 0.13 0.03 0.66 0.01
Retired-Has health insurance – – – 0.46 0.12 1.75 0.26
Retired-Has multimorbidity – – – 1.08 0.11 10.34 0.95
Retired- Income quintile 2 – – – 0.27 0.01 6.25 0.42
Retired- Income quintile 3 – – – 0.33 0.02 4.82 0.42
Retired- Income quintile 4 – – – 0.48 0.03 6.97 0.59
Retired- Income quintile 5 – – – 0.22 0.01 3.55 0.29
Bayesian Information Criteria (BIC) −4801.38 −4795.66
Goodness of fit (p-value)b 0.98 0.95

p values obtained with the Pearson Chi-squared test. Bold p values indicate a statistically significant estimation
at an alpha of 0.05
a Reference categories for dichotomic predictors are: male sex, not having a permanent partner, not having

health insurance, rural area, not having multimorbidity and not having functional limitations
bp values obtained with a generalized Hosmer Lemeshow test
 L. J. Bonilla-Tinoco et al.

women). Regarding the influence of retirement in the depression risk in men and women
with permanent partner, there was no significant effect, although point estimates also
suggested a protective association (RR: 0.74; CI 95% 0.21–2.54; p = 0.63 for men and
RR: 0.30; CI 95% 0.04–2.38; p = 0.10 for women). However, the estimations were very
imprecise due to the substantial reduction of the sample size in each model.
Finally, there was no evidence to support an effect modification given by income
quintile, health insurance tenure and multimorbidity (interaction terms not significant).
All the adjusted models used for the analyses met the regression assumptions, per-
formed well in the goodness-of-fit verification and did not have specification errors.

Discussion

The present study had two major findings: firstly, the initial lack of association between
retirement and depression in Mexican older adults when adjusting for sociodemographic
and health related covariates and when performing the stratified analysis by sex.
Secondly, the modifier effect of marital status on the retirement-depression association,
so that a substantial increase (slightly over four-fold) in the depression risk can be seen
in those who retired and did not have a permanent partner. Moreover, this effect
modification remained evident and significant in men, but not in women.
Regarding the first described finding of the present study, the lack of association
(either positive or negative) between retirement and incidence of depression contrasts
with former researches that found a significant association between retirement and
depression, that was either protective (Mojon-Azzi et al. 2007; Westerlund et al. 2010)
or harmful (Mosca and Barrett 2016). In the case of a protective association, a French
cohort, in which the participant’s depression score during retirement was compared
with their score at the time they were working, reported that individuals were 40% less
likely to have depressive symptoms during retirement (Westerlund et al. 2010). Another
case of a positive effect of retirement is a Swiss research that also compared pre and
prost-retirement depressive symptoms of participants, and described an improvement in
mental health given by a major likelihood of beneficial changes such as fewer
depressive and anxious symptoms (Mojon-Azzi et al. 2007). In the case of a harmful
association between retirement and depression, a research found that fully retirement
significantly increased the depression score of participants compared to being contin-
uously working (Mosca and Barrett 2016).
In addition, the initial absence of association in both men and women found in the
present study is not consistent with former studies that have described a gender-based
differential association between retirement and depression in older adults (Buxton et al.
2005; Dave et al. 2008; Kim and Moen 2002). For example, a previous investigation
found that not only retirement worsen mental health in about 11–14.5%, but also that
the mental impairment was more pronounced in women, whereas men had a higher
negative impact in physical health (Dave et al. 2008). However, the cited research
classified retirement as complete or partial, and did not include homemakers and
disabled people in the analysis, as opposed to the present study. In other study about
early retirees (defined as economically inactive people who were not working for
diverse reasons apart from retirement), it was found that early retired men were
significantly more likely to have a depressive disorder compared to working men,
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

