Jang, S-N., Cho, S-I., Chang, J., Boo, K., Shin, H-G., Lee, H., & Berkman, L.F. (2009). Employment status and depressive symptoms in koreans: results from a baseline survey of the korean longitudinal study of aging. Journal of Gerontology: Social Sciences, 64B(5), 677–683, doi:10.1093/geronb/gbp014. Advance Access publication on March 23, 2009.
Employment Status and Depressive Symptoms in Koreans: Results From a Baseline Survey of the Korean Longitudinal Study of Aging Soong-Nang Jang,1,2 Sung-Il Cho,2,3 Jiyeun Chang,4 Kachung Boo,4 Hyun-Goo Shin,4 Hyejung Lee,4 and Lisa F. Berkman1 1Department
of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts. 2Institute of Health and Environment, Seoul National University, Korea. 3Department of Epidemiology, School of Public Health, Seoul National University, Korea. 4Korea Labor Institute, Seoul.
Objectives. We investigated the association between employment status and depressive symptoms among Korean individuals according to age and gender. Methods. Data were obtained from a subsample of 3,907 men and 4,914 women aged 45 years and older without any severe disabilities who participated in the 2006 cross-sectional baseline survey of the Korean Longitudinal Study of Aging (KLoSA). We compared depressive symptoms as determined by the Center for Epidemiological Studies–Depression 10-item scale, adjusting for socioeconomic status, physical and cognitive function, and chronic disease. Using multiple regression analysis, we determined both age- and gender-specific differences associated with depressive symptoms and employment status. Results. Employment was associated with fewer depressive symptoms among middle-aged men but not among older men. Unemployment was associated with more depressive symptoms among middle-aged women but not among older women. Conclusion. Work role did not provide any benefit for depressive symptoms among older men and women. We discuss the increased depressive symptoms among older employed men and the differential association of employment status with age and gender in the context of Korean social structure. Key Words: Depressive symptoms—Employment status—Korean—Older adults.
T
O address current trends in population aging, early withdrawal from the labor force, and limited personal savings, many countries have adopted social policies to encourage the employment of older individuals (Butterworth et al., 2006; Melzer, Buxton, & Villamil, 2004). In Korea, employment rates of 68.6% and 41.9% for men and 43.8% and 22.7% for women aged 60–64 and 65 years or older, respectively (Korean National Statistics [KNS], 2006), are much higher than the mean labor force participation rates in the Organisation for Economic Co-operation and Development (OECD) countries, which have been reported as 52.3% and 16.7% for men and 32.5% and 7.6% for women, respectively (Jones, 2005). Among the older workforce in Korea, 37.4% were employed by the agricultural industry and 28.8% were employed in either temporary or low-paying manual labor positions, indicating that the occupational status of older workers was becoming marginalized (KNS, 2006; Kwon & Hwang, 2004). Most studies investigating the relationships between employment status and mental health among older individuals have emphasized retirement or job loss and have focused predominantly on Western developed countries. The variability of postretirement psychological outcomes convincingly reflects the fact that retirement involves multiple
factors, including objective factors such as societal roles and monetary income, as well as more subjective psychological factors such as transformations of personal identity, expectations, and preferences (Dannefer, 1984; Moen, 1996). Christ and colleagues (2007) reported mental health benefits for older workers, especially among those working for personal fulfillment. However, because poor health could both prevent older persons from working and cause increased levels of depression, it was recognized that the increased mental health benefits observed in working older persons could simply be the result of their good health or the healthy worker effect. Various social, governmental, and economic policies pertaining to older adults could also influence their employment status and mental health. Korea exhibits relatively immature social security and long-term health care insurance systems as opposed to some other developed countries (Chang, 2003). Older Korean men and women face considerable financial distress if they do not continue to work, and this appears to be the primary reason for their high participation rates in the workforce. Despite important age-related differences between the working roles of older men and those of older women from Western and Asian countries, the association of age and
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gender with postretirement depression remains unclear. For example, in Korea and other East Asian countries, social constraints and influences governed by such traditional norms as patriarchy and Confucianism represent one clear difference compared with Western societies (Jeon, Jang, Cho, Kawachi, & Rhee, 2007). Rapid social developments and the increasing participation of women in the workforce have introduced new norms governing division of labor in the household. Additionally, older men who lose their jobs in this changing social environment could have greater mental health risks than similarly affected older women because of the traditional norms of a patriarchal Korean society. Therefore, in the present study, we assessed the depressive symptoms of employed and unemployed Koreans across different age groups using a representative sampling of middle-aged and older men and women represented in the Korean Longitudinal Study of Aging (KLoSA). To minimize the healthy worker effect, we restricted our sample to healthy individuals without any severe disabilities. We hypothesized that employment status would have different influences on depressive symptoms depending on age and gender. In particular, we sought to determine if participation in the workforce was associated with any beneficial effects on the depressive symptoms of older men and women. Finally, we discuss the influence of employment status on depressive symptoms in the context of the distinct social environment and life course of older generations of Koreans.
