Simply relying on present health care systems without consideration of the unique barriers to quality care that ethnic and racial minority populations face is unlikely to affect the pattern of disparities observed. Populations reluctant to visit a clinic for depression care may have correctly anticipated the limited quality of usual care.

Objective: Prior work on racial/ethnic disparities in depression treatment has been limited by the scarcity of national samples that include an array of diagnostic and quality indicators and substantial non-English speaking minorities. Using nationally representative data (n=8762), we evaluate differences in access to and quality of depression treatments between ethnic/racial minority patients and non-Latino whites. Method: Access to mental health care was assessed by whether or not any mental health treatment was received in the past year. Quality treatment for acute depression was defined as four or more specialty/general health provider visits in the past year plus antidepressant use for 30 days or more; or eight or more specialty mental health provider visits of at least 30 minutes in length, with no antidepressant use. Results: For those with last year depressive disorder, 63.7% of Latinos, 68.7% of Asians and 58.8% of African Americans, vs. 40.2% of non-Latino whites, did not access any last year mental health treatment (significantly different at p<0.001). We also found that the disparities in the likelihood of both having access and receiving quality care for depression are significantly different for all minority groups as contrasted to non-Latino whites, except Latinos (marginally significant). Conclusion: Simply relying on present healthcare systems without considering the unique barriers to quality care that apply for ethnic and racial minorities is unlikely to affect the pattern of disparities observed. Populations reluctant to come to the clinic for depression care may have correctly anticipated the limited quality available in usual care.

We would also like to thank Janet Currie, Karen Norberg, and participants at the 2008 SOLE and ASHE meetings for very helpful suggestions. The views expressed herein are those of the author(s) and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peerreviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

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This paper investigates to what extent psychiatric disorders and mental distress affect labor market outcomes in two rapidly growing populations that have not been studied to date-ethnic minorities of Latino and Asian descent, most of whom are immigrants. Using data from the National Latino and Asian American Study (NLAAS), we examine the labor market effects of meeting diagnostic criteria for any psychiatric disorder in the past 12 months as well as the effects of psychiatric distress in the past year. The labor market outcomes analyzed are current employment status, the number of weeks worked in the past year among those who are employed, and having at least one work absence in the past month among those who are employed. Among Latinos, psychiatric disorders and mental distress are associated with detrimental effects on employment and absenteeism, similar to effects found in previous analyses of mostly white, American born populations. Among Asians, we find more mixed evidence that psychiatric disorders and mental distress detract from labor market outcomes. Our findings suggest that reducing disparities and expanding access to effective treatment may have significant labor market benefits-not just for majority populations, as has been demonstrated, but also for Asians and Latinos.

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. In this paper, we estimate the effect of psychiatric disorders on labor market outcomes using a structural equation model with a latent index for mental illness, an approach that acknowledges the continuous nature of psychiatric disability. We also address the potential endogeneity of mental illness using covariance instruments as suggested in Lewbel (2012), thus not requiring questionable exclusion restrictions for identification. Data come from the US National Comorbidity Survey -Replication (NCS-R) and the National Latino and Asian American Study (NLAAS). We find that depression and generalized anxiety disorder detract from the employment and labor force participation of males and females; however, we do not find evidence of adverse effects of panic attack or social phobia on any work outcomes of either males or females. After addressing the potential endogeneity of mental illness, we continue to find that mental illness adversely affects employment and labor force participation for both males and females, but the effect on weeks worked and days missed at work are significant for males only. Using our structural model we assess the policy implications of some of the recommendations in the Affordable Care Act, relating to expansion of benefits for mental health and substance use disorder benefits. We find potential gains in employment for 3.2 million individuals and reduction in workplace cost of absenteeism of $18.9 billion due to improved mental health of individuals who are in most need of treatment. Terms of use: Documents inJEL-Code: I100.

This paper uses data from the National Education Longitudinal Study to estimate the association between illicit drug use during high school and the number of years of schooling completed. The analysis accounts for the possibility that drug use is endogenous using two methods: (1) by controlling for individual-level characteristics measured before high school entrance; and (2) by using an instrumental variables method, with state drug policies and 8th grade school characteristics as identifying variables. Findings suggest that marijuana and cocaine use in both 10th and 12th grade are associated with reductions in the number of years of schooling completed. (Johnston et al. 2002). The recent increase in illicit drug use among youth has led to concern about both the short-term and the long-term consequences of this risky behavior (ONDCP 2003). PinkaPart of the concern about adolescent substance use stems from the idea that drug use interferes with the rapid accumulation of social, emotional and academic skills that normally takes place during adolescence. Drug use has the potential to detract from motivation, cognition, and memory as well as the potential to exacerbate existing mental disorders, all of which can affect academic performance (Hawkins et al. 1992, Brook et al. 1999. It is widely believed that drug use leads to academic failure, and, at first glance, the empirical evidence supports this viewpoint. Adolescent marijuana users, for example, are about twice as likely as non-users to drop out of high school, perform worse than non-users on some standardized achievement tests, and are much more likely than non-users to report poor academic performance. (Brook et al. 1999;Bray et al. 2000; Yamada et al. 1998, Diego et al. 2003, Pacula et al. 2003a.The relationship between substance use and academic outcomes, however, clearly has the potential to be bidirectional. While substance use during adolescence is associated with later academic problems, early school failure and low attachment to school have been identified as 3 leading risk factors for substance use, as well as good predictors of low educational attainment in the future, independent of drug use (Hawkins et al. 1992, Jessor & Jessor 1978. Substance use appears to be both a cause and a result of academic problems, and disentangling these pathways is an empirical challenge.The This study is the first to estimate using national data the effect of illicit drug use on educational attainment, while directly addressing the possibility that drug use is endogenous.The findings suggest that past month marijuana use in 10 th or 12 th grade is associated with a reduction in educational attainment at age 26 of about 0.2 to 0.3 years, while lifetime cocaine use by 10 or 12 th grade is associated with a reduction in attainment of about 0.2 to 0.4 years.However, there is evidence of some selection into drug use along observed variables, which may imply selection into drug use along unobserved factors that also affect educational attainment. 4The IV results, w...

Background: During the COVID-19 pandemic, there is concern that social distancing, fear of contagion, quarantining of providers, cancellation of elective procedures, media coverage about the pandemic, and other factors drastically reduced physician visits, putting severe financial strain on outpatient providers, and having unknown ramifications for health outcomes. Objectives: We estimate the effect of the pandemic on utilization of outpatient services. Research Design: Using 2010–2020 data from a national dataset, the Outpatient Influenza-like Illness Surveillance Network, we estimate the difference in outpatient care utilization during the time period of the COVID-19 pandemic versus the same weeks in prior years. Results: Our findings indicate that the pandemic started to reduce visits during the week of March 15–21. The effect on visits grew until reaching a peak during the week of April 5–11, 2020, when the pandemic reduced the total number of outpatient visits per provider by 70% relative to the same week in prior years. We find negative effects of the pandemic on visits for non-flu symptoms as well as on visits for flu symptoms, but the magnitudes of these latter effects tended to be larger in magnitude. The pandemic’s impact declined over time, and by the week of June 28 to July 4, 2020, there was no longer any difference in total visits per provider relative to the same week in prior years. Despite the resurgence of COVID-19 in June and July, we still find no effects on total visits when our data end in July 26 to August 1, 2020. Conclusions: Our findings show that one by-product of the COVID-19 pandemic in the United States is a large decline in the use of outpatient care which peaked around the week of April 5–11. Total outpatient visits rebounded completely and remain stable as of July 26 to August 1, 2020.