although the same association was not found in women (Buxton et al. 2005). Finally,
other investigation found that continuously retired men significantly reported more
depressive symptoms than recently retired men and working men; whereas in women
no effect was observed (Kim and Moen 2002).
A possible explanation for the lack of a differential association by gender in this
study might come from Mexico’s pension context. It should be noted that Mexico had a
pension reform in 1997, but people who were already working by that time (“the
transition generation”) were given the option to choose how they wanted to retire:
either with the law of 1973 or with the reform of 1997. A vast majority of people retired
through the first law, since it was better for them in terms of financial benefits (the
received pension was considerably higher) compared with the new reform conditions
(OCDE 2016). Taken this into account, it could be considered that there was no
association between retirement and incidence of depression in male older adults
because in spite of being retired, they would still have a source of income that
prevented them from experiencing financial distress and allowed them to keep fulfilling
their “home provider role” (Instituto Nacional de las Mujeres 2007; Kim and Moen
2001a, 2001b). Additionally, more than half of men from this study had a permanent
partner, which could also help them adapt more easily to their new retiree role since
social resources are very important for an adequate adjustment to retirement (Kim and
Moen 2001b), as will be discussed later in this section.
In the case of women, not finding an association between retirement and incidence of
depression at the beginning was probably because their participation in the workforce
was not as marked as men’s: in this study, they mostly belonged to the group of people
who could not retire, accounting for 80.24% of this category, of whom almost 92% were
homemakers. This contrasts with men, who were mainly working or retired and only this
two categories accounted for 70% of the male sample, as shown in Table 1. Given this
situation, it can be inferred that female older adults experience the retirement transition
in a much smaller magnitude and are not as exposed to the changes that come with it as
male older adults, so that retirement might not have such a major meaning to them,
similarly to the less central role of work in their lives (Kim and Moen 2001b). This
would be in accordance with previous texts indicating a more disrupted work-history of
women, compared to men, and that retirement is a “qualitatively different experience for
men and women” (Asenova 2014; Kim and Moen 2001b). However, it should be noted
that this might not be the case for today’s women and future female older adults, since
participation of women in the workforce has been steadily increasing during the past
decades (Lazarevich and Mora-carrasco 2008) and the way they are going to experience
retirement might be different from the cohort analyzed here.
As for the second described finding, it was also found an effect modification of the
retirement-incidence of depression association given by marital status, so that retire-
ment increased the risk of depression in people who did not have a permanent partner.
This result is consistent with that of a research using data from the Health and
Retirement Study, which showed that complete retirement was associated with a major
increase in the depression score among single participants compared to married ones
(Dave et al. 2008). Similarly, other study found that individuals who were less satisfied
with retirement were generally unmarried compared to those who experienced a greater
life-satisfaction during the retirement transition; these latter were married in a higher
proportion and thus, had more resources to help them adjust more easily to this life-
 L. J. Bonilla-Tinoco et al.

