Employment Status and Depressive Symptoms in Koreans: Results From a Baseline Survey of the Korean Longitudinal Study of Aging

Transcription

1 Jng, S-N., Cho, S-I., Chng, J., Boo, K., Shin, H-G., Lee, H., & Berkmn, L.F. (2009). Employment sttus nd depressive symptoms in korens: results from bseline survey of the koren longitudinl study of ging. Journl of Gerontology: Socil Sciences, 64B(5), , doi: /geronb/gbp014. Advnce Access publiction on Mrch 23, Employment Sttus nd Depressive Symptoms in Korens: Results From Bseline Survey of the Koren Longitudinl Study of Aging Soong-Nng Jng,1, 2 Sung-Il Cho,2, 3 Jiyeun Chng, 4 Kchung Boo,4 Hyun-Goo Shin,4 Hyejung Lee,4 nd Lis F. Berkmn1 1 Deprtment of Society, Humn Development nd Helth, Hrvrd School of Public Helth, Boston, Msschusetts. 2 Institute of Helth nd Environment, Seoul Ntionl University, Kore. 3 Deprtment of Epidemiology, School of Public Helth, Seoul Ntionl University, Kore. 4Kore Lbor Institute, Seoul. Objectives. We investigted the ssocition between employment sttus nd depressive symptoms mong Koren individuls ccording to ge nd gender. Methods. Dt were obtined from subsmple of 3,907 men nd 4,914 women ged 45 yers nd older without ny severe disbilities who prticipted in the 2006 cross-sectionl bseline survey of the Koren Longitudinl Study of Aging (KLoSA). We compred depressive symptoms s determined by the Center for Epidemiologicl Studies Depression 10-item scle, djusting for socioeconomic sttus, physicl nd cognitive function, nd chronic disese. Using multiple regression nlysis, we determined both ge- nd gender-specific differences ssocited with depressive symptoms nd employment sttus. Results. Employment ws ssocited with fewer depressive symptoms mong middle-ged men but not mong older men. Unemployment ws ssocited with more depressive symptoms mong middle-ged women but not mong older women. Conclusion. Work role did not provide ny benefit for depressive symptoms mong older men nd women. We discuss the incresed depressive symptoms mong older employed men nd the differentil ssocition of employment sttus with ge nd gender in the context of Koren socil structure. Key Words: Depressive symptoms Employment sttus Koren Older dults. T O ddress current trends in popultion ging, erly withdrwl from the lbor force, nd limited personl svings, mny countries hve dopted socil policies to encourge the employment of older individuls ( Butterworth et l., 2006 ; Melzer, Buxton, & Villmil, 2004 ). In Kore, employment rtes of 68.6% nd 41.9% for men nd 43.8% nd 22.7% for women ged nd 65 yers or older, respectively ( Koren Ntionl Sttistics [KNS], 2006 ), re much higher thn the men lbor force prticiption rtes in the Orgnistion for Economic Co-opertion nd Development (OECD) countries, which hve been reported s 52.3% nd 16.7% for men nd 32.5% nd 7.6% for women, respectively ( Jones, 2005 ). Among the older workforce in Kore, 37.4% were employed by the griculturl industry nd 28.8% were employed in either temporry or low- pying mnul lbor positions, indicting tht the occuptionl sttus of older workers ws becoming mrginlized ( KNS, 2006 ; Kwon & Hwng, 2004 ). Most studies investigting the reltionships between employment sttus nd mentl helth mong older individuls hve emphsized retirement or job loss nd hve focused predominntly on Western developed countries. The vribility of postretirement psychologicl outcomes convincingly reflects the fct tht retirement involves multiple fctors, including objective fctors such s societl roles nd monetry income, s well s more subjective psychologicl fctors such s trnsformtions of personl identity, expecttions, nd preferences ( Dnnefer, 1984 ; Moen, 1996 ). Christ nd collegues (2007) reported mentl helth benefits for older workers, especilly mong those working for personl fulfillment. However, becuse poor helth could both prevent older persons from working nd cuse incresed levels of depression, it ws recognized tht the incresed mentl helth benefits observed in working older persons could simply be the result of their good helth or the helthy worker effect. Vrious socil, governmentl, nd economic policies pertining to older dults could lso influence their employment sttus nd mentl helth. Kore exhibits reltively immture socil security nd long-term helth cre insurnce systems s opposed to some other developed countries ( Chng, 2003 ). Older Koren men nd women fce considerble finncil distress if they do not continue to work, nd this ppers to be the primry reson for their high prticiption rtes in the workforce. Despite importnt ge-relted differences between the working roles of older men nd those of older women from Western nd Asin countries, the ssocition of ge nd The Author Published by Oxford University Press on behlf of The Gerontologicl Society of Americ. 677 All rights reserved. For permissions, plese e-mil: journls.permissions@oxfordjournls.org.