Methods
Study Design and Data We used cross-sectional data from the baseline survey of the KLoSA, which was conducted by the Korean Labor Institute and funded by the Korean Ministry of Labor in 2006. The KLoSA was a national representative longitudinal study designed to follow up every even year. The instrument assesses demographics, families, health and functional status, employment, income, assets, and subjective expectations. The KLoSA targeted Koreans aged 45 years or older and their families. Households were selected using multistage stratified probability sampling based on geographical area. Regions were stratified into urban and rural areas based on the 15 metropolitan cities and provinces of Korea. A total of 803 and 197 districts were allocated into urban and rural areas, respectively. With fixed samples, 12–15 households were randomly selected for each district. Trained interviewers conducted interviews with each family where at least one eligible family member in the household was aged 45 years or older. After 6 months (July to November 2006) of in-home, face-to-face interviews, KLoSA had a panel of 10,254 respondents. The household response rate was 70.7%, and the
individual response rate within the households was 75.4%. The average age of the panel respondents was 61.89 ± 11.13 years old, with a range of 45–105 years. The sample that we used for this study was limited to adults with no activities of daily living (ADL) disabilities. A total of 489 persons (4.7% of the total sample) consisting of 204 men and 285 women exhibited one or more ADL disability, and most (96.4%) of them were not in the labor force. After excluding missing cases (n = 944), the final sample for this study consisted of 8,821 persons. Outcome Measure The outcome variable was based on the short-form Center for Epidemiological Studies–Depression 10-item scale (CES-D 10) developed at the Boston site of Established Populations for Epidemiological Studies of the Elderly (Kohout, Berkman, Evans, & Cornoni-Huntley, 1993). The CES-D 10 is a brief screening test that assesses depressive symptoms in older adults for the most recent week. The 10 items were divided into two positively phrased categories: (a) feel pretty good and (b) overall satisfied, and eight negatively phrased categories: (a) lose interest, (b) trouble concentrating, (c) feel depressed, (d) feel tired out or low in energy, (e) afraid of something, (f) trouble falling asleep, (g) feel alone, and (h) feel down on yourself and no good or worthless. The original Boston version of the CES-D 10 had a two-response format (yes/no), whereas the CES-D 10 used in KLoSA had a 4-point scaled response format for each item ranging from 0 to 3, where 0 = very rarely, 1 = sometimes, 2 = often, and 3 = almost always. We used the sum of the 10 items as an outcome measure. The CES-D 10 alpha coefficient was .86, and little variation was found between the middle-aged and older aged groups in this study sample, suggesting that the pattern of responses on the CES-D 10 was reasonably consistent among the different age groups. The Boston version of the CES-D 10 reported alpha coefficients of .80 for older adults (Kohout et al., 1993) and .92 for middle-aged persons (Irwin, Artin, & Oxman, 1999). Employment Status The overall circumstances of the respondents’ employment were assessed beginning with a question about whether the respondent participated in the labor market. Unemployed respondents were asked about the reasons for their unemployment; their possible responses were (a) worked before but retired, (b) worked before and intend to work in the future, and (c) never had a regular job before. Retired persons were identified as not presently working, having no income-related activities, and having no intentions of engaging in any future employment. Unemployed persons with intentions of finding future jobs were categorized as “unemployed.” Respondents who never had a regular job were categorized as “out of the labor force.”
