Publication Type: Abstract
Abstract: Rationale: Depression is one of the most common illnesses in the United States today. More than 19 million adults living in the US (9.5% of the population) suffer from a depressive disorder. While 80% of those suffering from depression can be treated successfully, few sufferers are treated properly or even diagnosed. Depression is estimated to cost the nation $44 billion a year in productivity losses for those between the ages of 25 – 44. Of the $44 billion, $12 billion can be attributed to lost workdays, with an additional $11 billion attributed to decreased productivity due to the symptoms of depression. These costs do not include any influences from the depression symptoms of a spouse or family member on the productivity of an individual. These external depression symptoms not only impact an individual’s depression symptoms, but may also lead to a disruption the productivity of others in the household.

Objectives: The objective of this study is to determine what impact a spouse’s depression
symptoms have on their partner’s depression symptoms, work hours, and labor market status. These new estimates will be used to determine more accurate measures of the true cost of depression symptoms by including the impact of the spouse.

Methodology: This paper uses data from the Rand version of the Health and Retirement Study (RandHRS). The RandHRS is a streamlined version of the first 5 waves of the HRS. The RandHRS one of the most comprehensive and detailed data sets that collects information on both individuals who were at least 51 years old in 1991 and their spouses. This paper exploits the rich individual and spousal data, including mental health and labor market data, to determine the impact of a spouse’s depression symptoms on their partner’s depression symptoms, work hours and labor market status. A sample selection estimator is used to show that individuals with a higher number of depression symptoms may self-select out of the labor force and/or retire. In addition, the panel nature of the data allows the model to account for the timing of depression symptoms and labor market exit.

Results: This study finds that while the individual’s work hours and labor market status are both negatively associated with that individual’s depression symptoms, a spouse’s depression symptoms are negatively associated with an individual’s labor market status only. Also, this paper shows that without controlling for both spousal depression symptoms and sample selection estimates of the impact of individual depression symptoms on the labor market decisions of an individual will be inaccurate.

Publication Type: Abstract
Abstract: Background: Depression screening is being considered as a future “pay for performance” measure for primary care practices. However, primary care practices do not receive reimbursement by managed behavioral health organizations for depression care. We report on one aspect of a pilot program to improve depression care in academic primary care clinics in which an insurance plan and a partner managed behavioral health organization provided reimbursement to primary care clinics for depression care of their dually insured patients by credentialed providers. This strategy meets one of the recommendations from the recent Institute of Medicine report on mental health. Credentialing involved training in depression care best practices, and payments were received by the overall clinic. Only faculty members could be credentialed.

Methods: Depression screening activity was recorded at four academic primary care clinics from 10/1/2002 to 8/30/2005. Screening activity was analyzed by provider. Additional analyses will be presented at the conference.

Results: Among the 37,872 patients seen during the study period, only 5471 were screened. Credentialed providers conducted 70% of overall screening. After excluding screening by non-eligible providers (7% of overall screening), credentialed providers conducted 86% of all screening. Few credentialed providers submitted claims for reimbursement. In the clinic providing the majority of submitted claims, only 3 of 12 credentialed providers submitted any claims even though an additional 4 providers were eligible to submit claims. Those providers submitting claims conducted 50% of screening by credentialed providers, while those eligible providers who did not submit claims conducted 37% of screening by credentialed providers.

Conclusions: Our findings suggest that financial incentives can increase depression screening activity. However, financial incentive use by credentialed providers appears low. This may be either due to lack of direct incentives, difficulty navigating through the reimbursement process, or due to low prevalence of patients meeting the criteria for claims.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Research on the mental health of gay, lesbian, bisexual and transgender (GLBT) adolescents is extensive. This research often operationalizes key variables such as sexual orientation, depression and suicidology differently. Definition variance occurs in many areas of social science research, and standardization of key variables is critical for accurate data interpretation. Other science based fields such as neuropsychiatry, use standardized definitions allowing researchers to establish commonality across research. These definitions create a more solid platform to compare data across multiple studies and to strengthen theories. Stigma often impacts self report data relative to sexual orientation, and with difficulty in obtaining accurate data, consistency is especially important. Consistent data collection across the GLBT field calls for a base standardization and operationalization of key terms. In establishing common ground, the consistency of GLBT adolescent research will be advanced with a stronger understanding of the data and its implications. Research in a marginalized population on suicide and depression with standardization and stronger theories allows the implementation of more targeted programs. This literature review outlines the importance of research in the area of GLBT adolescent depression and suicide. The incorporated critical analysis of research identifies issues with consistency, reliability and validity of data.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Stigma is one of the most serious and problematic consequences of mental illness. However, relatively little is known about the stigmatizing attitudes and perceptions associated with depression, and particularly childhood depression. Given the current concerns about the prevalence of depression among children and adolescents, we use data from the 1996 and 2002 GSS to assess and compare public knowledge of and response to adult and childhood depression. Using a vignette technique, respondents were asked to report on stigmatizing attitudes and behavioral predispositions, including perceptions of competence, violence and desire for social distance. We find that, overall, the American public responds differently to depression in adults and children. It views depression in children and adolescents as more serious and problematic than in adults, and is more likely to force children into treatment. Also, the public reports having more stigmatizing attitudes, including perceptions of violence, and preferences for social distance from children with depression. We suggest that these findings may relate to the media’s sensationalist reporting of Columbine and other incidents of violence perpetrated by children and adolescents, and to the association of these crimes with mental illness.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: The link between emotional well-being and social problems and behavior is an important topic of inquiry among social scientists. However, analysis generally takes one of two perspectives on the matter: well-being as a mitigating or aggravating factor in social problems, or social problems and behavior as contributing to various facets of well-being. Combining the two perspectives, while rare, can facilitate theoretical development and a deeper understanding of complex social phenomena. Our study moves sociological inquiry forward by examining the complex, dynamic, and contemporaneous relation of depressive affect and alcohol use among a sample of American teenagers. A set of full-information maximum-likelihood nonrecursive structural equation models are estimated and compared. Clear circularity exists when adolescent boys’ and girls’ depressive affect and drinking are modeled together: the more a teen drinks ostensively the more depressive symptomatology they report, while the more depressed they become the more they drink. A very different—asymmetrical—picture emerges when gender is modeled separately. Although depressed mood does not influence girls’ drinking, drinking increases girls’ reports of depressive symptomatology. The reverse is true for boys: depressive affect has a substantial effect on increased drinking, but drinking has no discernable impact on their well-being.