transition (Pinquart and Schindler 2007). On the contrary, the results of the present
study are not consistent with a Japanese investigation that also explored the potential
modifier-effect of the change in marital status on the association between transition to
retirement (recently retired and continuously retired older adults) and incidence of
depression; however, the tested interaction term was not significant (Shiba et al. 2017).
The described effect modification can be explained from the life-course, ecological
model perspective, which posits that social/relationship resources are one of the main
factors that influence the retirement adjustment, along with economic/financial and
personal resources (Kim and Moen 2001a, 2001b, 2002). Within those social resources,
marital status plays a very important role, since the spouses/partners can provide the
retirees the necessary support to help them adjust to their new retiree role and to
successfully deal with the stressful events that arise with retirement transition (Kim and
Moen 2001b, 2002). More specifically, it has been described that retirees might feel
depressed, empty or lonely in the initial period of the retirement adjustment, which
makes them need support from their spouse/partner or family in that critical moment
(Osborne 2012). Additionally, it has to be considered that retirement comes with a
decrease in social contacts, especially in those formed at the workplace (Asenova 2014;
Dave et al. 2008), so if in addition to that, the retiree does not count with the social
resource of a permanent partner, the weakened social interaction deepens and, there-
fore, they become more vulnerable to a diminished psychological well-being. In
summary, the marital status influences the retirement and depression association
because it is part of an individual’s social resources and these affect the whole
retirement process through the supply of material and immaterial support, and of an
adequate social context that can replace the social network of the workplace (Kim and
Moen 2001b; Wang and Shi 2014).
Furthermore, the described effect modification remained evident, though not precise,
in men, but was not as clear in women (the imprecision of the estimates was due to the
scarce sample in the categories under study, which results in a power problem that
hinders the evaluation of double stratifications). This finding reflects a particular
situation of men’s retirement transition: a major part of men’s identities is based on
their jobs (work has a central role in men’s lives), so when they retire, they experience
the loss of the important structure given by work, which might cause them more
difficulty in adjusting to retirement (Kim and Moen 2001b; Osborne 2012). This
particularity along with the above-mentioned initial loneliness of the retirement process
might partly explain the vulnerability of retired men with no permanent partner. Not
only they experience the loss of a role that has been dominant in their adult years, but
also they lack an important social resource (a spouse/partner) that can provide them the
necessary support to successfully adjust to retirement. Another possible explanation for
the effect modification to remain significant in men could be proposed from the role
theory perspective (George 1993; Wang and Shi 2014). Men who retire and do not have
a permanent partner might experience psychological distress and maladjustment to
retirement from having to start a new role related to the housework, which in Mexico
has been culturally and historically assigned to women (Instituto Nacional de las
Mujeres 2007). This “domestic” role could cause role strain and decreased psycholog-
ical well-being because it does not fit the expected values of Mexican society of what a
man should do or aspire to, since men hold a “provider role” and do not usually
participate in the home-duties.
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

Regarding the other explored interaction terms, the analysis did not provide enough
evidence to support an effect modification given by income quintile, health insurance
tenure and the presence of multimorbidity. The former contrasts with a meta-analysis
that found occupational status (a proxy of socioeconomic status) to be a moderator
variable of the association between unemployment and mental health (Paul and Moser
2009). The results found in the present study could be explained by thinking again of
Mexico’s pension context. It was mentioned previously that most people from the
transition generation (to which the sample belongs) chose to retire through the 1973
pension law because it had more flexible requisites to access benefits2 and the pensions
they received were significantly higher, but additionally, they also remained covered by
health insurance (OCDE 2016). Considering this, it could be hypothesized that the
association between retirement and incidence of depression is not different across
income quintiles and the health insurance tenure levels (yes or no) because retired
people from this cohort are able to maintain benefits similar to those of working people,
which prevent them of experimenting financial strains and health-care difficulties.
In resume, the principal results of our research suggest the relation between retirement
and depression is more complex than just an absolute positive or negative association, but
rather, it depends on the context surrounding the retirement transition. However, it should
be noted that the referred context does not only refer to the household environment of the
retiree, but also to the societal environment in which retirement takes place. To have an
integral view of the whole context, researches can appeal to the Multilevel Model of
Retirement, which specifies three levels to understand the surroundings of the retirement
transition (Wang and Shi 2014). The first level is the macrolevel, which comprises the
cultural values and social norms of how people see retirement and what it means to be
retired; and to the economic contexts. The second level is the mesolevel; it encompasses
the work context (job’s characteristics and organization) and the social/family networks
(social support from family and friends, marital conditions). The third level is the
microlevel, which refers to individual features such as demographic and economic
attributes, knowledge and attitudes towards retirement. All of these can influence the
retirement’s decisions, planning, timing and activities in the post-retirement period (Wang
and Shi 2014). In the case of the sample used in the present study, it has to be considered
that they lived a large part of their economically active life in a period when Mexico
experienced a high development in its economy, so rates of informal and formal employ-
ment were low (8.4% in 1980–85 vs. 58% in 2014) and high, respectively (Aguilar García
2002; OCDE 2016). Besides that, the pension laws were more flexible, so the conditions
to access a pension were easier than the actual ones. These situations suggests that the
results presented here might not be the same for future cohorts of retirees, since the
context they are living is substantially different.
Moreover, our findings are consistent with other studies that evidence that retire-
ment’s effect on older adult’s mental health depends on the context where it takes place.
For example, it has been reported that voluntary retirement improves mental health,
whereas involuntary job loss and involuntary retirement worsens it (Mandal and Roe