DEPRESSIVE SYMPTOMS AND EMPLOYMENT STATUS IN KOREANS
Covariates In order to assess the net association of employment status in each age and gender group, we considered possible covariates according to the results of previous research (Holzer et al., 1986; Pearlin, Morton, Menaghan, & Mullan, 1981). Educational level was categorized as follows: (a) elementary school graduate or less, (b) middle school graduate, (c) high school graduate, and (d) college graduate or more. Household equivalent income was calculated as the total household income divided by the square root of the number of household members (Khang & Kim, 2006) and then divided into quartiles. Participants were also categorized as either national health insurance beneficiaries (1) or those on medical aid or without insurance (0). Respondents were asked about their marital status and dichotomized as either married and living together (1) or other (0). Living arrangement was also dichotomized as either living with a child or child’s family (1) or other (0). The presence of chronic diseases was categorized as none (0), one (1), two (2), or three or more (3), based on the following self-reported medical conditions diagnosed by a physician: hypertension, diabetes, cancer, lung disease, heart problems, stroke, arthritis, and gastrointestinal disease. Level of disability was measured using the 10-item instrumental activities of daily living scale (IADL), which includes personal grooming, going out a short distance, using transportation, making/receiving phone calls, managing money, doing household chores, preparing meals, shopping, taking medications, and doing the laundry (Won et al., 2002). If respondents were dependent in one or more activities, they were categorized as having any disability (1); if they were dependent in none of the IADL items, they were classified as having no disability (0). Cognitive function was measured using the Korean Mini-Mental State Examination (MMSE), with the total score ranging from 0 to 30, and score validities were confirmed by the method of Kang, Na, and Han (1997).
Analysis We calculated the frequencies of the weighted proportions using stratum-specific weights from the Korean population in 2005 and the distribution of employment status, marital status, socioeconomic status, health status, and other characteristics in the subsamples by gender (male or female) and age group (45–64 and 65 years or older). We presented the least-squares means of the CES-D 10 by gender and age groups adjusted for covariates. Multiple regressions were used to evaluate the influence of employment status on the depressive symptoms score with reference to employment in each gender and age group. We also investigated the possible interaction between each employment status, age, and gender category and then conducted statistical tests to compare regression coefficients across groups by gender and age. A contrast analysis of a general linear model
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(Littell, Stroup, & Freund, 2002) was used to test the null hypothesis that the regression coefficients of each employment status were equal. Age and gender differences in the coefficient of employment status with depressive symptoms were tested.
Results We examined employment status, socioeconomic characteristics, and health status by age and gender of the participants (Table 1). Among the men, 81.7% and 31.7% were classified as employed in the 45–64 and 65 years or older age groups, respectively. Among the women, 37.6% and 11.5% were classified as employed in the 45–64 and 65 years or older age groups, respectively. Men aged 65 years or older were more likely to be retired than were younger men. The majority of men reported being married, whereas 51.5% of the women aged 65 years or older were widowed. Most of the participants (89.9%–96.3%) were covered by national health insurance, which covers all Korean people who are employees or self-employed and who are sponsored by employers and government subsidies. Among the groups, women aged 65 years or older had the highest proportion receiving medical aid (10.3%). This medical aid was provided by the health care program established for poor Koreans and financed by the general revenues of their central and local governments. With regard to living with children, persons aged 65 years or older were less likely to live with their children than were middle-aged persons. As expected, compared with middle-aged persons, older persons exhibited a higher frequency of multiple chronic diseases and were also more likely to report having some disability. MMSE scores were lowest among the older women. For depressive symptoms, the mean CES-D 10 scores were lowest in middle-aged men (5.15) and highest in older women (8.45). Compared with the other employment status groups, being currently employed showed a lower correlation