2 678 JANG ET AL. gender with postretirement depression remins uncler. For exmple, in Kore nd other Est Asin countries, socil constrints nd influences governed by such trditionl norms s ptrirchy nd Confucinism represent one cler difference compred with Western societies ( Jeon, Jng, Cho, Kwchi, & Rhee, 2007 ). Rpid socil developments nd the incresing prticiption of women in the workforce hve introduced new norms governing division of lbor in the household. Additionlly, older men who lose their jobs in this chnging socil environment could hve greter mentl helth risks thn similrly ffected older women becuse of the trditionl norms of ptrirchl Koren society. Therefore, in the present study, we ssessed the depressive symptoms of employed nd unemployed Korens cross different ge groups using representtive smpling of middle-ged nd older men nd women represented in the Koren Longitudinl Study of Aging (KLoSA). To minimize the helthy worker effect, we restricted our smple to helthy individuls without ny severe disbilities. We hypothesized tht employment sttus would hve different influences on depressive symptoms depending on ge nd gender. In prticulr, we sought to determine if prticiption in the workforce ws ssocited with ny beneficil effects on the depressive symptoms of older men nd women. Finlly, we discuss the influence of employment sttus on depressive symptoms in the context of the distinct socil environment nd life course of older genertions of Korens. Methods Study Design nd Dt We used cross-sectionl dt from the bseline survey of the KLoSA, which ws conducted by the Koren Lbor Institute nd funded by the Koren Ministry of Lbor in The KLoSA ws ntionl representtive longitudinl study designed to follow up every even yer. The instrument ssesses demogrphics, fmilies, helth nd functionl sttus, employment, income, ssets, nd subjective expecttions. The KLoSA trgeted Korens ged 45 yers or older nd their fmilies. Households were selected using multistge strtified probbility smpling bsed on geogrphicl re. Regions were strtified into urbn nd rurl res bsed on the 15 metropolitn cities nd provinces of Kore. A totl of 803 nd 197 districts were llocted into urbn nd rurl res, respectively. With fixed smples, households were rndomly selected for ech district. Trined interviewers conducted interviews with ech fmily where t lest one eligible fmily member in the household ws ged 45 yers or older. After 6 months (July to November 2006) of in-home, fce-to-fce interviews, KLoSA hd pnel of 10,254 respondents. The household response rte ws 70.7%, nd the individul response rte within the households ws 75.4%. The verge ge of the pnel respondents ws ± yers old, with rnge of yers. The smple tht we used for this study ws limited to dults with no ctivities of dily living (ADL) disbilities. A totl of 489 persons (4.7% of the totl smple) consisting of 204 men nd 285 women exhibited one or more ADL disbility, nd most (96.4%) of them were not in the lbor force. After excluding missing cses ( n = 944), the finl smple for this study consisted of 8,821 persons. Outcome Mesure The outcome vrible ws bsed on the short-form Center for Epidemiologicl Studies Depression 10-item scle (CES-D 10) developed t the Boston site of Estblished Popultions for Epidemiologicl Studies of the Elderly ( Kohout, Berkmn, Evns, & Cornoni-Huntley, 1993 ). The CES-D 10 is brief screening test tht ssesses depressive symptoms in older dults for the most recent week. The 10 items were divided into two positively phrsed ctegories: () feel pretty good nd (b) overll stisfied, nd eight negtively phrsed ctegories: () lose interest, (b) trouble concentrting, (c) feel depressed, (d) feel tired out or low in energy, (e) frid of something, (f) trouble flling sleep, (g) feel lone, nd (h) feel down on yourself nd no good or worthless. The originl Boston version of the CES-D 10 hd two-response formt (yes/no), wheres the CES-D 10 used in KLoSA hd 4-point scled response formt for ech item rnging from 0 to 3, where 0 = very rrely, 1 = sometimes, 2 = often, nd 3 = lmost lwys. We used the sum of the 10 items s n outcome mesure. The CES-D 10 lph coefficient ws.86, nd little vrition ws found between the middle-ged nd older ged groups in this study smple, suggesting tht the pttern of responses on the CES-D 10 ws resonbly consistent mong the different ge groups. The Boston version of the CES-D 10 reported lph coefficients of.80 for older dults ( Kohout et l., 1993 ) nd.92 for middle-ged persons ( Irwin, Artin, & Oxmn, 1999 ). Employment Sttus The overll circumstnces of the respondents employment were ssessed beginning with question bout whether the respondent prticipted in the lbor mrket. Unemployed respondents were sked bout the resons for their unemployment; their possible responses were () worked before but retired, (b) worked before nd intend to work in the future, nd (c) never hd regulr job before. Retired persons were identified s not presently working, hving no income-relted ctivities, nd hving no intentions of engging in ny future employment. Unemployed persons with intentions of finding future jobs were ctegorized s unemployed. Respondents who never hd regulr job were ctegorized s out of the lbor force.

