Mental disorders and lifetime earnings

Previous version May 202

Exploring the labor market consequences of psychiatric disorders : An event study approach

Vast literature documents a negative association between mental disorders and labor market performance but it is challenging to find a research design that could provide an reliable estimate for an effect. This paper provides new evidence on the immediate labor market consequences following the first psychiatric admission using the event study framework. To reduce selection bias, I exploit variation in the timing of the first psychiatric admission to estimate the effect of the first psychiatric treatment on labor market performance. Using Finnish administrative data, I find that the first psychiatric admission leads to loss in earned income of about AC1700 (10%). However, but to a large extent the empirical analyses demonstrate decreasing pre-trends in labor market outcomes before the event year, thus signaling problems related to endogeneity. Anxiety disorders provide a notable exception by exhibiting pre-event labor market trajectories for which parallel trends assumption cannot be ruled out. This study provides evidence that research designs that use timing variation in the first health may produce very modest pre-trends also in relationships typically considered endogenous.</p

Essays on economics of mental health

This dissertation consists of an introductory chapter and three empirical essays that examine the linkages between economic activity and mental disorders. I examine two separate themes: the effect of migration on long-term mental health and the association of mental disorders and labor market performance. The first article of the thesis exploits a historical natural experiment in forced migration in the World War II to study the impact of migration on mental health. The Finnish-Soviet wars resulted in the displacement of 11% of the Finnish population. As the forced migration of Finnish Karelians was unexpected and was conducted with full compliance, the displacement provides a compelling “naturalexperiment” framework to study the mental health effects of forced migration free on confounding. We do not find evidence that supports migration being a risk factor for mental disorders in the long-term. This result is at odds with the general finding from non-experimental studies that point to a positive association between migration and mental disorders. Our results highlights the importance of an appropriate research design when measuring the impacts of migration. The second article examines the lifetime labor market consequences of mental disorders. The main contribution stems from the scope of the data, which allows the identification of the emergence of severe mental disorders as the first psychiatric admission. By documenting that, the labor market deficits are the greater the earlier the mental health problems manifest, the paper motivates the need for early intervention to tackle these problems. The third article focuses more closely on the immediate changes in labor market performance surrounding the first psychiatric admission. I exploit a recently popularized dynamic differences-in-differences strategy where counterfactuals are constructed from amongst the individuals with psychiatric admissions, but who are just treated for the first time a few years later than the treatment group. I show that this way the observable differences between treatment and control group are considerably reduced relative to case-control comparison. This strategy also produce results that do not violate the parallel trends assumption in anxiety disorders.Esseitä mielenterveydestä ja taloudellisesta toiminnasta Tämä väitöskirja koostuu johdantoluvusta sekä kolmesta esseestä, jotka tarkastelevat taloudellista toimintaa ja mielenterveyshäiriöitä. Tarkastelu jakautuu kahteen aihepiiriin: muuttoliikkeen pitkän aikavälin mielenterveysvaikutuksiin sekä mielenterveyshäiriöiden yhteydestä työmarkkinamenestykseen. Ensimmäisessä väitöskirjatutkimuksessani tarkastelen pakkosiirtolaisuuden pitkän aikavälin vaikutuksia mielenterveysongelmiin. Suomen ja Neuvostoliiton välillä käydyt sodat tarkoittivat sitä, että Neuvostoliitolle luovutetuilla asunut Suomen väestö tuli uudelleenasuttaa muualle Suomeen. Hyödynnämme Luovutetun Karjalan väestön pakkosiirtolaisuutta ns. ”luonnollisena kokeena”, joka mahdollistaa muuttoliikkeen mielenterveysvaikutusten tutkimisen ilman muuttoliikkeeseen tyypillisesti liittyvää valikoitumisharhaa. Aiemmista tutkimuksista poiketen emme havaitse muuttoliikkeen olevan yhteydessä kohonneeseen pitkän aikavälin mielenterveyshäiriöriskiin. Tutkimuksemme havainnollistaa tutkimusasetelman merkitystä muuttoliikkeeseen liittyvissä vaikutusarvioinneissa. Toisessa paperissani tarkastelen mielenterveyshäiriöiden yhteyttä elinajan työmenestykseen. Tutkimus hyödyntää aiempaa kattavammin suomalaista rekisteriaineistoa, joka mahdollistaa ensimmäisten psykiatristen hoitokäyntien tunnistamisen. Tutkimuksessa havaitaan, että työuran työmarkkinamenestys on sitä heikompaa mitä aikaisemmin sairastuu vakavaan mielenterveyshäiriöön. Tämä havainto kannustaa arvioimaan psykiatristen varhaisten interventioiden vaikutusta myös taloudellisesta näkökulmasta. Kolmannessa paperissani tarkastelen vakavien mielenterveysongelmien välitöntä yhteyttä työmarkkinamenestykseen. Hyödynnän tutkimuksessa dynaamista differences-in-differences -tutkimusasetelmaa, jossa sairastuneita verrataan muihin muutamaa vuotta myöhemmin sairastuneisiin. Havainnollistan, että tämänkaltainen vertailu vähentää valikoituvuusongelmaa suhteessa tyypilliseen tapausverrokkiasetelmaan sekä täyttää yhtenevien trendien oletuksen ahdistuneisuushäiriöissä