with depressive symptoms scores based on the leastsquares means of CES-D 10 by employment status, although this effect was not statistically significant for the older women. Unemployed persons were most depressed among middle-aged men and women. Older men who were out of the labor force showed higher depressive symptoms scores than those in the other employment status groups (Figure 1). Table 2 shows the independent associations between employment status and depressive symptoms. Among the middle-aged (45–64 years old) men, those who were retired, unemployed, or out of the labor force exhibited more significant depressive symptoms than men who were employed. However, among the older men (65 years or older), only those who were out of the labor force exhibited significantly negative depressive symptoms relative to those who were employed. There was no difference in the correlation between
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Table 1. General Characteristics of the Study Subjects Aged 45 Years or Older for Koreans Without Activities of Daily Living Disabilities Men Age 45–64 Years
Age 65 Years or Older
Age 45–64 Years
Age 65 Years or Older
%b
Na
%b
1,908 249 45 134
81.68 10.66 1.93 5.74
433 676 24 235
31.65 49.42 1.75 17.18
1,105 394 50 1,392
37.57 13.40 1.70 47.33
206 338 6 1,247
11.46 18.81 0.33 69.39
424 478 1,031 551
17.07 19.24 41.51 22.18
696 236 305 186
48.91 16.58 21.43 13.07
1,160 716 996 222
37.49 23.14 32.19 7.18
1,541 149 103 27
84.67 8.19 5.66 1.48
2,319 41 124
93.36 1.65 4.99
1,278 125 20
89.81 8.78 1.41
2,623 327 144
84.78 10.57 4.65
849 938 33
46.65 51.54 1.81
93 2,389
3.75 96.25
97 1,323
6.83 93.17
127 2,963
4.11 95.89
187 1,626
10.31 89.69
367 448 754 915
14.77 18.04 30.35 36.84
467 480 304 172
32.82 33.73 21.36 12.09
588 706 884 916
19.00 22.82 28.57 29.61
725 553 331 211
39.84 30.38 18.19 11.59
868 1,616
34.94 65.06
1,030 393
72.38 27.62
1,307 1,787
42.24 57.76
1,179 641
64.78 35.22
2,232 252
89.86 10.14
1,186 237
83.35 16.65
2,998 96
96.90 3.10
1,525 295
83.79 16.21
1,664 563 189 68 27.19 5.15
66.99 22.67 7.61 2.74 (2.53) (3.99)
41.67 36.26 15.53 6.54 (4.19) (4.74)
1,938 776 277 103 26.32 5.89
62.64 25.08 8.95 3.33 (3.24) (4.45)
Na Employment status Employed Retired Unemployed Out of labor force Education Elementary school or less Middle school High school College or more Marital status Married Widowed Other Health insurance type Medicare Public insurance Income 1Qc 2Q 3Q 4Q Living with children No Yes Any disability No Yes Number of chronic diseases 0 1 2 3+ MMSE (M, [SD]) CES-D 10 (M, [SD])
Women
593 516 221 93 24.80 6.64
Na
%b
Na
566 673 376 205 21.04 8.45
%b
31.10 36.98 20.66 11.26 (5.84) (5.52)
Notes: CES-D 10 = Center for Epidemiological Studies–Depression 10-item scale; MMSE = Mini-Mental State Examination. denotes sample frequency. b % denotes weighted percentage. c Q = quartile. aN
employment status and depression among older men. Among the middle-aged women, those who were unemployed exhibited significantly higher depressive symptoms than those who were employed. No significant association of depressive symptoms with employment status was observed for the older women. The age and gender groups differed in terms of the associations found between employment status and depressive symptoms (Table 3). Employment was associated with low depressive symptoms in middle-aged men but not in older men; the difference in association between age groups was statistically significant (F = 3.94, p = .047). Among the retirees, middle-aged men were more likely to report depressive symptoms than those who were older. A significantly different regression coefficient was also found between middle-aged and older women who were out of
the labor force. Older women who were out of the labor force showed a stronger association between depressive symptoms and employment status than did middle-aged women. Regarding the gender difference, the regression coefficient in the employed category was significantly different (F = 7.29, p = .0070) in the middle-aged group but not in the older group. These results suggested that the potential benefit of employment on depressive symptoms was stronger for men than for women only among middleaged persons. By contrast, a gender difference in the association of retirement with depressive symptoms appeared in the older group but not in the middle-aged group. A significant difference in the correlation coefficient was also found according to gender among those who were middle-aged and out of the labor force (F = 14.52, p = .0001).
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DEPRESSIVE SYMPTOMS AND EMPLOYMENT STATUS IN KOREANS
Figure 1. Least-squares means of the Center for Epidemiological Studies– Depression 10-item scale score according to employment status among Koreans aged 45 years or older in the Korean Longitudinal Study of Aging. *p < .01.