3 DEPRESSIVE SYMPTOMS AND EMPLOYMENT STATUS IN KOREANS 679 Covrites In order to ssess the net ssocition of employment sttus in ech ge nd gender group, we considered possible covrites ccording to the results of previous reserch ( Holzer et l., 1986 ; Perlin, Morton, Menghn, & Mulln, 1981 ). Eductionl level ws ctegorized s follows: () elementry school grdute or less, (b) middle school grdute, (c) high school grdute, nd (d) college grdute or more. Household equivlent income ws clculted s the totl household income divided by the squre root of the number of household members ( Khng & Kim, 2006 ) nd then divided into qurtiles. Prticipnts were lso ctegorized s either ntionl helth insurnce beneficiries (1) or those on medicl id or without insurnce (0). Respondents were sked bout their mritl sttus nd dichotomized s either mrried nd living together (1) or other (0). Living rrngement ws lso dichotomized s either living with child or child s fmily (1) or other (0). The presence of chronic diseses ws ctegorized s none (0), one (1), two (2), or three or more (3), bsed on the following self-reported medicl conditions dignosed by physicin: hypertension, dibetes, cncer, lung disese, hert problems, stroke, rthritis, nd gstrointestinl disese. Level of disbility ws mesured using the 10-item instrumentl ctivities of dily living scle (IADL), which includes personl grooming, going out short distnce, using trnsporttion, mking/receiving phone clls, mnging money, doing household chores, prepring mels, shopping, tking medictions, nd doing the lundry ( Won et l., 2002 ). If respondents were dependent in one or more ctivities, they were ctegorized s hving ny disbility (1); if they were dependent in none of the IADL items, they were clssified s hving no disbility (0). Cognitive function ws mesured using the Koren Mini-Mentl Stte Exmintion (MMSE), with the totl score rnging from 0 to 30, nd score vlidities were confirmed by the method of Kng, N, nd Hn (1997). Anlysis We clculted the frequencies of the weighted proportions using strtum-specific weights from the Koren popultion in 2005 nd the distribution of employment sttus, mritl sttus, socioeconomic sttus, helth sttus, nd other chrcteristics in the subsmples by gender (mle or femle) nd ge group (45 64 nd 65 yers or older). We presented the lest-squres mens of the CES-D 10 by gender nd ge groups djusted for covrites. Multiple regressions were used to evlute the influence of employment sttus on the depressive symptoms score with reference to employment in ech gender nd ge group. We lso investigted the possible interction between ech employment sttus, ge, nd gender ctegory nd then conducted sttisticl tests to compre regression coefficients cross groups by gender nd ge. A contrst nlysis of generl liner model ( Littell, Stroup, & Freund, 2002 ) ws used to test the null hypothesis tht the regression coefficients of ech employment sttus were equl. Age nd gender differences in the coefficient of employment sttus with depressive symptoms were tested. Results We exmined employment sttus, socioeconomic chrcteristics, nd helth sttus by ge nd gender of the prticipnts ( Tble 1 ). Among the men, 81.7% nd 31.7% were clssified s employed in the nd 65 yers or older ge groups, respectively. Among the women, 37.6% nd 11.5% were clssified s employed in the nd 65 yers or older ge groups, respectively. Men ged 65 yers or older were more likely to be retired thn were younger men. The mjority of men reported being mrried, wheres 51.5% of the women ged 65 yers or older were widowed. Most of the prticipnts (89.9% 96.3%) were covered by ntionl helth insurnce, which covers ll Koren people who re employees or self-employed nd who re sponsored by employers nd government subsidies. Among the groups, women ged 65 yers or older hd the highest proportion receiving medicl id (10.3%). This medicl id ws provided by the helth cre progrm estblished for poor Korens nd finnced by the generl revenues of their centrl nd locl