Mental illness, nativity, gender and labor supply

Causal effects of mental health on food security

Although mental health conditions are known to be associated with socioeconomic hardships, their causal effects remain largely unexplored. Using a sample of low-income families in the National Health Interview Survey (NHIS), we assess causal effects of serious mental illness (SMI) and related mental health conditions on family food security. We apply partial identification methods to account for fundamental endogeneity and measurement identification problems in a unified framework. To implement these methods, we combine a proxy measure of SMI in the NHIS with an estimate of the true rate of SMI from the Substance Abuse and Mental Health Services Administration. We also develop an innovative approach to approximate true prevalence rates when only self-reported prevalence rates are available. Applying relatively weak monotonicity assumptions on latent food security outcomes, we find that alleviating SMI would improve the food security rate by at least 9.5 percentage points, or 15 %. JEL codes: C21, I10, I38.

Household Wealth and Individuals' Mental Health: Evidence from the 2012-2018 China Family Panel Survey

Based on the data from the 2012-2018 China Family Panel Survey, this study examines the impact of household wealth on individuals' mental health using a two-way fixed effects model. The findings indicate that household wealth exerts a significant positive effect on individuals' mental health. Furthermore, this study shows that the impact of household wealth on individuals' mental health is nonlinear but inverted U-shaped. Considering the possible endogeneity problem, this study further examines the effect of household wealth on residents' mental health using two-stage least squares, and the conclusions remain robust. The results of the heterogeneity analysis indicate that household wealth has a greater impact on the mental health of residents in the low-education group and western region. Furthermore, the results of the mechanisms reveal that household wealth affects mental health by influencing insurance investment and individuals' labor supply. Moreover, this study finds that household wealth affects individuals' mental health not only in the short term but also in the medium and long terms. This study provides policy implications for the government toward improving individuals' mental health.

Depression and labor supply: Evidence from the Netherlands

We estimate the relationship between depression and labor-market outcomes using data from the Longitudinal Internet studies for the Social Sciences (LISS) panel (2008 - 2018) from the Netherlands. The paper provides three main findings. First, depression is not associated with women's labor market participation, but it is associated with their likelihood of having paid employment (conditional on being in the labor force). Second, depression is associated with men's labor force participation, likelihood of having paid employment and likelihood of working full time. Third, severity of depression matters. More severe symptoms are associated with more adverse labor-market outcomes. In addition, we examine the mechanism behind the relationship between depression and labor market outcomes. We find that happiness, life satisfaction, and pessimistic beliefs about the future are partially mediating the effects.

Active leisure, passive leisure and health

Leisure consumption has been increasing in the United States since the 1960s. Over the same period, inactive lifestyles have contributed to adverse health outcomes. We propose a new way of categorizing leisure into groups based on the amount of physical exercise needed. Our results show that physically active leisure is a normal good whose demand rises with education and health, while physically passive leisure is an inferior good whose demand rises with lower education and poorer health. These patterns allow us to propose a taxonomy that categorizes various leisure activities into 'Active' and 'Passive' groups.

No gain in pain: psychological well-being, participation, and wages in the BHPS

Accounting for endogeneity, unobserved heterogeneity, and sample selection in an unified framework, we investigate the effect of psychological well-being on wages and labour market participation using a panel from the British Household Panel Survey. We find the effect of psychological well-being on labour market outcomes to differ across gender. In particular, psychological distress significantly reduces participation across genders, but, conditional on participation, has a significant negative effect on hourly wages only in the female sample.

Heterogeneity in the associations between common mental disorders and labour outcomes - a population study from southern Sweden

Background

Previous research has shown that Common Mental Disorders (CMD) are unequally distributed between population subgroups, but we know less about how labour outcomes following such disorders are distributed. Our aim is to investigate how the labour outcomes following a CMD diagnosis differ over sex, age, schooling and country of birth.

Methods

We use a population sample from southern Sweden of patients diagnosed with CMD during calendar years 2009–2011, and a matched general population control group, to study labour market outcomes three years following diagnosis. Logistic regression is used to study the associations between a CMD diagnosis and outcomes in employment, sick leave, and disability pension. Interaction analysis is used to study heterogeneity in these associations.