Discussion Our cross-sectional analysis of KLoSA showed that depressive symptoms were lowest among middle-aged employed men, whereas being employed showed little influence on depressive symptoms among older men. Among women, unemployed middle-aged women had the highest depressive symptoms. The associations suggested by our results may have complex causes, including reverse causation of mental disorders and employment status (Flippen & Tienda, 2000; Moen, 1996). Given the cross-sectional study design, possible se-
lection issues also arise in that those with more severe mental illness are less likely to remain employed, as a result of poor mental health. This might be problematic in assessing a correlation between depression and unemployment. In recent nationwide cross-sectional studies conducted in Britain (Melzer et al., 2004) and Australia (Butterworth et al., 2006), no link between age and depression was observed among employed men. The interaction between age and employment status for men resulted from a reduction in depression among retirees at the age of retirement (Butterworth et al., 2006). Although our data showed a reduction in depressive symptoms among older retired men, it appeared to be inconsistent with previous research indicating that employed Korean men exhibited more depressive symptoms with increasing age. One possibility is that the observations might not actually be caused by an age effect on the depressive symptoms, as indicated by the notable difference in the depressive symptoms score means between age groups in Table 1. Additionally, after further analysis, the significant association of age with depression disappeared when our model included covariates (data not shown). Older men who did not suffer the loss of personal status or function exhibited approximately the same level of depression as middleaged men who did (Mirowsky & Ross, 1992). One explanation could be related to the cohort effect on depression and employment status (Moen, 1996). Many older Koreans received only a limited standard education (Jeon et al., 2007), and those individuals experienced limitations upon entering the labor force in a modern, rapidly industrializing society. The depression among older working men could be a cumulative negative mental health effect derived from unemployed, increased job stress, and lowskilled work experiences throughout life (Ezzy, 1993; Hepworth, 1980; Hill, 1978; Warr & Jackson, 1984). They also have low pension benefits.
Table 2. Association of Employment Status With the Center for Epidemiological Studies–Depression Symptoms Score by Age and Gender Men
Employment status Employed Retired Unemployed Out of labor force Education Married National health insurance Income Living with children Number of chronic diseases Any disability MMSE N R2
Women
Age 45–64 Years ßa (SE)
65 Years and Older ßa (SE)
Age 45–64 Years ßa (SE)
65 Years and Older ßa (SE)
Reference 0.64 (0.26)* 2.55 (0.57)** 1.67 (0.34)** −0.12 (0.08) 1.33 (0.17)** −2.16 (0.41)** −0.39 (0.08)** −0.17 (0.16) 0.62 (0.10)** 0.30 (0.25) −0.08 (0.03)** 2,484 0.1323
Reference −0.18 (0.27) 0.50 (0.91) 1.19 (0.36)** −0.24 (0.12)* 2.90 (0.33)** −1.99 (0.47)** −0.40 (0.12)** 0.48 (0.27)* 0.59 (0.13)** 0.90 (0.32)** −0.18 (0.03)** 1,423 0.1681
Reference −0.21 (0.24) 1.67 (0.60)* −0.07 (0.16) −0.16 (0.09) 1.01 (0.15)** −2.93 (0.38)** −0.39 (0.07)** 0.00 (0.16) 1.02 (0.10)** 0.06 (0.43) −0.16 (0.03)** 3,094 0.1383
Reference 0.01 (0.45) 3.59 (2.14) −0.59 (0.38) −0.52 (0.21)* 0.65 (0.24)** −2.87 (0.41)** −0.64 (0.13)** 0.39 (0.27) 0.83 (0.13)** 0.29 (0.35) −0.14 (0.02)** 1,820 0.1307
Notes: a Adjusted for age, education, marital status, health insurance, income level, living with children, number of chronic diseases, disability, and MMSE (MiniMental State Examination) score. *p < .05; **p < .01.
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JANG ET AL.
Table 3. A Comparison of the Regression Coefficients for Age Groups and Gender for Each Employment Status Comparison Coefficient (F value, Pr > F)a Age 45–54 Versus 65 Years and Older Employment Status Employed Retired Unemployed Out of labor force
Men Versus Women
Men
Women
Aged 45–64 Years
Aged 65 Years or Older
3.94 (p = .0474)* 6.48 (p = .0110)* 3.45 (p = .0632) 0.01 (p = .9270)
0.97 (p = .3258) 3.18 (p = .0746) 1.16 (p = .2822) 3.94 (p = .0473)*
7.29 (p = .0070)** 1.47 (p = .2252) 0.29 (p = .5905) 14.52 (p = .0001)**
1.14 (p = .2861) 5.81 (p = .0160)* 2.64 (p = .1042) 19.89 (p < .0001)**
Notes: aF values were calculated using the contrast test in the general linear model for each employment status. *p < .05. ** p < .01.
