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

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Psychiatric Disorders and Labor Market Outcomes
Evidence from the National Latino and Asian
American Study (NLAAS)

• Pinka Chatterji, PhD, Mingshan Lu, PhD, Margarita
  Alegria, PhD and David Takeuchi, PhD
• June 7, 2004
• Disparities in Treatment for Impact of Mental
  Illness
• AcademyHealth 2004 Annual Research Meeting

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Acknowledgements

• The NLAAS data used in this analysis was provided
  by the Center for Multicultural Mental Health
  Research at the Cambridge Health Alliance
• The project was supported by NIH Research Grant
  U01 MH62209 funded by the National Institute of
  Mental Health (M. Alegria and D. Takeuchi, PIs)
  as well as SAMHSA/CMHS and OBSSR
• Pinka Chatterji additionally acknowledges
  research support from grant K01 AA000328-03 from
  the National Institute of Alcohol Abuse and
  Alcoholism
• Mingshan Lu is an AHFMR (Alberta Heritage
  Foundation for Medical Research) Population
  Health Investigator and thanks the foundation and
  Institute of Health Economics for financial
  supports

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Objective

• The objective of this paper is to investigate
  the effect of recent psychiatric disorders on
  three labor market outcomes (current employment
  status, the number of weeks worked in the past
  year, and the number of work absences in the past
  month) using a nationally representative sample
  of Latino and Asian Americans

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Motivation

• Mental health and labor market outcomes
  literature recent psychiatric disorders appear
  to detract from employment and earnings
• Disparities in mental health and impact of mental
  illness -
• Minority individuals face distinct labor market
  experiences due to factors such as
  discrimination, citizenship, and language
  barriers
• Thus, the labor market consequences of mental
  disorders may be different for Latinos, Asians
  and other minority individuals the availability
  of the NLAAS allows us to investigate this
  question for the first time

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Background

• Previous work based on the NCS and the ECA
  surveys indicates that a recent psychiatric
  disorder is associated with
• 21 percent reduction in earnings among men (Frank
  Gertler 1991)
• 11 percentage point reduction in the probability
  of being employed among men and women (Ettner et
  al. 1997)
• Substance use and substance use disorders are
  linked to reduced educational attainment, but not
  necessarily to worse labor market outcomes
• ECA data indicates that onset of alcohol abuse
  before age 19 reduces schooling by 1.5 years,
  which in turn reduces earnings (Mullahy
  Sindelar 1994)
• Alcoholism is associated with higher rates of
  employment among white women (Mullahy Sindelar
  1997)
• Illicit drug use has negative or no effects on
  employment, but mixed effects on wages (DeSimone
  2002, Kaestner 1991, 1994a, 1994b)

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Contribution of this study

• Builds on previous research on the labor market
  consequences of mental disorders
• Comprehensive measures of psychiatric illness
• First study to investigate the impact of mental
  illness on labor market outcomes among ethnic
  minorities
• Nationally representative sample of Asians and
  Latinos

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Data

• NLAAS is a national psychiatric epidemiologic
  study being conducted to measure psychiatric
  disorders and mental health service usage in a
  nationally representative sample of Asians and
  Latinos
• Analysis samples include NLAAS respondents
  between 18 and 65 years old who are not in school
  and have complete survey information
• Separate analysis by Latino and Asian ethnicity
  and gender
• Male Latino sample (n 1,024)
• Female Latino sample (n 1,233)
• Male Asian sample (n 820)
• Female Asian sample (n 892)
• Descriptive statistics and models are weighted
  using nationally representative survey weights

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NLAAS Sampling Design

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

• Focus on Chinese, Vietnamese, Filipinos other
  Asians

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Methods

• Previous researchers have faced two major
  methodological challenges
• statistical endogeneity (unobserved
  heterogeneity)
• structural endogeneity (reverse causality work
  affects mental health)
• Standard regression methods (such as OLS) ignore
  endogeneity problem
• To deal with this problem, we use two approaches
  
• Including lifetime psychiatric disorder as a
  covariate
• Does not directly address structural endogeneity
• IV methods, which purge mental disorder measure
  of its correlation with the disturbance term,
  leading to consistent estimates
• We use number of disorders with onset before age
  18 as an identifying instrument (following Ettner
  et al. 1997)
• Should be a good predictor of current mental
  disorders, but should not directly impact current
  labor market outcomes if models control
  adequately for indirect pathways

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Methods

• Labor market outcomes
• Employed dummy variable 1 if respondent is
  currently employed, 0 if respondent is unemployed
  or out of labor force
• Log of weeks worked among employed individuals,
  the log of the number of weeks worked in past
  year
• Number of absences among employed individuals,
  number of full days of work respondent missed in
  the past 30 days
• Current Psychiatric Disorders
• Any DSM IV mental disorder in past 12 months
  (major depression, dysthymia, agoraphobia, panic
  disorder, social phobia, substance use disorder,
  generalized anxiety disorder, PTSD, anorexia or
  bulimia)
• Results by type of psychiatric disorder in paper
  not shown here
• Other covariates ethnicity, number of family
  members under 18, age, education, marital status,
  state unemployment rate

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DESCRIPTIVE STATISTICS
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SUMMARY OF REGRESSION RESULTS
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Summary of Results

• Any mental disorder in past 12 months detracts
  from employment for Latinos (both men and women)
  but not necessarily for Asians
• Effects persist in IV models and in models that
  include lifetime psychiatric disorder
• No effects of mental disorders on absences and
  weeks worked among employed individuals
• Similar results for depression, anxiety and
  substance abuse/dependence (shown in the paper)

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Conclusions and Future Work

• Results for Latinos are similar to estimates
  based on US nationally representative data
• Results for Asians are unexpected require
  further investigation
• Future work will consider respondent net earnings
  as a dependent variable