Results

CMD diagnosis is associated with reduced employment and increased odds of sick leave and disability pension. Following a CMD diagnosis, men and higher educated individuals have higher odds of non-employment and sick leave compared to women and the lower educated. Foreign-born individuals have higher odds of non-employment and lower odds of sick leave, compared to individuals born in Sweden. Heterogeneity appears to be present also based on age. Younger age is associated with higher odds of non-employment and disability pension and lower odds of sick leave, following a CMD diagnosis.

Conclusions

Heterogeneity in labour outcomes following a CMD diagnosis sometimes contributes to and sometimes mitigates inequalities in employment, sick leave and disability pension between population subgroups. When developing new strategies to tackle mental ill-health in the population, it may therefore be motivated to consider not only inequalities in the prevalence of mental disorders but also heterogeneity in associated adverse labour outcomes.

Working with a Severe Mental Illness: Estimating the Causal Effects of Employment on Mental Health Status and Total Mental Health Costs

Employment is an important goal for persons who have a severe mental illness (SMI). The current literature finds some evidence for a positive relationship between employment and measures of mental health (MH) status, however study design issues have prevented a causal interpretation. This study aims to measure the causal effect of employment on MH status and total MH costs for persons with SMI. In a quasi-experimental prospective design, self-reported data measured at baseline, 6-months, and 12-months, on MH status and employment are paired with Public Mental Health System (PMHS) claims data. The study population (N = 5162) is composed of persons with a SMI who received PMHS services for a year or more. Outcome variables are MH status symptom scores from the BASIS-24 instrument and total MH costs. The estimation method is full information maximum likelihood, which allows for tests of employment endogeneity. Outcomes with an insignificant test of endogeneity are estimated using tobit or ordinary least square (OLS). Employment has modest but meaningful effects on MH status (including overall MH status, functioning, and relationships) and reduces total mental health costs on average by $538 in a 6-month period. Tests of endogeneity were largely insignificant, except for the depression score that tested marginally statistically significant. Interaction terms between baseline MH scores and employment indicated larger employment effects for individuals with worse baseline scores. This study demonstrates the non-vocational benefits of employment for individuals with SMI. Results have high generalizability and should be of interest to federal and state governments in setting appropriate disability policy and funding vocational programs. From a methodological perspective, future research should still be concerned with potential endogeneity problems, especially if employment status and MH outcomes are simultaneously measured and/or baseline measures of MH are not adequately controlled for future research should continue to examine the multi-dimensional nature of MH status and costs. Our analyses also demonstrate the practical use of a state-wide outcomes measurement program in assessing the factors that influence the recovery trajectories of individuals with SMI.

Paid employment and common mental disorders in 50-64-year olds: analysis of three cross-sectional nationally representative survey samples in 1993, 2000 and 2007

AIMS

Associations between employment status and mental health are well recognised, but evidence is sparse on the relationship between paid employment and mental health in the years running up to statutory retirement ages using robust mental health measures. In addition, there has been no investigation into the stability over time in this relationship: an important consideration if survey findings are used to inform future policy. The aim of this study is to investigate the association between employment status and common mental disorder (CMD) in 50-64-year old residents in England and its stability over time, taking advantage of three national mental health surveys carried out over a 14-year period.

METHODS

Data were analysed from the British National Surveys of Psychiatric Morbidity of 1993, 2000 and 2007. Paid employment status was the primary exposure of interest and CMD the primary outcome - both ascertained identically in all three surveys (CMD from the revised Clinical Interview Schedule). Multivariable logistic regression models were used.

RESULTS

The prevalence of CMD was higher in people not in paid employment across all survey years; however, this association was only present for non-employment related to poor health as an outcome and was not apparent in those citing other reasons for non-employment. Odds ratios for the association between non-employment due to ill health and CMD were 3.05 in 1993, 3.56 in 2000, and 2.80 in 2007, after adjustment for age, gender, marital status, education, social class, housing tenure, financial difficulties, smoking status, recent physical health consultation and activities of daily living impairment.

CONCLUSIONS

The prevalence of CMD was higher in people not in paid employment for health reasons, but was not associated with non-employment for other reasons. Associations had been relatively stable in strength from 1993 to 2007 in those three cross-sectional nationally representative samples.

