1. 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

2. Acknowledgements The NLAAS data used in this analysis was provided by the Center for Multicultural Mental Health Research at the Cambridge Health Alliance 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 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 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 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

3. 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

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

5. Background Previous work based on the NCS and the ECA surveys indicates that a recent psychiatric disorder is associated with: 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) 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) 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 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) 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) 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) Illicit drug use has negative or no effects on employment, but mixed effects on wages (DeSimone 2002, Kaestner 1991, 1994a, 1994b)

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

7. 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 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 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 Separate 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 representative survey weights Descriptive statistics and models are weighted using nationally representative survey weights

8. NLAAS Sampling Design Focus on Cubans, Mexicans, Puerto Ricans & other Latinos/Latinas Focus on Chinese, Vietnamese, Filipinos & other Asians

9. Methods Previous researchers have faced two major methodological challenges: Previous researchers have faced two major methodological 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 problem Standard regression methods (such as OLS) ignore endogeneity problem To deal with this problem, we use two approaches – To deal with this problem, we use two approaches – 1.Including lifetime psychiatric disorder as a covariate a) Does not directly address structural endogeneity 2.IV methods, which purge mental disorder measure of its correlation with the disturbance term, leading to consistent estimates a) We use number of disorders with onset before age 18 as an identifying instrument (following Ettner et al. 1997) b) 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

10. Methods Labor market outcomes: Labor market outcomes: Employed: dummy variable =1 if respondent is currently employed, 0 if respondent is unemployed or out of labor force 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 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 Number of absences: among employed individuals, number of full 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 depression, dysthymia, agoraphobia, panic disorder, social phobia, substance use disorder, generalized anxiety disorder, PTSD, anorexia or bulimia) 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 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 Other covariates: ethnicity, number of family members under 18, age, education, marital status, state unemployment rate

11. DESCRIPTIVE STATISTICS

12. Variable Asian Males AsianFemalesLatinoMalesLatinoFemales Employed0.8590.6650.8540.615 Out of labor force 0.0900.2430.0710.318 Unemployed0.0510.0920.0760.067 Weeks worked 45.0437.4145.4334.68 Number of absences in past 30 days 1.512.371.371.51

13. Variable Asian Males AsianFemalesLatinoMalesLatinoFemales Any current disorder 0.0960.0880.1360.190 Current major depression 0.0560.0380.0500.089 Current anxiety 0.0560.0450.0750.124 Current substance abuse or dependence 0.0180.0060.0450.014 Number of disorders with onset prior to age 18 0.2480.2010.3200.334

14. SUMMARY OF REGRESSION RESULTS

15. Dependent Variable – Employed (0/1) Latino Samples Coefficient(p-value) OLS OLS w/Lifetime IV Males, 18-64 Any 12 month disorder -0.121(0.021)-0.115(0.050)-0.071(0.401) N1,024 Females, 18-64 Any 12 month disorder -0.154(0.002)-0.145(0.027)-0.160(0.100) N1,233

16. Dependent Variable – Employed (0/1) Asian Samples Coefficient(p-value) OLS OLS w/Lifetime IV Males, 18-64 Any 12 month disorder -0.131(0.176)-0.075(0.522)-0.128(0.503) N820 Females, 18-64 Any 12 month disorder -0.059(0.547)0.080(0.610)-0.334(0.102) N892

17. Dependent Variable – Log of weeks worked in past year Latino Samples (Limited to Employed Persons) Coefficient(p-value) OLS OLS w/Lifetime IV Males, 18-64 Any 12 month disorder 0.014(0.833)0.072(0.437)0.134(0.191) N826 Females, 18-64 Any 12 month disorder -0.078(0.461)-0.168(0.148)0.103(0.606) N758

18. Dependent Variable – Log of weeks worked in past year Asian Samples (Limited to Employed Persons) Coefficient(p-value) OLS OLS w/Lifetime IV Males, 18-64 Any 12 month disorder -0.037(0.627)0.064(0.560)-0.163(0.506) N690 Females, 18-64 Any 12 month disorder -0.251(0.445)-0.365(0.283)0.221(0.405) N605

19. Dependent Variable – Number of work days missed in past month Latino Samples (Limited to Employed Persons) Coefficient(p-value) OLS OLS w/Lifetime IV Males, 18-64 Any 12 month disorder 1.31(0.100)1.00(0.242)0.018(0.983) N825 Females, 18-64 Any 12 month disorder 0.436(0.389)1.32(0.015)-0.354(0.747) N747

20. Dependent Variable – Number of work days missed in past month Asian Samples (Limited to Employed Persons) Coefficient(p-value) OLS OLS w/Lifetime IV Males, 18-64 Any 12 month disorder 0.619(0.587)0.678(0.616)-0.421(0.644) N690 Females, 18-64 Any 12 month disorder -0.064(0.938)2.05(0.111)2.11(0.332) N603

21. Summary of Results Any mental disorder in past 12 months detracts from employment for Latinos (both men and women) but not necessarily for Asians 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 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 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) Similar results for depression, anxiety and substance abuse/dependence (shown in the paper)

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