Youth and adolescents have faced an unprecedented confluence of stressors to their mental health in the wake of the COVID-19 pandemic. This study draws on individual-level electronic health records from a large and geographically diverse cohort of primary care patients to examine how the COVID-19 induced labor market shock of Spring 2020 affected the prevalence of common mental health conditions among youth ages 12–17. We leverage variation in the impact of the pandemic-induced recession on county-level, sector-specific employment to estimate a series of generalized difference-in-differences models to compare outcomes across counties with more versus less exposure to the pandemic economic shock. Despite an overall decrease in the use of primary care among our study sample, we find that the frequency of primary care visits with positive diagnosis for mental health conditions increased following the pandemic onset. We find significant increases in the probability of positive mental health diagnoses among patients in counties with larger pre-pandemic shares of sectors that were most vulnerable to pandemic-induced contractions. We further find that this overall effect is primarily driven by visits for ADHD, anxiety, and affective mood disorders. Triple-differences estimates suggest larger increases were experienced by patients with pre-existing mental health diagnoses, patients with non-private insurance coverage, and among White patients. 

• Presented at American Society for Health Economists 2023 Annual Meeting (Slides) 

• Upcoming: APPAM Fall Research Conference 2023, Southern Economic Association Annual Meeting

Effective policy solutions to combat the rising rates of poor mental health and substance use disorder are critically needed, especially in the wake of the COVID-19 pandemic. Findings from early in the pandemic indicate that Black and Hispanic adults disproportionately experienced substantial increases in suicidal ideation, anxiety and depression, and substance abuse relative to white adults. Yet little research has focused on the population health benefit of labor market policies on nonfatal mental health outcomes. And although minimum wages and the earned income tax credit (EITC) have greater income effects on Black and Hispanic workers, few studies have examined whether higher incomes would reduce the racial and ethnic disparities that exist across several of these outcomes, including suicide attempts, poor-mental-health days, and illicit drug abuse and dependence. (Sponsored by the Robert Wood Johnson Foundation Policies for Action Research Hub at the University of California, Berkeley)

Existing research suggests that policy interventions that improve household economic conditions in childhood may yield health benefits and human capital accumulation throughout the life-course. The Aid to Dependent Children (ADC) program – a key feature of the 1935 Social Security Act in response to the Great Depression – was one such program, yet the long-term effects of this program have been understudied. Using individual-level death records linked with the 1940 Census (Goldstein et al. 2021) and area-level ADC expenditure data from archived US Census Bureau reports, we examine how exposure to ADC within the first year of life improved longevity relative to children who were exposed to ADC later in childhood. Using a difference-in-differences design to leverage temporal and geographic variation in ADC exposure by birth cohort, intent-to-treat estimates suggest that an additional year of exposure to ADC in the most generous quintile of counties increased longevity by 0.57 years, or approximately 0.9% of the mean age at death, relative to similarly aged cohorts born in the least generous counties. Future work will consider exposure in utero and cumulative exposure across longer sensitive periods of development, as well as intermediary human capital and health outcomes. 

• Presented at the 2023 Population Association of America Annual Meeting (poster)

The recent rise in suicide across racial and ethnic groups defies easy explanation. This paper examines the role of “perceived economic threat” as a potential driver of suicide in an effort to better understand the trends and racial patterning of suicide among working-age adults in the United States. I build on existing research suggesting that the false perception of economic parity across racial and ethnic groups in the United States may serve as a distal driver of suicide by fueling fears of job loss and more proximal determinants of suicide such as shame and anxiety. To test this hypothesis, I estimating a series of panel fixed effects and long difference models in which I use group-specific employment rates to proxy for changes in economic opportunities at the local level. To mitigate potential bias due to differential labor supply effects, I estimate a series of instrumental variables models in which I instrument for changes in employment rates across racial and ethnic groups using a Bartik-style shift share instrument. In my preferred stacked first difference models, I find consistent evidence that once controlling for own-group employment, suicide rates among non-Hispanic White adults vary countercylically with employment rates among non-White segments of the labor force. This cross-group protective effect is especially strong among females, for whom I estimate large reductions in suicide by firearm and intentional overdose in response to employment rate increases among non-White adults. 

• Presented at American Society for Health Economists 2023 Annual Meeting (Slides) 

• Presented at the Interdisciplinary Association for Population Health Sciences Annual Conference (Poster)

The UPSTREAM Research Center at Stanford University (in partnership with the University of California, Davis, and the University of California, San Francisco) is evaluating how income support policies may improve health behaviors and alleviate inequities in the burden of colorectal cancer in persistent poverty areas. In this study, we employing several quasi-experimental research designs to examine how recent eligibility changes in the California Earned Income Tax Credit (CalEITC) are associated with behavioral outcomes and the uptake of preventative care across a diverse set of communities in California. Read more about this project and other initiatives of the UPSTREAM Center here.