Psychiatric Disorders and Labor Psychiatric Disorders and Labor Market Outcomes: Evidence Market Outcomes: Evidence from the National Latino and from the National Latino and

Asian American Study (NLAAS)Asian American Study (NLAAS)

Pinka Chatterji, PhD, Mingshan Lu, PhD, Pinka Chatterji, PhD, Mingshan Lu, PhD, Margarita Alegria, PhD and David Takeuchi, PhDMargarita Alegria, PhD and David Takeuchi, PhD

June 7, 2004June 7, 2004

Disparities in Treatment for & Impact of Mental Disparities in Treatment for & Impact of Mental IllnessIllness

AcademyHealth 2004 Annual Research MeetingAcademyHealth 2004 Annual Research Meeting

AcknowledgementsAcknowledgements► The NLAAS data used in this analysis was provided by the The NLAAS data used in this analysis was provided by the

Center for Multicultural Mental Health Research at the Center for Multicultural Mental Health Research at the Cambridge Health Alliance Cambridge Health Alliance

► The project was supported by NIH Research Grant # U01 The project was supported by NIH Research Grant # U01 MH62209 funded by the National Institute of Mental Health MH62209 funded by the National Institute of Mental Health (M. Alegria and D. Takeuchi, PIs) as well as SAMHSA/CMHS (M. Alegria and D. Takeuchi, PIs) as well as SAMHSA/CMHS and OBSSR and OBSSR

► Pinka Chatterji additionally acknowledges research support Pinka Chatterji additionally acknowledges research support from grant K01 AA000328-03 from the National Institute of from grant K01 AA000328-03 from the National Institute of Alcohol Abuse and Alcoholism Alcohol Abuse and Alcoholism

► Mingshan Lu is an AHFMR (Alberta Heritage Foundation for Mingshan Lu is an AHFMR (Alberta Heritage Foundation for Medical Research) Population Health Investigator and thanks Medical Research) Population Health Investigator and thanks the foundation and Institute of Health Economics for financial the foundation and Institute of Health Economics for financial supportssupports

Objective Objective

The objective of this paper is to investigate the The objective of this paper is to investigate the effect of recent psychiatric disorders on three effect of recent psychiatric disorders on three labor market outcomes (current employment labor market outcomes (current employment

status, the number of weeks worked in the past status, the number of weeks worked in the past year, and the number of work absences in the year, and the number of work absences in the past month) using a nationally representative past month) using a nationally representative

sample of Latino and Asian Americanssample of Latino and Asian Americans

MotivationMotivation

A.A. Mental health and labor market outcomes Mental health and labor market outcomes literature –recent psychiatric disorders appear to literature –recent psychiatric disorders appear to detract from employment and earningsdetract from employment and earnings

B.B. Disparities in mental health and impact of mental Disparities in mental health and impact of mental illness - illness -

Minority individuals face distinct labor market Minority individuals face distinct labor market experiences due to factors such as experiences due to factors such as discrimination, citizenship, and language barriersdiscrimination, citizenship, and language barriers

Thus, the labor market consequences of mental Thus, the labor market consequences of mental disorders may be different for Latinos, Asians disorders may be different for Latinos, Asians and other minority individuals – the availability and other minority individuals – the availability of the NLAAS allows us to investigate this of the NLAAS allows us to investigate this question for the first timequestion for the first time

Background Background

► Previous work based on the NCS and the ECA surveys indicates Previous work based on the NCS and the ECA surveys indicates that a recent psychiatric disorder is associated with:that a recent psychiatric disorder is associated with: 21 percent reduction in earnings among men (Frank & Gertler 1991)21 percent reduction in earnings among men (Frank & Gertler 1991) 11 percentage point reduction in the probability of being employed 11 percentage point reduction in the probability of being employed

among men and women (Ettner et al. 1997)among men and women (Ettner et al. 1997)

► Substance use and substance use disorders are linked to Substance use and substance use disorders are linked to reduced educational attainment, but not necessarily to worse reduced educational attainment, but not necessarily to worse labor market outcomeslabor market outcomes ECA data indicates that onset of alcohol abuse before age 19 ECA data indicates that onset of alcohol abuse before age 19

reduces schooling by 1.5 years, which in turn reduces earnings reduces schooling by 1.5 years, which in turn reduces earnings (Mullahy & Sindelar 1994)(Mullahy & Sindelar 1994)

