Transitioning to unemployment and medication use for depression or anxiety among older adults: educational stratification in medicalisation processes

Unemployment transitions in later life are associated with mental distress, yet their translation into mental health care utilisation remains underexamined. Adopting a medicalisation perspective, this study investigates associations between unemployment transitions and medication use for depression or anxiety among older adults, and whether these associations vary by educational attainment.

We analysed six biennial SHARE waves (4-9), including 20,158 observations from 14,225 respondents aged 50-67 years across 27 countries. Weekly medication use for depression or anxiety was examined using three-level random-effects logistic regression, with waves nested within individuals and individuals within countries. Models adjusted sequentially for health complaints, depressive complaints, and doctor visits, and tested interactions with education.

Transitioning into unemployment was associated with higher medication use, even after accounting for measured mental health complaints. Persistent unemployment was also associated with higher use, whereas re-employment showed no significant reduction. Interaction analyses indicated that persistent unemployment was most strongly associated with medication use among longer-educated adults.

Findings suggest that late-career unemployment is linked to socially patterned pharmacological responses beyond measured need. They therefore support a stratified medicalisation perspective and underline the importance of addressing both unemployment-related distress and the educationally patterned ways it becomes pharmacologically managed.