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
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
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
Motivation
A.
B.
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
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)
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
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
NLAAS Sampling Design
Focus on Cubans,
Mexicans, Puerto
Ricans & other
Latinos/Latinas
Focus on Chinese,
Vietnamese,
Filipinos & other
Asians
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 –
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
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
DESCRIPTIVE
STATISTICS
Variable
Asian
Males
0.859
Asian
Females
0.665
Latino
Males
0.854
Latino
Females
0.615
Employed
Out of labor
force
0.090
0.243
0.071
0.318
Unemployed
0.051
0.092
0.076
0.067
Weeks
worked
45.04
37.41
45.43
34.68
Number of
absences in
past 30 days
1.51
2.37
1.37
1.51
Variable
Asian
Males
0.096
Asian
Females
0.088
Latino
Males
0.136
Latino
Females
0.190
Any current
disorder
Current major
depression
0.056
0.038
0.050
0.089
Current anxiety
0.056
0.045
0.075
0.124
Current substance
abuse or
dependence
0.018
0.006
0.045
0.014
Number of
disorders with
onset prior to age
18
0.248
0.201
0.320
0.334
SUMMARY OF
REGRESSION RESULTS
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)
N
-0.115
(0.050)
-0.071
(0.401)
1,024
Females, 18-64
Any 12
month
disorder
N
-0.154
(0.002)
-0.145
(0.027)
1,233
-0.160
(0.100)
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)
N
-0.075
(0.522)
-0.128
(0.503)
820
Females, 18-64
Any 12
month
disorder
N
-0.059
(0.547)
0.080
(0.610)
892
-0.334
(0.102)
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)
N
0.072
(0.437)
0.134
(0.191)
826
Females, 18-64
Any 12 month
disorder
N
-0.078
(0.461)
-0.168
(0.148)
758
0.103
(0.606)
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)
N
0.064
(0.560)
-0.163
(0.506)
690
Females, 18-64
Any 12 month
disorder
N
-0.251
(0.445)
-0.365
(0.283)
605
0.221
(0.405)
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)
N
1.00
(0.242)
0.018
(0.983)
825
Females, 18-64
Any 12 month
disorder
N
0.436
(0.389)
1.32
(0.015)
747
-0.354
(0.747)
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)
N
0.678
(0.616)
-0.421
(0.644)
690
Females, 18-64
Any 12 month
disorder
N
-0.064
(0.938)
2.05
(0.111)
603
2.11
(0.332)
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)
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