Economic security after retirement could also influence employment status and its association with depressive symptoms among older workers. Before developing a stable social security system for postretirement, Korea had suffered a period of national economic hardship beginning in 1997, induced by a foreign exchange crisis. Many older workers lost their jobs involuntarily and moved to self-employed jobs or the agricultural industry (Kim & Yoo, 2004; OECD, 2000). Without the reward of retirement, these older employed men might be more likely to become depressed than younger working men. The fact that many of the jobs available to women are not regular positions might discourage female participation in the labor force. Only 37% of female wage employees were classified as regular workers in 2004 compared with 62% of male wage employees (Jones, 2005). Even women employed as regular workers before interrupting their careers to have children found it difficult to return to the labor force as regular workers. This and other important labor market practices could present employment barriers and function to induce depressive symptoms among unemployed middle-aged women. The gender difference found in the association of employment status and mental health could be explained by social norms that dictate gender roles, which are strongly divided throughout life. Along these lines, it has been suggested that the loss of work roles was more threatening to the mental health of men than women (Jeon et al., 2007). Employment status was not a significant factor for depressive symptoms in older women, but it remained statistically significant in older men. Clearly, the older men who were out of the labor force in our study experienced more depressive symptoms, which suggests that the early loss of the breadwinner role had a greater negative psychological effect on older men for whom the traditional patriarchal social norms have greater value—although, again, we cannot rule out selection issues related to the possibility that men with more mental illness would be less likely to remain employed. We have presented only an initial step in the description of the association between employment status and depressive symptoms among middle-aged and older adults in Korea. Even though we limited the subjects to those without ADL disability, the healthy worker effect might remain, and we also cannot rule out reverse causation with chronic illness and employment status. A longitudinal study would
further elucidate the link between employment status and health and would enable us to make stronger causal inferences. In addition, a Korean version of CES-D 10 has not been validated using any gold standard clinical measure and has not been tested in relation to the valid cutoff point suggested by Andresen, Malmgren, and Patrick (1994). Readers should consider this limitation when interpreting who might be in need of mental health services or appropriately be given a clinical diagnosis. A more detailed assessment by employment type might be more valid for revealing deleterious working conditions that contribute to the depressive symptoms of older workers. In this study, working role did not provide any benefit for depressive symptoms among older men and women. We discovered a need for policies that provide support for employed older adults, especially in a society with rapid population growth and no mature social security system for retirees. In the future, additional longitudinal studies could provide evidence for the impact of employment status on depressive symptoms, particularly in developing countries. Funding This study was made possible by a Korea Research Foundation Grant (KRF-2007-321-B00096) funded by the Korean government Ministry of Education and Human Resource Development. Acknowledgments S. N. Jang performed all statistical analyses and interpretation and wrote and revised the paper. S. I. Cho helped data analyses and helped plan the study. J. Chang, K. Boo, H. G. Shin, and H. Lee contributed to study design, data collection, and interpretation of data. L. F. Berkman supervised data analyses and revising the paper. Correspondence Address correspondence to Soong-Nang Jang, PhD, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115. Email:
[email protected]. edu References Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiological Studies Depression Scale). American Journal of Preventive Medicine, 10, 77–84. Butterworth, P., Gill, S. C., Rodgers, B., Anstey, K. J., Villamil, E., & Melzer, D. (2006). Retirement and mental health: Analysis of the
