The Economics Of Gender And Mental Illness PDF
Preview The Economics Of Gender And Mental Illness
CONTENTS LISTOFCONTRIBUTORS vii INTRODUCTION DaveE.MarcotteandVirginiaWilcox-Gök 1 GENDERDIFFERENCESINMENTALDISORDERSINTHE U.S.NATIONALCOMORBIDITYSURVEY RonaldC.Kessler 7 EARLYONSETDEPRESSIONANDHIGHSCHOOL DROPOUT VirginiaWilcox-Gök,DaveE.Marcotte,FarahFarahati andCareyBorkoski 27 GENDERDIFFERENCESINTHELABORMARKET EFFECTSOFSERIOUSMENTALILLNESS PierreKébreauAlexandre,JosephYvardFede andMarshaMullings 53 MENTALILLNESS:GENDERDIFFERENCESWITH RESPECTTOMARITALSTATUSANDLABOURMARKET OUTCOMES NielsWestergaard-Nielsen,EsbenAgerbo,TorEriksson andPrebenBoMortensen 73 MENTALHEALTHANDEMPLOYMENTTRANSITIONS CaroleRoanGresenzandRolandSturm 95 v vi GENDER-SPECIFICPATTERNSOFEMPLOYMENTAND EMPLOYMENTTRANSITIONSFORPERSONSWITH SCHIZOPHRENIA:EVIDENCEFROMTHE SCHIZOPHRENIACAREANDASSESSMENT PROGRAM(SCAP) DavidS.Salkever,EricP.SladeandMustafaKarakus 109 THEROLEOFGENDERINACOMPANY-WIDEEFFORT TOEXPANDANDDESTIGMATIZEMENTALHEALTH TREATMENT AnthonyT.LoSasso,RichardC.Lindrooth andIthaiZ.Lurie 133 GETTINGMENANDWOMENRECEIVING DEPRESSION-RELATEDSHORT-TERMDISABILITY BENEFITSBACKTOWORK:WHEREDOWEBEGIN? CarolynS.Dewa,JeffreyS.HochandPaulaGoering 155 INSURANCESTATUSOFDEPRESSEDLOW-INCOME WOMEN AllisonA.Roberts 177 LIST OF CONTRIBUTORS EsbenAgerbo NationalCenterforRegisterResearch, UniversityofAarhus,Denmark PierreKe´breau HealthServicesResearchCenterand Alexandre DepartmentofEpidemiologyandPublic Health,SchoolofMedicine,Universityof Miami,USA CareyBorkoski DepartmentofPublicPolicy,Universityof Maryland,BaltimoreCounty,USA CarolynS.Dewa CentreforAddictionandMentalHealth, HealthSystemsResearch&ConsultingUnit, UniversityofTorontoDepartmentof Psychiatry,Canada TorEriksson CenterforCorporatePerformance,Aarhus SchoolofBusiness,Denmark FarahFarahati ProgramforAssessmentandTechnologyand Healthcare,McMasterUniversity,Canada JosephYvardFede HealthServicesResearchCenter,Schoolof Medicine,UniversityofMiami,USA PaulaGoering CentreforAddictionandMentalHealth, HealthSystemsResearch&ConsultingUnit, UniversityofToronto,Departmentof Psychiatry,Canada CaroleRoanGresenz RANDCorporation,USA JeffreyS.Hoch DepartmentofEpidemiologyand Biostatistics,UniversityofWesternOntario, Canada vii viii MustafaKarakus DepartmentofHealthPolicyand Management,BloombergSchoolofPublic Health,JohnsHopkinsUniversity,USA RonaldC.Kessler DepartmentofHealthCarePolicy,Harvard MedicalSchool,USA RichardC.Lindrooth DepartmentofHealthAdministrationand Policy,MedicalUniversityofSouth Carolina,USA AnthonyT.LoSasso InstituteforPolicyResearch,Northwestern University,USA IthaiZ.Lurie InstituteforPolicyResearch,Northwestern University,USA DaveE.Marcotte DepartmentofPublicPolicy,Universityof Maryland,BaltimoreCounty,USA PrebenBoMortensen NationalCenterforRegisterResearch, UniversityofAarhus,Denmark MarshaMullings HealthServicesResearchCenter,Schoolof Medicine,UniversityofMiami,USA AllisonA.Roberts DepartmentofEconomics,LakeForest College,USA DavidS.Salkever DepartmentofHealthPolicyand Management,BloombergSchoolofPublic Health,JohnsHopkinsUniversity,USA EricP.Slade DepartmentofHealthPolicyand Management,BloombergSchoolofPublic Health,JohnsHopkinsUniversity,USA RolandSturm RANDCorporation,USA Niels CenterforCorporatePerformance,Aarhus Westergaard-Nielsen SchoolofBusiness,Denmark VirginiaWilcox-Go¨k DepartmentofEconomics,Northern IllinoisUniversity,USA INTRODUCTION Dave E. Marcotte and Virginia Wilcox-Go¨k The past quarter-century has seen research on the economic impacts of mental illnessflourish.Innovationsinmeasurementandthereleaseofseveralcommunity- based and often nationally representative data sets containing valid and reliable diagnosticinformationhaveenabledresearcherstomakesubstantialadvancesin understandingthemyriadwaysthatmentalillnessimpactstheeconomiclivesof the ill and their families. Among the most interesting and persistent findings in thisliteratureisthatmentalillnessaffectswomenandmendifferently.Notonlydo womenandmenhaveverydifferentratesofprevalenceforvariousdiseases,but mentalillnessisalsocommonlyfoundtohavedifferenteffectsintheireconomic lives. Researchintothewaysinwhichmentalillnessshapestheeconomiclivesofthe