governments. With regrd to living with children, persons ged 65 yers or older were less likely to live with their children thn were middle-ged persons. As expected, compred with middle-ged persons, older persons exhibited higher frequency of multiple chronic diseses nd were lso more likely to report hving some disbility. MMSE scores were lowest mong the older women. For depressive symptoms, the men CES-D 10 scores were lowest in middle-ged men (5.15) nd highest in older women (8.45). Compred with the other employment sttus groups, being currently employed showed lower correltion with depressive symptoms scores bsed on the lestsqures mens of CES-D 10 by employment sttus, lthough this effect ws not sttisticlly significnt for the older women. Unemployed persons were most depressed mong middle-ged men nd women. Older men who were out of the lbor force showed higher depressive symptoms scores thn those in the other employment sttus groups ( Figure 1 ). Tble 2 shows the independent ssocitions between employment sttus nd depressive symptoms. Among the middle-ged (45 64 yers old) men, those who were retired, unemployed, or out of the lbor force exhibited more significnt depressive symptoms thn men who were employed. However, mong the older men (65 yers or older), only those who were out of the lbor force exhibited significntly negtive depressive symptoms reltive to those who were employed. There ws no difference in the correltion between

4 680 JANG ET AL. Tble 1. Generl Chrcteristics of the Study Subjects Aged 45 Yers or Older for Korens Without Activities of Dily Living Disbilities Men Women Age Yers Age 65 Yers or Older Age Yers Age 65 Yers or Older N % b N % b N % b N % b Employment sttus Employed 1, , Retired Unemployed Out of lbor force , , Eduction Elementry school or less , , Middle school High school 1, College or more Mritl sttus Mrried 2, , , Widowed Other Helth insurnce type Medicre Public insurnce 2, , , , Income 1Q c Q Q Q Living with children No , , , Yes 1, , Any disbility No 2, , , , Yes Number of chronic diseses 0 1, , MMSE (M, [SD]) (2.53) (4.19) (3.24) (5.84) CES-D 10 ( M, [SD]) 5.15 (3.99) 6.64 (4.74) 5.89 (4.45) 8.45 (5.52) Notes : CES-D 10 = Center for Epidemiologicl Studies Depression 10-item scle; MMSE = Mini-Mentl Stte Exmintion. N denotes smple frequency. b % denotes weighted percentge. c Q = qurtile. employment sttus nd depression mong older men. Among the middle-ged women, those who were unemployed exhibited significntly higher depressive symptoms thn those who were employed. No significnt ssocition of depressive symptoms with employment sttus ws observed for the older women. The ge nd gender groups differed in terms of the ssocitions found between employment sttus nd depressive symptoms ( Tble 3 ). Employment ws ssocited with low depressive symptoms in middle-ged men but not in older men; the difference in ssocition between ge groups ws sttisticlly significnt ( F = 3.94, p =.047). Among the retirees, middle-ged men were more likely to report depressive symptoms thn those who were older. A significntly different regression coefficient ws lso found between middle-ged nd older women who were out of the lbor force. Older women who were out of the lbor force showed stronger ssocition between depressive symptoms nd employment sttus thn did middle-ged women. Regrding the gender difference, the regression coefficient in the employed ctegory ws significntly different ( F = 7.29, p =.0070) in the middle-ged group but not in the older group. These results suggested tht the potentil benefit of employment on depressive symptoms ws stronger for men thn for women only mong middleged persons. By contrst, gender difference in the ssocition of retirement with depressive symptoms ppered in the older group but not in the middle-ged group. A significnt difference in the correltion coefficient ws lso found ccording to gender mong those who were middle-ged nd out of the lbor force ( F = 14.52, p =.0001).

