In a British occupational cohort, statutory retirement and voluntary early retirement were associated with better mental health and physical functioning compared with being in the workforce. Retirement on health grounds was associated with poorer mental health and physical functioning but not with an accelerated decline in health over time. On average, mental health improved after midlife and reached a plateau around the age of 60. Such improvement in mental health after the midlife years has been observed in several previous studies, 25,30
although the explanation for this general pattern remains unknown. The present findings show that people retiring early may enjoy a head start in this post-midlife mental health improvement.
The improved mental health and physical functioning of retirees tended to attenuate over time since retirement, particularly in voluntary early retirement. This may reflect a process in which people adapt to changes in their life circumstances – a process observed in several studies of life events and subjective wellbeing.31
However, it bears emphasis that the level of health in those who took early/statutory retirement did not drop below their pre-retirement health level even in participants who were retired for most of the study period. Despite the possible attenuation of the health benefits, being retired for several years appears to have no adverse impact on health. Participants taking ill-health retirement, in turn, recovered from their initially low physical functioning while their mental health did not change over the time.
The sex- and SES-specific multilevel models suggest that the associations between retirement and health were qualitatively similar across sexes and SES groups, although statutory retirement and voluntary early retirement were slightly more strongly associated with improved health in men than women and in participants with high than low SES (eFigures 1-4 [http://links.lww.com
]). There was one exception to these general patterns; participants retiring due to ill health from a high SES job did not have low physical functioning at the beginning of their ill-health retirement, but their physical functioning did improve over time and their mental health deteriorated over time. This stands in contrast to the effect pattern observed in the total sample (or in participants with low SES), i.e., a recovery from an initially poor physical functioning and no change in mental health. Reasons for these SES-related differences are unknown. Perhaps having to retire due to ill health is mentally more stressful to employees with high SES because they lose a high-status occupation. Despite declining mental health, however, they appear to enjoy the improving physical functioning associated with ill-health retirement.
Health causation and selection
Survival analyses indicate that all three forms of retirement were predicted by poor rather than good health; the specific associations varied according to reason for retirement. Poor mental health increased the probability of opting for voluntary early retirement, while poor physical functioning increased the probability of leaving the workforce at statutory retirement age. It is possible that people with mental health problems are more troubled by work-related stressors and therefore more likely to retire early. The decision to continue working beyond statutory retirement age, in turn, might be affected more by individuals’ physical capabilities than their mental health. Both poor mental health and physical functioning contributed to the probability of ill health retirement, which is in agreement with the fact that ill health retirement is granted because of mental and physical illnesses.
Our study shares the limitations inherent to all observational studies, including the difficulty of establishing causal relations. Nevertheless, two arguments support a causal interpretation for the association of statutory and early retirement with improved health. First, our analyses of reverse causality indicate that the probability of retirement was increased by poor health, and so reverse causality is unlikely to account for the observed association between retirement and improved health. If anything, such a selection effect might have led to a conservative estimation of the health improvements associated with retirement. Second, longitudinal within-participant analyses suggested that, for a given individual, mental health and physical functioning were better after retirement than before.
Not surprisingly, and in contrast to patterns observed for statutory and early voluntary retirement, our analyses suggest that the association between ill-health retirement and poor health reflects health selection rather than causation. First, possible selection and causation effects were both in the same direction, i.e., ill-health retirement was associated with poorer health both pre- and post-retirement. Second, within-participant analyses indicated no deterioration in mental health after ill-health retirement. There was an initial decline in physical functioning associated with ill-health retirement, which may reflect an onset of a disease between the study phases, i.e., the cause rather than the effect of ill-health retirement. However, physical functioning of ill-health retirees improved over time and tended to reach its pre-retirement level in approximately 15 years. Together these findings suggest that, with the exception of participants with high SES, ill-health retirement has generally no adverse health effects. If anything, it may be related to recovering of physical functioning.
Given the inherent limits of observational studies in establishing causal relationships, the causal role of retirement remains uncertain and should be interpreted cautiously. The changes in health after retirement were most pronounced in early retirees, suggesting that removal of work-related mental strain32-34
could underlie the beneficial effect of retirement. Increased leisure time and opportunity to pursue personal interests and hobbies could also be contributing factors. One may argue that it is actually these factors, rather than retirement per se, that improve health. However, we believe that such life changes following retirement are best interpreted as mediating mechanisms that bring about the beneficial effects of retirement, rather than as co-occurring events confounding the independent effects of retirement. If retirement had not taken place, the life changes and opportunities following retirement would not have taken place either. From this perspective, it seems justifiable to consider retirement as a potentially causal social transition that influences health.
Strengths and limitations of the study
The main strength of the study is the prospective longitudinal design, with 6 follow-up phases covering the ages between 39 and 76 years (during which most people leave the workforce). These data allowed us to model health trajectories across the adult life-course while taking into account age at retirement and the length of time spent in retirement. Multiple repeated measurements of retirement and health outcomes strengthened the evidence supporting causal interpretations, thus contributing to previous evidence based on cross-sectional studies and longitudinal studies with only one follow-up, including two earlier studies1,4
of retirement in the Whitehall II cohort. The main limitation of the study was the homogeneity of the study sample, as the participants consisted mainly of white-collar men and women working in public sector workplaces. Further research is needed to assess whether our results are generalizable across all occupational settings and across different countries with different retirement policies. For instance, recent evidence from the GAZEL study35,36
suggests that the beneficial effects of retirement may not be limited to UK settings, as retirement in this French occupational cohort, including also blue-collar workers, was associated with a substantial decrease in the prevalence of sleep disturbances and improved self-rated health.
In conclusion, data from British civil servants provide clear support for the hypothesis that mental health and physical functioning improve after statutory and voluntarily retirement, although the improvement appears to attenuate over time. The magnitude of observed improvements was relatively modest, particularly in the within-participant analyses and for statutory retirement, and thus the health consequences of retirement should not be overemphasized. Our findings suggest that these health consequences are mostly positive and that much of the assumed negative health effects of retirement14,15
are attributable to health selection rather than causation.