2
The requirements to access a pension were contributing to the pension system for at least 500 weeks and
having 65 years. However, there was the possibility to retire early starting from the age of 60 years, although
there was a penalty of five percentual points for each year of anticipated retirement. The full retirement pension
could be obtained at 65 years.
 L. J. Bonilla-Tinoco et al.

2008; Rhee et al. 2016); and that voluntary and mandatory retirement due to old age do
not significantly increase the likelihood of depression in the post-retirement period,
compared to working (J. Lee and Smith 2009). All things being considered, the results
drawn from our study suggest the relation between retirement and depression is more
complex than just an absolute positive or negative association, but rather, it depends on
the context surrounding the retirement transition. Even more, the findings from this
study point towards the application of a model that considers not only the individual
factors, but also the social and economic context of the retiring individual. Some
alternatives could be the previously described multilevel model of retirement or the
life-course, ecological model, which indicates that retirement’s effect should be ana-
lyzed considering its social and situational contexts, since it is a transition where roles,
relationships and routines suffer several changes (Kim and Moen 2001a, 2001b).

Limitations and Strengths

Regarding the limitations of the present study, differential losses in the follow-up were
found, so there is the possibility of a potential selection bias. However, the impact they
could have had on the findings was controlled by adjusting the significantly different
variables in the multiple regression models, which yielded very similar results to those
obtained with propensity score. Besides, it is also worth noting that the majority of
follow-up losses between wave 0 and 1 were due to not being able to locate the selected
participants in their homes, not because they refused to participate, so it is reasonable to
think that the initial losses were random and not differential (Kowal et al. 2012). As to a
possible information bias, it could arise from the fact that depression in wave 0 was not
measured with the same instrument used in wave 1; however, it has been reported an
estimated kappa of 0.73–0.83 (Wittchen 1994), which indicates a high agreement
between the CIDI and ICD-10 criteria, so our results could be considered to not be
affected to a great extent by the use of different instruments. Another source of
information bias could be due to a differential detection of depression between working
and retired people, since the health insurance coverage and access to health care might
be different between them, so workers could be diagnosed in a higher proportion and
the association be underestimated. Nevertheless, as previously mentioned, retired
people also remain covered by health insurance (OCDE 2016), so they might have
the same opportunity as working people to get a medical diagnosis of depression.
Regarding the detection of depressed people in wave 0, it could be considered that
some people who might have experienced a depressive episode more than a year before
the interview and who did not have a medical diagnosis could be erroneously classified
as not having the outcome and, therefore, overestimate the incidence of depression in
wave 1. Nonetheless, this would have happened in a low proportion because a person
who experiments depressive symptoms in their middle-age years has a higher proba-
bility of having major depression instead of subclinical depressive symptoms (like
older adults), so their likelihood of having recurrent episodes and of getting a medical
diagnosis is higher too (American Psychiatric Association 2014; Fiske et al. 2009).
Similarly, incidence of depression in wave 1 could be underestimated because of the
misclassification, as healthy individuals, of people who experienced a depressive
episode more than a year before the interview and did not have a medical diagnosis.
With respect to confounding, the present study could not include in the analysis certain
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

