Skip to main content


Log in

The impact of transitions from employment to retirement on suicidal behaviour among older aged Australians

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript



Transition from employment to retirement may be detrimental to mental health, and associated with suicidal behaviour. This study investigated the association between employment and retirement status and suicidal behaviour among older aged Australians.


This study was based on the ‘45 and Up Study’, a large prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed up over the period 2006–2018. The risk of attempted suicide and suicide was compared between categories of employment and retirement status in a series of recurrent event survival analysis models adjusting for identified time variant and invariant confounders.


Compared to those who were employed, the risk of attempted suicide was higher among those who were not in the labour force and not retired (predominantly those who were sick or disabled, or carers) (HR = 1.97–95% CI 1.49–2.62), those who retired involuntarily (HR = 1.35–95% CI 1.03–1.77), and to a lesser extent those unemployed (HR = 1.31–95% CI 0.89–1.92). Risk of attempted suicide among those who retired voluntarily was similar to those who remained employed (HR = 1.09–95% CI 0.82–1.45). A similar pattern was evident for suicide, with a higher risk of suicide among those who were not in the labour force or retired, and those who retired involuntarily, compared to those who remained employed; however, these differences were not statistically significant.


Transition from employment to retirement may be an important precipitating factor for suicidal behaviour, affected by current and previous mental health status. Services and programs facilitating continued or re-employment in older age, and adjustment to the transition from employment to retirement may prevent suicidal behaviour.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Code availability

Code can be provided by the authors on request


  1. Milner A, Page A (2016) A rise in Australian suicide? A reflection on the 2016 cause of death statistics. Aust N Z J Psychiatry 51(1):99–100

    Article  Google Scholar 

  2. Australian Bureau of Statistics (2018) 3303.0 Causes of Death, Australia, 2017. Commonwealth of Australia, Canberra

    Google Scholar 

  3. Milner A, Page A, LaMontagne AD (2013) Duration of unemployment and suicide in Australia over the period 1985–2006: An ecological investigation by sex and age during rising versus declining national unemployment rates. J Epidemiol Commun Health 67(3):237–244

    Article  Google Scholar 

  4. Butterworth P, Gill SC, Rodgers B, Anstey KJ, Villamil E, Melzer D (2006) Retirement and mental health: analysis of the Australian national survey of mental health and well-being. Soc Sci Med 62(5):1179–1191

    Article  Google Scholar 

  5. Milner A, Page A, LaMontagne AD (2013) Long-term unemployment and suicide: a systematic review and meta-analysis. PLoS ONE [Electronic Resource] 8(1):e51333.

    Article  CAS  Google Scholar 

  6. Milner A, Page A, Morrell S, Hobbs C, Dudley M, Duflou J, Taylor R (2014) The effects of involuntary job loss on suicide and suicide attempts among young adults: evidence from a matched case-control study. Aust N Z J Psychiatry 48(4):333–340.

    Article  PubMed  Google Scholar 

  7. Milner A, Spittal M, Page A, LaMontagne A (2013) The effect of leaving employment on mental health: testing ‘adaptation’versus ‘sensitisation’in a cohort of working-age Australians. Occupat Environ Med.

    Article  Google Scholar 

  8. Vo K, Forder PM, Tavener M, Rodgers B, Banks E, Bauman A, Byles JE (2015) Retirement, age, gender and mental health: findings from the 45 and Up Study. Aging Mental Health 19(7):647–657

    Article  Google Scholar 

  9. Schneider B, Grebner K, Schnabel A, Hampel H, Georgi K, Seidler A (2011) Impact of employment status and work-related factors on risk of completed suicide A case-control psychological autopsy study. Psychiatry Res 190(2–3):265–270.

    Article  PubMed  Google Scholar 

  10. Wong PWC, Chan WSC, Chen EYH, Chan SSM, Law YW, Yip PSF (2008) Suicide among adults aged 30–49: a psychological autopsy study in Hong Kong. BMC Public Health 8:147.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Harwood DMJ, Hawton K, Hope T, Harriss L, Jacoby R (2006) Life problems and physical illness as risk factors for suicide in older people: a descriptive and case-control study. Psychol Med 36(9):1265–1274

    Article  Google Scholar 

  12. Minayo MCdS, Meneghel SN, Cavalcante FG (2012) Suicide of elderly men in Brazil. Cienc 17(10):2665–2674

    Google Scholar 

  13. Milner A, Spittal MJ, Pirkis J, LaMontagne AD (2013) Suicide by occupation: systematic review and meta-analysis. Br J Psychiatry 203(6):409–416

    Article  Google Scholar 

  14. Fässberg MM, Orden KAV, Duberstein P, Erlangsen A, Lapierre S, Bodner E, Canetto SS, Leo DD, Szanto K, Waern M (2012) A systematic review of social factors and suicidal behavior in older adulthood. Internat J Environ Res Public Health 9(3):722–745

    Article  Google Scholar 

  15. Barnow S, Linden M, Freyberger H-J (2004) The relation between suicidal feelings and mental disorders in the elderly: results from the Berlin Aging Study (BASE). Psychol Med 34(4):741–746