The burden of out of pocket costs and medical debt faced by households with chronic health conditions in the United States

Introduction

To examine the relationship between chronic health conditions and out-of-pocket costs (OOPC) and medical debt.

Methods

Secondary data from the 2013 Panel Study of Income Dynamics (PSID) was used. Households whose head of household and spouse (for married households) were 18 to 64 years old were included.

Results

Households with 1 to 3 chronic conditions had higher odds of having any OOPC compared to households with no chronic conditions (AOR 1.74, 95% CI 1.39, 2.17) (p < .01). Households with 1 to 3 and 4 or more chronic health conditions were associated with higher odds of having any medical debt (AOR 2.24, 95% CI 1.75 to 2.87; AOR 5.04, 95% CI 3.04 to 8.34) compared to those with no chronic conditions (p < 0.01). Similarly, 1 to 3 and 4 or more chronic health conditions was associated with higher amounts of OOPC (Exponentiated Coefficient 1.18, 95% CI 1.03 to 1.36; Exponentiated Coefficient 1.56, 95% CI 1.17 to 2.07) and medical debt (Exponentiated Coefficient 1.69, 95% CI 1.23 to 2.34; Exponentiated Coefficient 2.73, 95% CI 1.19 to 6.25) compared to households with no chronic conditions (p < 0.05).

Conclusions

Findings from this study show that the presence of chronic health conditions impose a large financial burden on some households.

The impact of adverse health events on consumption: Understanding the mediating effect of income transfers, wealth, and health insurance

Using data from the Panel Study of Income Dynamics for years 1999-2013, we investigate the impact of physical and mental illnesses on household consumption and financial status. In comparison to severe physical health problems, mental illnesses lead to larger decreases in labor income. Increases in public and private transfers following the onset of a mental illness do not completely offset the decline in labor income. Consequently, we find a significant decrease in consumption expenditures after the household head experiences a mental problem. On the other hand, public and private transfers and accumulated wealth offset the relatively smaller decline in labor income and enable households with severe physical problems to smooth their consumption. Health insurance helps to prevent larger drops in consumption after the onset of a mental health problem.

Effects of Psychiatric Disorders on Labor Market Outcomes: A Latent Variable Approach Using Multiple Clinical Indicators

In this paper, we estimate the effect of psychiatric disorders on labor market outcomes using a structural equation model with a latent index for mental illness, an approach that acknowledges the continuous nature of psychiatric disability. We also address the potential endogeneity of mental illness using an approach proposed by Lewbel (2012) that relies on heteroscedastic covariance restrictions rather than questionable exclusion restrictions for identification. Data come from the US National Comorbidity Survey - Replication and the National Latino and Asian American Study. We find that mental illness adversely affects employment and labor force participation and also reduces the number of weeks worked and increases work absenteeism. To assist in the interpretation of findings, we simulate the labor market outcomes of individuals meeting diagnostic criteria for mental disorder if they had the same mental health symptom profile as individuals not meeting diagnostic criteria. We estimate potential gains in employment for 3.5 million individuals, and reduction in workplace costs of absenteeism of $21.6 billion due to the resultant improvement in mental health. Copyright © 2015 John Wiley & Sons, Ltd.

Crime Victimisation and Subjective Well-Being: Panel Evidence From Australia

This paper estimates the effect of physical violence and property crimes on subjective well-being in Australia. Our methodology improves on previous contributions by (i) controlling for the endogeneity of victimisation and (ii) analysing the heterogeneous effect of victimisation along the whole distribution of well-being. Using fixed effects panel estimation, we find that both types of crimes reduce reported well-being to a large extent, with physical violence exerting a larger average effect than property crimes. Furthermore, using recently developed panel data quantile regression model with fixed effects, we show that the negative effects of both crimes are highly heterogeneous, with a monotonic decrease over the distribution of subjective well-being. Copyright © 2015 John Wiley & Sons, Ltd.

Effects of maternal depression on family food insecurity

We use data from the Early Childhood Longitudinal Study-Birth Cohort to estimate the effects of maternal depression, a condition that is fairly common and can be severe, on food insecurity, a hardship that has increased substantially in the U.S. Using various model specifications, we find convincing evidence that severe maternal depression increases the likelihood that young children experience food insecurity by 23-79%, with estimates depending on model specification and measures of depression and food insecurity. For household food insecurity, the corresponding estimates are 11-69%. We also find that maternal depression increases reliance on several types of public programs, suggesting that the programs play a buffering role.