illhasidentifiedimportantgenderdifferencesthroughoutthelifecycle.Beginning duringadolescence,mentalillnessamongfamilymembersappearstohavediffer- enteffectsonboys’andgirls’educationalattainment.Duringadulthood,women often withdraw from the labor market more quickly than do men when afflicted withmentalillness.Amongthosewhoareemployed,earningslossesduetomen- talillnessareoftenfoundtovarybygender.Further,womenandmenundertake treatmentformentalillnessatdifferentrates,andthismayaffecttheirabilityto maintainproductivelivesastheyadapttotheirillnesses. Thedimensionsalongwhichtheexperiencesofmenandwomenwithmental illnessdifferarenumerous,asarethedata,methodsandeconomistswhohavestud- iedthetopic.Whilegenderhassooftenbeenfoundtobeanimportantdeterminant ofprevalenceandoutcomesofmentalillness,economistshaverarelyfocusedon genderdifferencesasacentralelementoftheiranalyses.Inthisvolume,ouraimis todirectthefocusofresearchintheeconomicsofmentalhealthmoresquarelyon TheEconomicsofGenderandMentalIllness ResearchinHumanCapitalandDevelopment,Volume15,1–6 ©2004PublishedbyElsevierLtd. ISSN:0194-3960/doi:10.1016/S0194-3960(04)15001-4 1 2 DAVEE.MARCOTTEANDVIRGINIAWILCOX-GO¨K thetopicofgender.Eachpaperinthisvolumeeachprovidesinsightintotheways inwhichwomenandmenareafflictedandaffectedbymentalillnessinthelabor market; highlighting both differences and similarities. It is our intention that by compilingasetoffirst-ratepapersthatfocusongender,wecanfacilitateamore complete understanding of the patterns and economic consequences of mental illnessoverthelifecourse. Wehopethattheresearchcompiledherein,asindividualpapersandasacol- lection, will provide the reader with a richer understanding of the prevalence of mental disorders, the educational, employment and earnings impacts of psychi- atricdisease,andprospectsfortreatingandprovidingaccesstohealthcareforthe mentally ill. Accordingly, we have organized this volume along just these lines: prevalence,effectsofdisease,andtreatmentandaccesstocare. ThevolumebeginswithastudybyKesslerthatreportsongenderdifferences inpatternsofmentalillnessintheUnitedStatesfromtheNationalComorbidity Survey(NCS).TheNCSisthefirstnationallyrepresentativedatasetthatallows estimationof12-monthandlifetimeratesofprevalenceofmentalillnessaswellas theassessmentofdemographic,social,andeconomiccorrelatesofprevalence.The NCSemployedamodifiedversionoftheWorldHealthOrganization’sComposite International Diagnostic Interview (CIDI) to make diagnoses using the criteria definedbytheDiagnosticandStatisticalManual,3rdedition,revised(DSM-III- R). The structured diagnostic interview is used by non-clinicians and has been shown to be a reliable and valid instrument for measuring mental illness. While Kesslerfindssmalldifferencesintheoverallratesofprevalenceofmentalillness,he reportssubstantialdifferencesinprevalencefornearlyallspecificillnesses.Most notably,womenaresubstantiallymorelikelytosufferfrommooddisordersand anxietydisorders,whilemenweremorelikelytohavesubstanceabuseandconduct andantisocialbehaviordisorders.Kesslerreportsthatamongtheill,womenare muchmorelikelythanmentoreportseekingprofessionalhelpfortheirpsychiatric problems.Hepresentssomeevidencethatthisisbecausewomencanmorereadily perceiveneedforsuchhelp.Finally,Kesslernotesthatitistroublingthatwomen haveequallypersistentandseverehistoriesofmentalillness,despitetheirhigher rateoftreatment.Thisleavesopenimportantquestionsaboutgenderdifferences intherapeuticefficacy. Thenextpaperfocusesonunderstandingeconomiceffectsofmentalillnessat anearlystageofthelifecycle.Wilcox-Go¨k,Marcotte,FarahatiandBorkoskipoint outthatwhilewehavecometounderstandtheemploymentandearningseffects ofmentalillnessfairlywell,littleisknownabouttheimpactofadolescentmental illnessoneducationalattainment.UsingtheNCSdata,Wilcox-Go¨ketal.estimate the effects of depression on the likelihood of dropping out of high school. They do so because high school dropout is known to be associated with substantial, Introduction 3 and growing, earnings losses during a person’s working life, and claim that this focus provides an indication of heretofore little examined indirect labor market costs of depression. To identify the effects of