features of retirement (to evaluate its influence and adjust for them), such as timing and
choice, that is, if retirement was early or in time, and if it was voluntary or forced. This
aspects are relevant because it has been described they might shape the adjustment to
retirement, since they relate to the control a person may have over this midlife
transition: if retirement is early or forced, it is more likely to have deleterious effects
on the individual’s mental health (Moen 1996). Additionally, this study could not
evaluate the association of incidence of depression with other variables like ethnicity,
social networks (aside from the marital status), having a retirement pension and the job
conditions before retirement because that specific information was not available in
wave 0 or was only available for workers. Finally, it should be noted that the results
obtained here might be relevant for Mexican older adults from the “transition genera-
tion”, but not for the following retiree cohort, since the socioeconomic, pension and
work conditions have changed significantly in the past decades.
On the other hand, the strengths of this research relate to the longitudinal
design based on the first two waves from SAGE and to the exclusion of people
who were depressed in wave 0 (the baseline). These two conditions allowed a
maximum approach to the temporality criteria, which not only guarantees that
depressed older adults in wave 1 are incident cases, but also avoids the reverse
causality limitation and enables the estimation of true risk measures in the
analysis (relative risks). Finally, the present study used a nationally representa-
tive sample of Mexican older adults, which also contributes to fill the void of
this kind of research in low and middle-income countries.

Conclusion

The results obtained in the present study indicate that the association between retire-
ment and incidence of depression in Mexican older adults is dependent on the
characteristics of the context surrounding it. Thereby, the risk of depression increases
in retired older adults without a permanent partner. This is an important finding because
it might help guiding the health-policies, regarding the mental health-care of older
adults, towards the improvement of loneliness and the supply of social support during
the transition and adjustment to retirement. Furthermore, our results can be considered
for the decision-making on work-policies too, since they show the influence of
retirement on depression risk under some specific conditions that should be kept in
mind when making a restructuring of the pension system. However, the study of the
association between retirement and depression in older adults (or other mental health
disorders) must continue as the political and socioeconomic contexts are constantly
changing, and the results obtained in our research might not be applicable to the next
retiree cohort. Additionally, future research should attempt to approach retirement from
the multiple ways it can be characterized: by its timing (early or in time), by its quality
(partial or full), by its planning (voluntary/mandatory or involuntary/forced) and by its
duration (continuously or newly retired); in summary, to have an integral view of this
important life-transition.

Acknowledgements This paper uses data from the WHO World Health Surveys / Multi-Country Survey
Study (as appropriate) and from WHO’s Study on Global Ageing and Adult Health (SAGE). SAGE is
 L. J. Bonilla-Tinoco et al.

supported by the US National Institute on Aging through Interagency Agreements OGHA 04034785;
YA1323-08-CN-0020; Y1-AG-1005-0) and through research grants R01-AG034479 and R21-AG034263.

Compliance with Ethical Standards

Conflict of Interest The authors declare that they have no conflict of interest.

Research Involving Human Participants and/or Animals Formal consent is not required, since this is a
retrospective research. However, it is important to note that the present investigation was approved by the
ethical committee of the Universidad Industrial de Santander and obtained the permission of the World Health
Organization Multi-Country Studies Data Archive to use waves 0 and 1 databases. This data are public and
can be used previous access request, although it does not have any information that allows individual
identification of participants.

Informed Consent All individuals included in this study gave their informed consent to participate in
SAGE waves.