The Take-Up of Employer-Sponsored Insurance Among Americans with Mental Disorders: Implications for Health Care Reform

Little is known about how take-up of private health insurance coverage differs between those with and without mental disorders. This study seeks to fill this gap by using data from the 2004-2008 Medical Expenditure Panel Survey to examine differences in offers and take-up of employer-sponsored insurance (ESI) among adults aged 27-54. Little evidence that mental disorders are associated with take-up of offers of ESI coverage was found. This suggests that take-up rates in the Affordable Care Act (ACA) marketplaces by those with and without mental disorders may be similar. The ACA is especially important to Americans with mental disorders, many of whom lack access to ESI coverage to pay for mental health treatment either through their own job or through a spouse's job.

The effect of mental health on employment: evidence from Australian panel data

To what extent does poor mental health affect employment outcomes? Answering this question involves multiple technical difficulties: two-way causality between health and work, unobservable confounding factors and measurement error in survey measures of mental health. We attempt to overcome these difficulties by combining 10 waves of high-quality panel data with an instrumental variable model that allows for individual-level fixed effects. We focus on the extensive margin of employment, and we find evidence that a one-standard-deviation decline in mental health reduces employment by 30 percentage points. Further investigations suggest that this effect is predominantly a supply rather than a demand-side response and is larger for older than young workers.

Exploring the intergenerational persistence of mental health: evidence from three generations

This paper uses data from the 1970 British Cohort Study to quantify the intergenerational persistence of mental health, and the long-run economic costs associated with poor parental mental health. We find a strong and significant intergenerational correlation that is robust to different covariate sets, sample restrictions, model specifications and potential endogeneity. Importantly, the intergenerational persistence is economically relevant, with maternal mental health associated with lasting effects on the child's educational attainment, future household income and the probability of having criminal convictions. These results do not disappear after controlling for children's own childhood and adulthood mental health.

Poor health, employment transitions and gender: evidence from the British Household Panel Survey

OBJECTIVES

We examined health selection in the context of transitions across employment statuses (employment, unemployment and inactivity), with attention to gender differences.

METHODS

60,536 transitions from 7,901 individuals were pooled from 17 waves of the British Household Panel Survey. Associations between self-rated health and transitions across employment statuses were examined using multilevel multinomial analysis.

RESULTS

Health selective employment transitions between year t-1 and t were observed at entry to as well as exit from employment. Associations for poor health with the transitions were similar for men and women in transitions from employment to both unemployment and to inactivity, but with some differences in other transitions. When leaving employment, transitions from employment to unemployment (OR(adjusted)(adjusted odds ratio) = 1.51, 95 % CI = 1.21-1.89 for men and OR(adjusted) = 1.60, 95 % CI = 1.25-2.04 for women) and to inactivity (OR(adjusted) = 1.58, 95 % CI = 1.21-1.89 for men and OR(adjusted) = 1.63, 95 % CI = 1.35-1.96 for women) were affected by health status among both men and women. Similarly, poor health lowered the probability of transitions to employment from unemployment and inactivity; however, the negative impact of poor health was statistically significant only for women.

CONCLUSIONS

There is a strong relationship between health and transitions both into and out of employment suggesting an independent role for poor health, and these associations were similar for men and women.

Course of major depressive disorder and labor market outcome disruption

BACKGROUND

Major depressive disorder (MDD) has been found to be negatively associated with labor market outcomes. However, MDD has many different courses that are chronic or persistent, relapsing and remitting, or limited to a single lifetime episode. Such heterogeneity has been ignored in most past analyses.

AIMS OF THE STUDY

We examine the impact of heterogeneity in course of MDD on labor market outcomes.

METHODS

Wave I (2001-2002) respondents of the National Epidemiological Survey on Alcohol and Related Conditions - a nationally representative panel survey - were interviewed on average 3 years later (2004-2005). We categorized changes in MDD before and after wave I and before wave II into six courses: incident, recent remission, persistent remission, relapse, persistent depression, and no history of MDD. Odds ratios (ORs) and marginal effects of MDD transitions in multivariable multinomial regressions of labor market outcomes (being out of the labor force, being unemployed, working part-time, and working full-time -- the reference outcome) are reported.