adolescent depression on dropout, Wilcox-Go¨ketal.focusonthesub-groupwithonsetbeforetheageof16(theage to which most states make attendance compulsory), dropping from the analysis thosewithonsetbetween16and18.Comparingtheserespondentstoareference groupwithoutearlyonsetmentalillness,theauthorsfindthatdepressionamong boysisassociatedwithasubstantiallyelevatedriskforhighschooldropout,butthe sameisnottrueforgirls.WhileWilcox-Go¨ketal.findthatearlyonsetofalcohol disorders increases the risk of high school dropout for both sexes, they report evidencethatthiscannotbeattributedtothecomorbiditybetweendepressionand alcoholdisorders. ThepaperbyAlexandre,FedeandMullingsanalyzestheeffectsofmentalillness and labor supply. Making use of data from the first-ever wave of the National HouseholdSurveyonDrugAbusetoincludemeasuresofseriousmentalillness, the authors estimate effects of mental illness on unemployment and the number of workdays skipped among the employed. Alexandre et al. attempt to identify the labor supply effects of mental illness by exploiting measures of religiosity as instruments for serious mental illness. They find that serious mental illness substantially increases the risk of unemployment among men, but not women. The authors suggest this pattern is likely the result of women dropping out of the labor force altogether when afflicted with mental illness, not to the lack of anemploymenteffect.Thiswouldbeentirelyconsistentwithpreviousresearch. Equallysuggestiveofanegativeeffectonlaborsupply,Alexandreetal.findthat among those who remain employed, the seriously mentally ill miss more work dayseachmonth,likelybecauseofthedisabilitiesimposedbyillness. Thenextpaperprovidesauniquelookattherelationshipbetweenpsychiatric illnessandemploymentandearnings,aswellasthelikelihoodofmarriage(orco- habitation).Westergaard-Nielsen,Agerbo,ErikssonandMortensonusedatafrom theDanishLongitudinalLaborMarketRegister,whichisacompilationofvarious administrativedatacontaininginformationonincomeandunemployment,among other things, for a 5% sample of the Danish adult population. The data provide observationsonmorethan200,000persons,andtracksthemfornearly2decades, from 1976 to 1993. The authors have merged these data with an administrative datasetcoveringalladmissionsintopsychiatricinpatienthospitalsinDenmark; providinginformationonlengthofstayanddiagnosis.Westergaard-Nielsenetal. makeuseofamatchedcontrolgroupdesigntoexaminepatternsofemployment andmarriagebeforeandafterapsychiatrichospitaladmissioncomparedtopattern forobservationallysimilarbuthealthypeers.Theauthorsfindthatthementallyill sufferemploymentandearningslossesmanyyearspriortoadmission.Theyfind 4 DAVEE.MARCOTTEANDVIRGINIAWILCOX-GO¨K nosubstantialdifferencesbetweenmenandwomeninthelikelihoodofmaintain- ingemployment,thoughtheyfindthatmensufferrelativelylargeearningseffects. The authors suggest this may be due to differences in the extent to which jobs accommodate or are impeded by mental illness. Other possibilities include gen- derdifferencesindiseaseorseverity,oraccesstotreatment.Westergaard-Nielsen etal.alsofindthatdifferencesbetweencasesandcontrolsgrowmostrapidlyjust priortoadmission,butthenstabilizeintheyearsfollowingadmission.Ahopeful interpretation of this last finding is that treatment prevents further decay in the economicandsociallivesoftheill.Ontheotherhand,theillneverrecovertheir pre-admissionlevelsofemploymentandearningsvis-a`-viscontrols. Thenextpaperhelpsprovidesomecontextonemploymenttransitionsandmen- talhealththat,amongotherthings,isusefulforinterpretingtheAlexandreetal. andWestergaard-Nielsenetal.papers.Inthispaper,GresenzandSturmmakeuse oftheHealthcareforCommunitiesdatatoanalyzetherelationshipbetweenmental healthandtransitionsbetweenemployment,unemploymentandbeingoutofthe labor force. The authors exploit panel features of the data to examine employ- ment transitions between waves and their relationship with recent mental health episodesasmeasuredattheinitialinterview.GresenzandSturmfindinteresting andimportantdifferencesbetweentheemploymenttransitionsofwomenandmen subsequent to an episode of mental illness. Most notably, they find that women