Alcoholism is associated with higher rates of employment among Alcoholism is associated with higher rates of employment among white women (Mullahy & Sindelar 1997)white women (Mullahy & Sindelar 1997)

Illicit drug use has negative or no effects on employment, but mixed Illicit drug use has negative or no effects on employment, but mixed effects on wages (DeSimone 2002, Kaestner 1991, 1994a, 1994b)effects on wages (DeSimone 2002, Kaestner 1991, 1994a, 1994b)

Contribution of this studyContribution of this study

►Builds on previous research on the labor Builds on previous research on the labor market consequences of mental disordersmarket consequences of mental disorders Comprehensive measures of psychiatric Comprehensive measures of psychiatric

illnessillness

►First study to investigate the impact of First study to investigate the impact of mental illness on labor market outcomes mental illness on labor market outcomes among ethnic minoritiesamong ethnic minorities Nationally representative sample of Asians Nationally representative sample of Asians

and Latinosand Latinos

DataData► NLAAS is a national psychiatric epidemiologic study being NLAAS is a national psychiatric epidemiologic study being

conducted to measure psychiatric disorders and mental health conducted to measure psychiatric disorders and mental health service usage in a nationally representative sample of Asians service usage in a nationally representative sample of Asians and Latinosand Latinos

► Analysis samples include NLAAS respondents between 18 and Analysis samples include NLAAS respondents between 18 and 65 years old who are not in school and have complete survey 65 years old who are not in school and have complete survey informationinformation

► Separate analysis by Latino and Asian ethnicity and genderSeparate analysis by Latino and Asian ethnicity and gender Male Latino sample (n = 1,024)Male Latino sample (n = 1,024) Female Latino sample (n = 1,233)Female Latino sample (n = 1,233) Male Asian sample (n = 820)Male Asian sample (n = 820) Female Asian sample (n = 892)Female Asian sample (n = 892)

► Descriptive statistics and models are weighted using nationally Descriptive statistics and models are weighted using nationally representative survey weights representative survey weights

NLAAS Sampling DesignNLAAS Sampling Design

Focus on Cubans, Mexicans, Puerto Ricans & other Latinos/Latinas

Focus on Chinese, Vietnamese,

Filipinos & other Asians

MethodsMethods► Previous researchers have faced two major methodological Previous researchers have faced two major methodological

challenges:challenges: statistical endogeneity (unobserved heterogeneity) statistical endogeneity (unobserved heterogeneity) structural endogeneity (reverse causality – work affects mental health)structural endogeneity (reverse causality – work affects mental health)

► Standard regression methods (such as OLS) ignore endogeneity Standard regression methods (such as OLS) ignore endogeneity problemproblem

► To deal with this problem, we use two approaches –To deal with this problem, we use two approaches –1.1. Including lifetime psychiatric disorder as a covariateIncluding lifetime psychiatric disorder as a covariate

a)a) Does not directly address structural endogeneityDoes not directly address structural endogeneity

2.2. IV methods, which purge mental disorder measure of its correlation with IV methods, which purge mental disorder measure of its correlation with the disturbance term, leading to consistent estimatesthe disturbance term, leading to consistent estimatesa)a) We use number of disorders with onset before age 18 as an We use number of disorders with onset before age 18 as an

identifying instrument (following Ettner et al. 1997)identifying instrument (following Ettner et al. 1997)b)b) Should be a good predictor of current mental disorders, but should Should be a good predictor of current mental disorders, but should

not directly impact current labor market outcomes if models control not directly impact current labor market outcomes if models control adequately for indirect pathwaysadequately for indirect pathways

MethodsMethods► Labor market outcomes:Labor market outcomes:

Employed:Employed: dummy variable =1 if respondent is currently dummy variable =1 if respondent is currently employed, 0 if respondent is unemployed or out of labor forceemployed, 0 if respondent is unemployed or out of labor force

Log of weeks worked:Log of weeks worked: among employed individuals, the log of among employed individuals, the log of the number of weeks worked in past year the number of weeks worked in past year