RESULTS

Men and women who exhibited persistent remission (2 to 3 years) were equally likely to be in the labor force, employed, and working full-time, compared to those with no history of MDD (reference group). For men, recently remitted MDD (less than 1 year), compared to the reference group, increased the likelihood of being unemployed (3.2% higher probability of being unemployed conditional on being in the labor force; OR = 1.97, 95% confidence interval [CI] = 1.13--3.44) and working part-time (5.8% higher probability of working part-time conditional on being employed; OR = 1.75, 95% CI = 1.10-2.80). For women, no statistically significant effect for recent remission was found. The negative effects of incident onset, relapse, and persistence of MDD were found on some labor market outcomes for men and, to a lesser extent, for women.

DISCUSSION

Clinical treatment for depression should be coordinated and/or integrated with work-related interventions that help individuals who are recovering from depression to maintain their jobs. Such coordination will add to the value of clinical treatment for depression.

IMPLICATIONS FOR HEALTH POLICIES

The impact of MDD on labor market outcomes varies by course of illness. Past studies may have underestimated lost earnings due to mental illness because they did not distinguish between recent and persistent remission and thus did not account for lost earnings due to recent remission.

IMPLICATIONS FOR FURTHER RESEARCH

Further research is needed to understand why there are differential impacts for men and women and to make causal inferences on the relationships between MDD and labor market outcomes.

Are adolescents with high socioeconomic status more likely to engage in alcohol and illicit drug use in early adulthood?

Background

Previous literature has shown a divergence by age in the relationship between socioeconomic status (SES) and substance use: adolescents with low SES are more likely to engage in substance use, as are adults with high SES. However, there is growing evidence that adolescents with high SES are also at high risk for substance abuse. The objective of this study is to examine this relationship longitudinally, that is, whether wealthier adolescents are more likely than those with lower SES to engage in substance use in early adulthood.

Methods

The study analyzed data from the National Longitudinal Survey of Adolescent Health (AddHealth), a longitudinal, nationally-representative survey of secondary school students in the United States. Logistic regression models were analyzed examining the relationship between adolescent SES (measured by parental education and income) and substance use in adulthood, controlling for substance use in adolescence and other covariates.

Results

Higher parental education is associated with higher rates of binge drinking, marijuana and cocaine use in early adulthood. Higher parental income is associated with higher rates of binge drinking and marijuana use. No statistically significant results are found for crystal methamphetamine or other drug use. Results are not sensitive to the inclusion of college attendance by young adulthood as a sensitivity analysis. However, when stratifying by race, results are consistent for white non-Hispanics, but no statistically significant results are found for non-whites. This may be a reflection of the smaller sample size of non-whites, but may also reflect that these trends are driven primarily by white non-Hispanics.

Conclusions

Previous research shows numerous problems associated with substance use in young adults, including problems in school, decreased employment, increases in convictions of driving under the influence (DUI) and accidental deaths. Much of the previous literature is focused on lower SES populations. Therefore, it is possible that teachers, parents and school administrators in wealthier schools may not perceive as great to address substance abuse treatment in their schools. This study can inform teachers, parents, school administrators and program officials of the need for addressing drug abuse prevention activities to this population of students.

Adolescents with depressive symptoms and their challenges with learning in school

We examine school performance among 83 adolescents at risk for major depression. Negative mood interfered with subjective measures of school performance, including ability to do well in school, homework completion, concentrate in class, interact with peers, and going to class. No significant relationships were found for mood and objective measures of school performance (school attendance, English, and Math grades). Students with a college-educated parent had stronger performance in objective measures (school attendance and Math grades), whereas males had lower English grades. In qualitative interviews, adolescents reported that negative thinking led to procrastination, which led to poor school performance, which led to more negative thinking. Adolescents with depressive symptoms that do not meet the threshold for referral report struggles in school. Understanding the specific challenges faced by adolescents with even low levels of depressive symptoms can help school nurses, teachers, and parents identify appropriate interventions to help adolescents succeed in school.