5 DEPRESSIVE SYMPTOMS AND EMPLOYMENT STATUS IN KOREANS 681 Figure 1. Lest-squres mens of the Center for Epidemiologicl Studies Depression 10-item scle score ccording to employment sttus mong Korens ged 45 yers or older in the Koren Longitudinl Study of Aging. * p <.01. Discussion Our cross-sectionl nlysis of KLoSA showed tht depressive symptoms were lowest mong middle-ged employed men, wheres being employed showed little influence on depressive symptoms mong older men. Among women, unemployed middle-ged women hd the highest depressive symptoms. The ssocitions suggested by our results my hve complex cuses, including reverse custion of mentl disorders nd employment sttus ( Flippen & Tiend, 2000 ; Moen, 1996 ). Given the cross-sectionl study design, possible selection issues lso rise in tht those with more severe mentl illness re less likely to remin employed, s result of poor mentl helth. This might be problemtic in ssessing correltion between depression nd unemployment. In recent ntionwide cross-sectionl studies conducted in Britin ( Melzer et l., 2004 ) nd Austrli ( Butterworth et l., 2006 ), no link between ge nd depression ws observed mong employed men. The interction between ge nd employment sttus for men resulted from reduction in depression mong retirees t the ge of retirement ( Butterworth et l., 2006 ). Although our dt showed reduction in depressive symptoms mong older retired men, it ppered to be inconsistent with previous reserch indicting tht employed Koren men exhibited more depressive symptoms with incresing ge. One possibility is tht the observtions might not ctully be cused by n ge effect on the depressive symptoms, s indicted by the notble difference in the depressive symptoms score mens between ge groups in Tble 1. Additionlly, fter further nlysis, the significnt ssocition of ge with depression disppered when our model included covrites (dt not shown). Older men who did not suffer the loss of personl sttus or function exhibited pproximtely the sme level of depression s middleged men who did ( Mirowsky & Ross, 1992 ). One explntion could be relted to the cohort effect on depression nd employment sttus ( Moen, 1996 ). Mny older Korens received only limited stndrd eduction ( Jeon et l., 2007 ), nd those individuls experienced limittions upon entering the lbor force in modern, rpidly industrilizing society. The depression mong older working men could be cumultive negtive mentl helth effect derived from unemployed, incresed job stress, nd lowskilled work experiences throughout life ( Ezzy, 1993 ; Hepworth, 1980 ; Hill, 1978 ; Wrr & Jckson, 1984 ). They lso hve low pension benefits. Tble 2. Assocition of Employment Sttus With the Center for Epidemiologicl Studies Depression Symptoms Score by Age nd Gender Men Age Yers ß (SE) 65 Yers nd Older ß ( SE ) Age Yers ß ( SE ) 65 Yers nd Older ß ( SE ) Employment sttus Employed Reference Reference Reference Reference Retired 0.64 (0.26)* 0.18 (0.27) 0.21 (0.24) 0.01 (0.45) Unemployed 2.55 (0.57)** 0.50 (0.91) 1.67 (0.60)* 3.59 (2.14) Out of lbor force 1.67 (0.34)** 1.19 (0.36)** 0.07 (0.16) 0.59 (0.38) Eduction 0.12 (0.08) 0.24 (0.12)* 0.16 (0.09) 0.52 (0.21)* Mrried 1.33 (0.17)** 2.90 (0.33)** 1.01 (0.15)** 0.65 (0.24)** Ntionl helth insurnce 2.16 (0.41)** 1.99 (0.47)** 2.93 (0.38)** 2.87 (0.41)** Income 0.39 (0.08)** 0.40 (0.12)** 0.39 (0.07)** 0.64 (0.13)** Living with children 0.17 (0.16) 0.48 (0.27)* 0.00 (0.16) 0.39 (0.27) Number of chronic diseses 0.62 (0.10)** 0.59 (0.13)** 1.02 (0.10)** 0.83 (0.13)** Any disbility 0.30 (0.25) 0.90 (0.32)** 0.06 (0.43) 0.29 (0.35) MMSE 0.08 (0.03)** 0.18 (0.03)** 0.16 (0.03)** 0.14 (0.02)** N 2,484 1,423 3,094 1,820 R Notes : Adjusted for ge, eduction, mritl sttus, helth insurnce, income level, living with children, number of chronic diseses, disbility, nd MMSE (Mini- Mentl Stte Exmintion) score. * p <.05; ** p <.01. Women

6 682 JANG ET AL. Tble 3. A Comprison of the Regression Coefficients for Age Groups nd Gender for Ech Employment Sttus Comprison Coefficient ( F vlue, Pr > F ) Age Versus 65 Yers nd Older Men Versus Women Employment Sttus Men Women Aged Yers Aged 65 Yers or Older Employed 3.94 ( p =.0474)* 0.97 ( p =.3258) 7.29 ( p =.0070)** 1.14 ( p =.2861) Retired 6.48 ( p =.0110)* 3.18 ( p =.0746) 1.47 ( p =.2252) 5.81 ( p =.0160)* Unemployed 3.45 ( p =.0632) 1.16 ( p =.2822) 0.29 ( p =.5905) 2.64 ( p =.1042) Out of lbor force 0.01 ( p =.9270) 3.94 ( p =.0473)* ( p =.0001)** ( p <.0001)** Notes : F vlues were clculted using the contrst test in the generl liner model for ech employment sttus. * p <.05. ** p <.01. Economic security fter retirement could lso influence employment sttus nd its ssocition with depressive symptoms mong older workers. Before developing stble socil security system for postretirement, Kore hd suffered period of ntionl economic hrdship beginning in 1997, induced by foreign exchnge crisis. Mny older workers lost their jobs involuntrily nd moved to self-employed jobs or the griculturl industry ( Kim & Yoo, 2004 ; OECD, 2000 ). Without the rewrd of retirement, these older employed men might be more likely to become depressed thn younger working men. The fct tht mny of the jobs vilble to women re not regulr positions might discourge femle prticiption in the lbor force. Only 37% of femle wge employees were clssified s regulr workers in 2004 compred with 62% of mle wge employees ( Jones, 2005 ). Even women employed s regulr workers before interrupting their creers to hve children found it difficult to return to the lbor force s regulr workers. This nd other importnt lbor mrket prctices could present employment brriers nd function to induce depressive symptoms mong unemployed middle-ged women. The gender difference found in the ssocition of employment sttus nd mentl helth could be explined by socil norms tht dictte gender roles, which re strongly divided throughout life. Along these lines, it hs been suggested tht the loss of work roles ws more thretening to the mentl helth of men thn women ( Jeon et l., 2007 ). Employment sttus ws not significnt fctor for depressive symptoms in older women, but it remined sttisticlly significnt in older men. Clerly, the older men who were out of the lbor force in our study experienced more depressive symptoms, which suggests tht the erly loss of the bredwinner role hd greter negtive psychologicl effect on older men for whom the trditionl ptrirchl socil norms hve greter vlue lthough, gin, we cnnot rule out selection issues relted to the possibility tht men with more mentl illness would be less likely to remin employed. We hve presented only n initil step in the description of the ssocition between employment sttus nd depressive symptoms mong middle-ged nd older dults in Kore. Even though we limited the subjects to those without ADL disbility, the helthy worker effect might remin, nd we lso cnnot rule out reverse custion with chronic illness nd employment sttus. A longitudinl study would further elucidte the link between employment sttus nd helth nd would enble us to mke stronger cusl inferences. In ddition, Koren version of CES-D 10 hs not been vlidted using ny gold stndrd clinicl mesure nd hs not been tested in reltion to the vlid cutoff point suggested by Andresen, Mlmgren, nd Ptrick (1994). Reders should consider this limittion when interpreting who might be in need of mentl helth services or ppropritely be given clinicl dignosis. A more detiled ssessment by employment type might be more vlid for reveling deleterious working conditions tht contribute to the depressive symptoms of older workers. In this study, working role did not provide ny benefit for depressive symptoms mong older men nd women. We discovered need for policies tht provide support for employed older dults, especilly in society with rpid popultion growth nd no mture socil security system for retirees. In the future, dditionl longitudinl studies could provide evidence for the impct of employment sttus on depressive symptoms, prticulrly in developing countries. Funding This study ws mde possible by Kore Reserch Foundtion Grnt ( KRF B00096 ) funded by the Koren government Ministry of Eduction nd Humn Resource Development. Acknowledgments S. N. Jng performed ll sttisticl nlyses nd interprettion nd wrote nd revised the pper. S. I. Cho helped dt nlyses nd helped pln the study. J. Chng, K. Boo, H. G. Shin, nd H. Lee contributed to study design, dt collection, nd interprettion of dt. L. F. Berkmn supervised dt nlyses nd revising the pper. Correspondence Address correspondence to Soong-Nng Jng, PhD, Deprtment of Society, Humn Development nd Helth, Hrvrd School of Public Helth, 677 Huntington Avenue, Boston, MA Emil: sjng@hsph.hrvrd. edu References Andresen, E. M., Mlmgren, J. A., Crter, W. B., & Ptrick, D. L. (1994 ). Screening for depression in well older dults: Evlution of short form of the CES-D (Center for Epidemiologicl Studies Depression Scle). Americn Journl of Preventive Medicine, 10, Butterworth, P., Gill, S. C., Rodgers, B., Anstey, K. J., Villmil, E., & Melzer, D. (2006 ). Retirement nd mentl helth: Anlysis of the

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