References

Aguilar García, J. (2002). Las políticas de empleo y la población informal en México durante la
modernización económica.
American Psychiatric Association. (2014). Trastornos depresivos. In Manual Diagnóstico y Estadístico de los
Trastornos Mentales (DSM-5) (Editorial., pp. 155–188).
Arokiasamy, P., Uttamacharya, U., Jain, K., Biritwum, R. B., Yawson, A. E., Wu, F., et al. (2015). The impact
of multimorbidity on adult physical and mental health in low- and middle-income countries: What does
the study on global ageing and adult health (SAGE) reveal? BMC Medicine, 13(1), 178. https://doi.
org/10.1186/s12916-015-0402-8.
Asenova, A. (2014). The effect of retirement on mental health and social inclusion of the elderly. http://ovidsp.
ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=70915453.
Ayuso-Mateos, J. L., Nuevo, R., Verdes, E., Naidoo, N., & Chatterji, S. (2010). From depressive symptoms to
depressive disorders: The relevance of thresholds. The British Journal of Psychiatry, 196(5), 365–371.
https://doi.org/10.1192/bjp.bp.109.071191.
Bloom, D. E., Canning, D., & Fink, G. (2010). Implications of population ageing for economic growth.
Oxford Review of Economic Policy, 26(4), 583–612. https://doi.org/10.1093/oxrep/grq038.
Bowlby, G. (2007). Defining retirement. Perspectives on Labour and Income, 8(2), 15–19 http://goo.gl/SxJ1tB.
Butterworth, P., Gill, S. C., Rodgers, B., Anstey, K. J., Villamil, E., & Melzer, D. (2006). Retirement and
mental health: Analysis of the Australian national survey of mental health and well-being. Social Science
& Medicine, 62(5), 1179–1191. https://doi.org/10.1016/j.socscimed.2005.07.013.
Buxton, J. W., Singleton, N., & Melzer, D. (2005). The mental health of early retirees. National interview
survey in Britain. Social Psychiatry and Psychiatric Epidemiology, 40(2), 99–105. https://doi.org/10.1007
/s00127-005-0866-5.
Dave, D., Rashad, I., & Spasojevic, J. (2008). The effects of retirement on physical and mental health
outcomes. Southern Economic Journal, 75(2), 497–523.
Denton, F. T., & Spencer, B. G. (2009). What is retirement? A review and assessment of alternative concepts
and measures. Canadian Journal on Aging, 28(1), 63–76.
Fernández-Niño, J. A., & Bustos-Vázquez, E. (2016). Multimorbilidad: bases conceptuales, modelos
epidemiológicos y retos de su medición. Biomédica, 36(2), 188–203. https://doi.org/10.7705/biomedica.
v36i2.2710.
Fiske, A., Wetherell, J., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology,
5, 363–389. https://doi.org/10.1146/annurev.clinpsy.032408.153621.Depression.
Garay, S., Redondo, N., & Montes de Oca, V. (2012). Cambios en los hogares con población envejecida en Argentina
y México: algunas aproximaciones a las transformaciones familiares derivadas de la transición demográfica. In
Retirement and Depression in Mexican Older Adults: Effect Modifiers...

Asociación Latinoamericana de Población (Ed.), El envejecimiento en América Latina: evidencia empírica y