Exploring the labor market consequences of psychiatric disorders: An event study approach

Vast literature documents a negative association between mental disorders and labor market performance but it is challenging to find a research design that could provide an reliable estimate for an effect. This paper provides new evidence on the immediate labor market consequences following the first psychiatric admission using the event study framework. To reduce selection bias, I exploit variation in the timing of the first psychiatric admission to estimate the effect of the first psychiatric treatment on labor market performance. Using Finnish administrative data, I find that the first psychiatric admission leads to loss in earned income of about AC1700 (10%). However, but to a large extent the empirical analyses demonstrate decreasing pre-trends in labor market outcomes before the event year, thus signaling problems related to endogeneity. Anxiety disorders provide a notable exception by exhibiting pre-event labor market trajectories for which parallel trends assumption cannot be ruled out. This study provides evidence that research designs that use timing variation in the first health may produce very modest pre-trends also in relationships typically considered endogenous.</p

Determinants of costs of care for patients attending primary care

Aims: We aimed to evaluate determinants of costs of somatic and psychiatric care forpatients attending primary care (PrC).Methods: 495 PrC patients filled in a questionnaire including questions on background,health behaviour, social contacts, perceived health and depressive symptoms. Costs ofsomatic and psychiatric care were obtained from the local healthcare register.Results: During 5 years’ follow-up, total inflation-adjusted costs of care were 8145 Eurosper capita in 2010 prices: 87.2% was due to somatic and 12.8% to psychiatric care. Ageassociated positively, but being single and working associated negatively with costsof somatic care. Costs of psychiatric care were high in young adults, single,divorced, unemployed, smokers, and those with few social contacts. In zero-inflatedmultivariate modelling, poor perceived health and being retired increased probabilityof seeking somatic care. Depressive symptoms and being unemployed increased, and oldage decreased probability of seeking psychiatric care.Concerning both services together, poor perceived health and being retired associatedwith increased, but depressive symptoms with decreased likelihood of being a serviceuser. Among service users, age group 25-44 and having poor perceived health associatedwith higher costs of care. Female gender, being single, employed, having low educationlevel, regular user of alcohol and regular physical exercise associated with lowercosts of care.Conclusions: In patients attending PrC, more than a tenth of total costs of care weredue to psychiatric care. Patients’ perceived health associated with costs of somatic,and depressive symptoms with costs of psychiatric care. Sociodemographic backgroundalso associated with costs of care.</p

Lapsen sairastuminen syöpään vähentää etenkin äitien työtuloja

</p