recentlysufferinganepisodeassociatedwithdepressionorananxietydisorderare more likely to drop out of the labor force altogether. Interestingly they are also morelikelytorejointhelaborforceiftheywereoutofthelaborforce.Formen, however,thereisnotthispatternofexitingthelaborforce.Nonetheless,Gresenz andSturmfindthatmenwithanxietyordepressivedisordersarelesslikelytofind employment. Inthefinalpaperinthevolumetoexamineemploymentconsequences,Salkever, SladeandKarakusexaminegenderdifferencesinemploymentpatternsandtran- sitionsamongpersonswithschizophrenia.Theyanalyzedatafromalargescale surveyconductedatsixsitesaroundtheUnitedStates:theSchizophreniaCareand AssessmentProgram(SCAP).SCAPisalongitudinalstudy,soparticipantswere interviewedatsixmonthintervalsoveraperiodofuptothreeyears.Notsurpris- ingly,employmentratesandemploymentstabilityarequitelowamongthosewith schizophreniacomparedtothegeneralpopulation.Importantly,Salkeveretal.find that among those with schizophrenia, women are more likely to have long-term periods of non-employment, and are more likely to lose a job if employed. The authorsfindthatamongschizophrenics,educationhasalargerpositiveeffecton thelikelihoodofemploymentforwomen.But,women’semploymentchancesare alsomorenegativelyaffectedbynegativesymptomsofdisease.Salkeverandhis colleagues speculate that this may be related to gender differences in the types Introduction 5 ofjobsthosewithschizophreniahold:perhapswomenholdjobsthatrequirein- terpersonalratherthanmanualskills,andhencenegativesymptomsimposemore importantlimitationsontheirjobperformance,onaverage.Whiletheauthorsdo not have the data to test this hypothesis, their results serve to both answer and raiseimportantquestionsaboutthewaysinwhichwomenandmensufferingfrom debilitatingmentalillnessexperiencethelabormarketdifferently. Each of these papers on labor market impacts of mental illness confirm some importantfindingsofpreviousresearch,andeachraisesimportantquestions,too. A particular value of these papers is that they each utilize new or novel data to examinethisrelationship,therebycontributingimportantnewperspectiveintothe existingbodyofknowledge. Thenextthreepapersalsomakeuseofuniqueandexcellentdata,andprovide unusualinsightintotherelevanceofgenderinmentalhealthservicesutilization, re-employment after disability leave, and also access to health insurance among poor,depressedwomen.Thefirstofthesepapersmakesuseofdatafromamulti- nationalU.S.communicationsandelectronicscompany,employingaround75,000 workersintheU.S.thatimplementedachangeinmentalhealthbenefits.Inthis paper,LoSasso,LindroothandLuriedescribeachangeinhealthinsurancebenefits atthiscompanythatreducedco-paymentsformentalhealthtreatment,provided employees access to a network of mental health providers which included non- physicianspecialists,andadoptedeffortstode-stigmatizementalhealthtreatment. Theauthorsfoundsignificantincreasesinthelikelihoodthatemployeesinitiated mentalhealthtreatmentsubsequenttothebenefitchange,andmostofthiswasthe resultofincreasesintheuseofnon-physicianmentalhealthspecialists.LoSasso et al. found no differences in the way women and men responded to the benefit change.Whilewomenweremorelikelytoinitiatementalhealthtreatmentpriorto andafterthebenefitchange,bothmenandwomenincreasedtheirratesofmental health care utilization subsequent to the change in the company’s mental health benefitpackageandde-stigmatizationeffort.Takenasawholetheauthors’findings providecauseforoptimismthatbothworkingmenandwomencanbeencouraged toseekmentalhealthtreatment. Inthenextpaper,Dewa,HochandGoeringexaminegenderdifferencesinout- comesfromshort-termdepression-relateddisabilityleave.Theauthorsmakeuseof administrativerecordsfromthreemajorfinancialcompaniesinCanada,together employing some 63,000 worker (about 12% of Canadian workers in the indus- try).Dewaetal.compileddatafromeachcompany’sshort-termdisabilityclaims, prescriptiondrugclaimsandoccupationalhealthdepartmentrecords.Theauthors usedthedatatoexaminehowworkexperience,occupation,depressionsymptoms, recommendedclinicalguidelineuseofantidepressantsalongwithgenderaffected twokeyoutcomes:useofanti-depressantmedicationduringthedisabilityepisode,
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