cuestiones metodológicas (1a., pp. 21–42). Río de Janeiro: Fondo de Población de las Naciones Unidas.
George, L. K. (1993). Sociological perspectives on life transitions. Annu. Rev. Social, 19, 353–373. https://doi.
org/10.1146/annurev.so.19.080193.002033.
Instituto Nacional de las Mujeres. (2007). El impacto de los estereotipos y los roles de género en México.
http://cedoc.inmujeres.gob.mx/documentos_download/100893.pdf.
Kim, J. E., & Moen, P. (2001a). Is retirement good or bad for subjective well-being? Current Directions in
Psychological Science, 10(3), 83–86. https://doi.org/10.1111/1467-8721.00121.
Kim, J. E., & Moen, P. (2001b). Moving into retirement: Preparation and transitions in late midlife. In
Handbook of midlife development (pp. 487–527). New York: Jon Wiley & Sons, Inc..
Kim, J. E., & Moen, P. (2002). Retirement transitions, gender, and psychological well-being: A life-course.
Ecological Modelling, 57(3), 212–222.
Kowal, P., Chatterji, S., Naidoo, N., Biritwum, R., Fan, W., Ridaura, R. L., et al. (2012). Data resource profile:
The World Health Organization study on global AGEing and adult health (SAGE). International Journal
of Epidemiology, 41(6), 1639–1649. https://doi.org/10.1093/ije/dys210.
Lazarevich, I., & Mora-carrasco, F. (2008). Depresión y género : Factores psicosociales de riesgo. Segunda
época, 4, 10–377. https://doi.org/10.1146/annurev-clinpsy-050212-185553.
Lee, J., & Smith, J. P. (2009). Work, retirement, and depression. Journal of Population Ageing, 2(1–2), 57–71.
https://doi.org/10.1007/s12062-010-9018-0.
Lee, R., Mason, A., & Cotlear, D. (2010). Some economic consequences of global aging: A discussion note
f o r t h e Wo r l d B a n k . Wa s h i n g t o n , D C . h t t p : / / s i t e r e s o u r c e s . w o r l d b a n k .
o r g / H E A LT H N U T R I T I O N A N D P O P U L AT I O N / R e s o u r c e s / 2 8 1 6 2 7 - 1 0 9 5 6 9 8 1 4 0 1 6 7
/SomeEconomicConsequencesOfGlobalAging.pdf.
Mandal, B., & Roe, B. (2008). Job loss, retirement and the mental health of older Americans. Journal of
Mental Health Policy and Economics, 11(4), 167–176.
Mein, G., Martikainen, P., Hemingway, H., Stansfeld, S., & Marmot, M. (2003). Is retirement good or bad for
mental and physical health functioning? Whitehall II longitudinal study of civil servants. American
Journal of Public Health, 57, 46–49.
Moen, P. (1996). A life course perspective on retirement, gender, and well-being. Journal of Occupational
Health Psychology, 1(2), 131–144.
Mojon-Azzi, S., Sousa-Poza, A., & Widmer, R. (2007). The effect of retirement on health: A panel analysis
using data from the Swiss household panel. Swiss Medical Weekly, 137, 581–585. https://doi.org/10.2007
/41/smw-11841.
Mosca, I., & Barrett, A. (2016). The impact of voluntary and involuntary retirement on mental health:
Evidence from older Irish adults. The Journal of Mental Health Policy and Economics, 19(1), 33–44.
Naidoo, N. (2011). Mexico - study on global Ageing and adult Health-2009/10, wave 1. MEX-WHO-SAGE-
2011-v01. http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/67. Accessed 9 Jan 2017.
OCDE. (2016). El sistema público de pensiones. In Estudio de la OCDE sobre los sistemas de pensiones:
México (Comisión N., pp. 39–66). OCDE. doi:https://doi.org/10.1787/9789264250017-es.
Olesen, K., Rod, N. H., Madsen, I. E. H., Bonde, J. P., & Rugulies, R. (2015). Does retirement reduce the risk
of mental disorders? A national registry-linkage study of treatment for mental disorders before and after
retirement of 245,082 Danish residents. Occupational and Environmental Medicine, 72, 366–372.
https://doi.org/10.1136/oemed-2014-102228.
Organización Mundial de la Salud (OMS). (2015). La salud en la vejez. In Informe mundial sobre el
envejecimiento y la salud (pp. 45–92). http://apps.who.int/iris/bitstream/10665/186466
/1/9789240694873_spa.pdf.
Osborne, J. W. (2012). Psychological effects of the transition to retirement. Canadian Journal of Counselling
and Psychotherapy, 46(1), 45–58. https://doi.org/10.1080/13642537.2012.734472.
Paul, K. I., & Moser, K. (2009). Unemployment impairs mental health: Meta-analyses. Journal of Vocational
Behavior, 74(3), 264–282. https://doi.org/10.1016/j.jvb.2009.01.001.
Pinquart, M., & Schindler, I. (2007). Changes of life satisfaction in the transition to retirement: A latent-class
approach. Psychology and Aging, 22(3), 442–455. https://doi.org/10.1080/01490400902988275.
Rhee, M.-K., Mor Barak, M. E., & Gallo, W. T. (2016). Mechanisms of the effect of involuntary retirement on
older adults’ self-rated health and mental health. Journal of Gerontological Social Work, 59(1), 35–55.
https://doi.org/10.1080/01634372.2015.1128504.
Scherer, P. (2002). Age of withdrawal from the labour force in OECD countries. OECD Labour Market and
Social Policy Ocassional Papers, 49, 60. https://doi.org/10.1787/327074367476.
 L. J. Bonilla-Tinoco et al.