Number of absences: Number of absences: among employed individuals, number of among employed individuals, number of full days of work respondent missed in the past 30 daysfull days of work respondent missed in the past 30 days

► Current Psychiatric Disorders:Current Psychiatric Disorders: Any DSM IV mental disorder in past 12 months (major Any DSM IV mental disorder in past 12 months (major

depression, dysthymia, agoraphobia, panic disorder, social depression, dysthymia, agoraphobia, panic disorder, social phobia, substance use disorder, generalized anxiety disorder, phobia, substance use disorder, generalized anxiety disorder, PTSD, anorexia or bulimia)PTSD, anorexia or bulimia)

Results by type of psychiatric disorder in paper – not shown hereResults by type of psychiatric disorder in paper – not shown here

► Other covariates: ethnicity, number of family members under 18, Other covariates: ethnicity, number of family members under 18, age, education, marital status, state unemployment rateage, education, marital status, state unemployment rate

DESCRIPTIVE DESCRIPTIVE STATISTICSSTATISTICS

VariableVariable Asian Asian MalesMales

Asian Asian

FemalesFemalesLatino Latino

MalesMalesLatinoLatino

FemalesFemales

EmployedEmployed 0.8590.859 0.6650.665 0.8540.854 0.6150.615

Out of Out of labor forcelabor force

0.0900.090 0.2430.243 0.0710.071 0.3180.318

UnemployeUnemployedd

0.0510.051 0.0920.092 0.0760.076 0.0670.067

Weeks Weeks workedworked

45.0445.04 37.4137.41 45.4345.43 34.6834.68

Number of Number of absences in absences in

past 30 past 30 daysdays

1.511.51 2.372.37 1.371.37 1.511.51

VariableVariable Asian Asian MalesMales

Asian Asian

FemalesFemalesLatino Latino

MalesMalesLatinoLatino

FemalesFemalesAny current Any current

disorderdisorder0.0960.096 0.0880.088 0.1360.136 0.1900.190

Current major Current major depressiondepression

0.0560.056 0.0380.038 0.0500.050 0.0890.089

Current anxietyCurrent anxiety 0.0560.056 0.0450.045 0.0750.075 0.1240.124

Current Current substance substance abuse or abuse or

dependencedependence

0.0180.018 0.0060.006 0.0450.045 0.0140.014

Number of Number of disorders with disorders with onset prior to onset prior to

age 18age 18

0.2480.248 0.2010.201 0.3200.320 0.3340.334

SUMMARY OF SUMMARY OF REGRESSION REGRESSION

RESULTSRESULTS

Dependent Variable – Employed (0/1)Dependent Variable – Employed (0/1)Latino Samples Latino Samples

CoefficientCoefficient

(p-value)(p-value)

OLSOLS OLS OLS w/Lifetimew/Lifetime

IVIV

Males, 18-64Males, 18-64

Any 12 Any 12 month month

disorderdisorder

-0.121-0.121

(0.021)(0.021)-0.115-0.115

(0.050)(0.050)-0.071-0.071

(0.401)(0.401)

NN 1,0241,024

Females, 18-64Females, 18-64

Any 12 Any 12 month month

disorderdisorder

-0.154-0.154

(0.002)(0.002)-0.145-0.145

(0.027)(0.027)-0.160-0.160

(0.100)(0.100)

NN 1,2331,233

Dependent Variable – Employed (0/1)Dependent Variable – Employed (0/1)Asian Samples Asian Samples

CoefficientCoefficient

(p-value)(p-value)

OLSOLS OLS OLS w/Lifetimew/Lifetime

IVIV

Males, 18-64Males, 18-64

Any 12 Any 12 month month

disorderdisorder

-0.131-0.131

(0.176)(0.176)-0.075-0.075

(0.522)(0.522)-0.128-0.128

(0.503)(0.503)

NN 820820

Females, 18-64Females, 18-64

Any 12 Any 12 month month

disorderdisorder

-0.059-0.059

(0.547)(0.547)0.0800.080

(0.610)(0.610)-0.334-0.334

(0.102)(0.102)

NN 892892

Dependent Variable – Dependent Variable –

Log of weeks worked in past year Log of weeks worked in past year Latino Samples (Limited to Employed Persons)Latino Samples (Limited to Employed Persons)