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Australian national survey of mental health and well-being. Social Science & Medicine, 62, 1179–1191. Chang, J. (2003). Labor market and labor policy in aging society. Seoul, South Korea: Korea Labor Institute. Christ, S. L., Lee, D. L., Fleming, L. E., LeBlane, W. G., Arheart, K. L., & Chung-Bridges, K. (2007). Employment and occupation effects on depressive symptoms in older Americans: Does working past age 65 protect against depression? Journals of Gerontology: Social Sciences, 62, S399–S403. Dannefer, D. (1984). Adult development and social theory: A paradigmatic reappraisal. American Sociological Review, 49, 100–116. Ezzy, D. (1993). Unemployment and mental health: A critical review. Social Science & Medicine, 37, 41–52. Flippen, C., & Tienda, M. (2000). Pathways to retirement: Patterns of labor force participation and labor market exit among the pre-retirement population by race, Hispanic origin, and sex. Journals of Gerontology: Social Sciences, 55, S14–S27. Hepworth, S. (1980). Moderating factors of the psychological impact of unemployment. Journal of Occupational Psychology, 53, 139–145. Hill, J. (1978). The psychological impact of unemployment. New Society, 798, 118–120. Holzer, C. E., Shea, B. M., Swanson, J. W., Leaf, P. J., Myers, J. K., George, L., Weissman, M. M., & Bednarski, P. (1986). The increased risk for specific psychiatric disorders among persons of low socioeconomic status: Evidence from the Epidemiologic Catchment Area Surveys. American Journal of Social Psychiatry, 6, 259–271. Irwin, M., Artin, K. H., & Oxman, M. (1999). Screening for depression in the older adult: Criterion validity of the 10-item Center for Epidemiological Studies–Depression Scale (CES-D). Archives of Internal Medicine, 159, 1701–1704. Jeon, K. S., Jang, S. N., Cho, S. I., Kawachi, I., & Rhee, S. J. (2007). Gender differences in correlates of mental health among elderly Koreans. Journals of Gerontology: Social Sciences, 62, S323–S329. Jones, S. J. (2005). The labor market in Korea: Enhancing flexibility and raising participation. Economic Department Working Papers, No. 469. Paris: Organisation for Economic Co-operation and Development. Kang, Y. W., Na, D. L., & Han, S. H. (1997). A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. Journal of the Korean Neurological Association, 15, 300–308. Khang, Y. H., & Kim, H. R. (2006). Socioeconomic mortality inequality in Korea: Mortality follow-up of the 1998 National Health and Nutri-
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tion Examination Survey (NHANES) Data. Journal of Preventive Medicine & Public Health, 39, 115–122. Kim, H. J., & Yoo, K. S. (2004). Determinants of reemployment of elderly workers. Journal of the Korean Gerontological Society, 24, 97–110. Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health, 5, 179–193. Korean National Statistics. (2006). Statistics for the elderly. Daejeon, South Korea: Author Korean National Statistics. Kwon, S., & Hwang, K. (2004). A study on determinants of retirement in the elderly: Focusing on differences by gender and residential district. Journal of the Korean Gerontological Society, 24, 69–90. Littell, R. C., Stroup, W. W., & Freund, R. J. (2002). SAS for linear models. (4th ed.) Cary, NC: SAS publishing Inc. Melzer, D., Buxton, J., & Villamil, E. (2004). Decline in common mental disorder prevalence in men during the sixth decade of life: Evidence from the National Psychiatric Morbidity Survey. Social Psychiatry and Psychiatric Epidemiology, 39, 33–38. Mirowsky, J., & Ross, C. E. (1992). Age and depression. Journal of Health and Social Behavior, 33, 187–205. Moen, P. (1996). A life course perspective on retirement, gender, and wellbeing. Journal of Occupational Health Psychology, 1, 131–144. Organisation for Economic Co-operation and Development. (2000). Labor market reform and social safety net: Policies in Korea. Retrieved September 18, 2008, from http://www.oecd.org/publications/Pol_brief/ Pearlin, L. I., Morton, A. L., Menaghan, E. G., & Mullan, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22, 33–57. Warr, P., & Jackson, P. (1984). Men without jobs: Some correlates of age and length of unemployment. Journal of Occupational Psychology, 57, 77–85. Won, C. W., Yang, K. Y., Rho, Y. G., Kim, S. Y., Lee, E., Yoon, J. L., Cho, K. H., Shin, H. C., Cho, B. R., Oh, J. R., et al. (2002). The development of Korean Activities of Daily Living (K-ADL) and Korean Instrumental Activities of Daily Living (K-IADL) Scale. Korean Journal of Geriatric Medicine, 6, 107–120. Received January 10, 2009 Accepted February 10, 2009 Decision Editor: Kenneth F. Ferraro, PhD