Shiba, K., Kondo, N., Kondo, K., & Kawachi, I. (2017). Retirement and mental health: Dose social
participation mitigate the association? A fixed-effects longitudinal analysis. BMC Public Health, 17(1),
1–10. https://doi.org/10.1186/s12889-017-4427-0.
United Nations Population Fund. (2012). Setting the scene. In Ageing in the Twenty-First Century: A
Celebration and A Challenge (pp. 19–34). New York. 978-0-89714-981-5.
Vega E, González J, Llibre J O. M. (2009). Trastornos Mentales en los Adultos Mayores. In A.-G. S.
Rodríguez Jorge, Kohn Robert (Ed.), Epidemiología de los trastornos mentales en América Latina y el
Caribe (Organizaci., pp. 243–255).
Wang, M., & Shi, J. (2014). Psychological research on retirement. Annual Review of Psychology, 65(1), 1.1–
1.25. https://doi.org/10.1146/annurev-psych-010213-115131.
Westerlund, H., Vahtera, J., Ferrie, J. E., Singh-Manoux, A., Pentti, J., Melchior, M., et al. (2010). Effect of
retirement on major chronic conditions and fatigue: French GAZEL occupational cohort study. BMJ
(Clinical research ed.), 341, c6149. https://doi.org/10.1136/bmj.c6149.
Wittchen, H.-U. U. (1994). Reliability and validity studies of the WHO–composite international diagnostic
interview (CIDI): A critical review. Journal of Psychiatric Research, 28(1), 57–84. https://doi.
org/10.1016/0022-3956(94)90036-1.
World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders -
Diagnostic Criteria for Research. World Health Organization (Vol. 10). Geneva. doi:https://doi.
org/10.1002/1520-6505(2000)9:5<201::AID-EVAN2>3.3.CO;2-P
World Health Organization. (2003). Mexico - World Health Survey 2003, Wave 0. MEX_2003_WHS_v01_M.
http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/82/related_materials. Accessed 9
January 2017.
World Health Organization. (2005). World Health Survey - Report of Mexico. http://apps.who.
int/healthinfo/systems/surveydata/index.php/catalog/82/related_materials.
World Health Organization. (2011). Technical appendix C. In World Report on Disability (pp. 287–294).

Affiliations

Laura Juliana Bonilla-Tinoco 1 & Julián Alfredo Fernández-Niño 2 & Betty Soledad
Manrique-Espinoza 3 & Martin Romero-Martínez 3 & Ana Luisa Sosa 4

Laura Juliana Bonilla-Tinoco

laurajulianabonilla@gmail.com
Betty Soledad Manrique-Espinoza
bmanrique@insp.mx

Martin Romero-Martínez
martin.romero@insp.mx

Ana Luisa Sosa

drasosa@hotmail.com

1
Public Health Department, Universidad Industrial de Santander, Cra. 32, #29-31 Bucaramanga, Colombia
2
Public Health Department, Universidad del Norte, Km 5, Vía Puerto, Barranquilla, Colombia
3
Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán,
62100 Cuernavaca, Mexico
4
Laboratorio de Demencias, Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez”,
Av. Insurgentes Sur 3877 Del. Tlalpan, Col. La Fama, Ciudad de México, Mexico

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