CoefficientCoefficient

(p-value)(p-value)

OLSOLS OLS OLS w/Lifetimew/Lifetime

IVIV

Males, 18-64Males, 18-64

Any 12 Any 12 month month

disorderdisorder

0.0140.014

(0.833)(0.833)0.0720.072

(0.437)(0.437)0.1340.134

(0.191)(0.191)

NN 826826

Females, 18-64Females, 18-64

Any 12 Any 12 month month

disorderdisorder

-0.078-0.078

(0.461)(0.461)-0.168-0.168

(0.148)(0.148)0.1030.103

(0.606)(0.606)

NN 758758

Dependent Variable – Dependent Variable –

Log of weeks worked in past year Log of weeks worked in past year Asian Samples (Limited to Employed Persons)Asian Samples (Limited to Employed Persons)

CoefficientCoefficient

(p-value)(p-value)

OLSOLS OLS OLS w/Lifetimew/Lifetime

IVIV

Males, 18-64Males, 18-64

Any 12 Any 12 month month

disorderdisorder

-0.037-0.037

(0.627)(0.627)0.0640.064

(0.560)(0.560)-0.163-0.163

(0.506)(0.506)

NN 690690

Females, 18-64Females, 18-64

Any 12 Any 12 month month

disorderdisorder

-0.251-0.251

(0.445)(0.445)-0.365-0.365

(0.283)(0.283)0.2210.221

(0.405)(0.405)

NN 605605

Dependent Variable – Dependent Variable –

Number of work days missed in past monthNumber of work days missed in past monthLatino Samples (Limited to Employed Persons)Latino Samples (Limited to Employed Persons)

CoefficientCoefficient

(p-value)(p-value)

OLSOLS OLS OLS w/Lifetimew/Lifetime

IVIV

Males, 18-64Males, 18-64

Any 12 Any 12 month month

disorderdisorder

1.311.31

(0.100)(0.100)1.001.00

(0.242)(0.242)0.0180.018

(0.983)(0.983)

NN 825825

Females, 18-64Females, 18-64

Any 12 Any 12 month month

disorderdisorder

0.4360.436

(0.389)(0.389)1.321.32

(0.015)(0.015)-0.354-0.354

(0.747)(0.747)

NN 747747

Dependent Variable – Dependent Variable –

Number of work days missed in past monthNumber of work days missed in past monthAsian Samples (Limited to Employed Persons)Asian Samples (Limited to Employed Persons)

CoefficientCoefficient

(p-value)(p-value)

OLSOLS OLS OLS w/Lifetimew/Lifetime

IVIV

Males, 18-64Males, 18-64

Any 12 Any 12 month month

disorderdisorder

0.6190.619

(0.587)(0.587)0.6780.678

(0.616)(0.616)-0.421-0.421

(0.644)(0.644)

NN 690690

Females, 18-64Females, 18-64

Any 12 Any 12 month month

disorderdisorder

-0.064-0.064

(0.938)(0.938)2.052.05

(0.111)(0.111)2.112.11

(0.332)(0.332)

NN 603603

Summary of ResultsSummary of Results

► Any mental disorder in past 12 months detracts Any mental disorder in past 12 months detracts from employment for Latinos (both men and from employment for Latinos (both men and women) but not necessarily for Asianswomen) but not necessarily for Asians

► Effects persist in IV models and in models that Effects persist in IV models and in models that include lifetime psychiatric disorderinclude lifetime psychiatric disorder

►No effects of mental disorders on absences and No effects of mental disorders on absences and weeks worked among employed individualsweeks worked among employed individuals

► Similar results for depression, anxiety and Similar results for depression, anxiety and substance abuse/dependence (shown in the substance abuse/dependence (shown in the paper)paper)

Conclusions and Future WorkConclusions and Future Work

►Results for Latinos are similar to Results for Latinos are similar to estimates based on US nationally estimates based on US nationally representative datarepresentative data

►Results for Asians are unexpected – Results for Asians are unexpected – require further investigationrequire further investigation

►Future work will consider respondent Future work will consider respondent net earnings as a dependent variablenet earnings as a dependent variable