    Article  CAS  Google Scholar 

  16. Takahashi Y, Hirasawa H, Koyama K, Asakawa O, Kido M, Onose H, Udagawa M, Ishikawa Y, Uno M (1995) Suicide and aging in Japan: an examination of treated elderly suicide attempters. Int Psychogeriatr 7(2):239–251

    Article  CAS  Google Scholar 

  17. Wiktorsson S, Runeson B, Skoog I, Östling S, Waern M (2010) Attempted suicide in the elderly: characteristics of suicide attempters 70 years and older and a general population comparison group. Am J Geriatr Psychiatry 18(1):57–67

    Article  Google Scholar 

  18. Dennis M, Wakefield P, Molloy C, Andrews H, Friedman T (2005) Self-harm in older people with depression: comparison of social factors, life events and symptoms. Br J Psychiatry 186(6):538–539

    Article  Google Scholar 

  19. Tsoh J, Chiu HF, Duberstein PR, Chan SS, Chi I, Yip PS, Conwell Y (2005) Attempted suicide in elderly Chinese persons: a multi-group, controlled study. Am J Geriat Psychiatry 13(7):562–571

    Article  Google Scholar 

  20. Fässberg MM, Cheung G, Canetto SS, Erlangsen A, Lapierre S, Lindner R, Draper B, Gallo JJ, Wong C, Wu J (2016) A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging & Mental Health 20(2):166–194

    Article  Google Scholar 

  21. 45 and Up Study_Collaborators (2008) Cohort profile: the 45 and up study. Int J Epidemiol 37(5):941

    Article  Google Scholar 

  22. Koenig HG, Westlund RE, George LK, Hughes DC, Blazer DG, Hybels C (1993) Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics 34(1):61–69

    Article  CAS  Google Scholar 

  23. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-L, Walters EE, Zaslavsky AM (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 32(6):959–976

    Article  CAS  Google Scholar 

  24. Andrews G, Slade T (2001) Interpreting scores on the Kessler psychological distress scale (K10). Aust N Z J Public Health 25(6):494–497

    Article  CAS  Google Scholar 

  25. Steele F (2011) Multilevel discrete-time event history models with applications to the analysis of recurrent employment transitions. Australian New J Stat 53(1):1–20

    Article  Google Scholar 

  26. Thomas L, Reyes EM (2014) Tutorial: survival estimation for Cox regression models with time-varying coefficients using SAS and R. J Stat Softw 61(c1):1–23

    Google Scholar 

  27. James G, Witten D, Hastie T, Tibshirani R (2014) An Introduction to Statistical Learning: With Applications in R. Springer Publishing Company, Incorporated

    Google Scholar 

  28. Core Team R (2018) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria

    Google Scholar 

  29. Dowle M, Srinivasan A (2019) data.table: Extension of `data.frame`. R package version 1.12.2.

  30. Wickham H (2016) ggplot2: Elegant Graphics for Data Analysis. Springer-Verlag, New York

    Book  Google Scholar 

  31. Harrison JE, Henley G (2014) Suicide and hospitalised self-harm in Australia: trends and analysis Injury research and statistics series INJCAT 169. Australian Institute of Health and Welfare, Canberra

    Google Scholar 

  32. Harrison JE, Pointer S, Abou Elnour A (2009) A review of suicide statistics in Australia. Australian Institute of Health and Welfare Canberra, Australia

    Google Scholar 

  33. Page A, Taylor R, Martin G (2010) Recent declines in Australian male suicide are real, not artefactual. Aust N Z J Psychiatry 44(4):358–363

    Article  Google Scholar 

  34. Mealing NM, Banks E, Jorm LR, Steel DG, Clements MS, Rogers KD (2010) Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs. BMC Med Res Methodol 10(1):26

    Article  Google Scholar 

  35. Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scocco P, Gallo J, Szanto K, Conwell Y, Draper B (2015) A systematic review of elderly suicide prevention programs. Crisis 32:88–98

    Article  Google Scholar 

  36. Page A, Milner A, Morrell S, Taylor R (2013) The role of under-employment and unemployment in recent birth cohort effects in Australian suicide. Soc Sci Med 93:155–162.

    Article  PubMed  Google Scholar 

Download references


We acknowledge the contribution to this project of A/Prof. Allison Milner who passed away in August 2019. With her untimely passing, the field of suicide prevention has lost an innovative and dynamic researcher, a principled colleague, and a friend. This research was completed using data collected through the 45 and Up Study ( The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW; and partners: the National Heart Foundation of Australia (NSW Division); NSW Ministry of Health; NSW Government Family AND Community Services—Ageing, Carers and the Disability Council NSW; and the Australian Red Cross Blood Service. We thank the many thousands of people participating in the ‘45 and Up Study’.


This work was supported by beyondblue and the National Health & Medical Research Council [APP1150655].

Author information

Authors and Affiliations


Corresponding author

Correspondence to Andrew Page.

Ethics declarations

Conflict of interest


Availability of data and material

Data from this study cannot be shared due to Data Custodian agreements relating to the access and use of the linked ‘45 and Up Study’ data held by the Sax Institute.

Additional information

Allison Milner: Deceased.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 572 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Page, A., Sperandei, S., Spittal, M.J. et al. The impact of transitions from employment to retirement on suicidal behaviour among older aged Australians. Soc Psychiatry Psychiatr Epidemiol 56, 759–771 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: