This special issue of the Journal of Human Resources showcases an emerging literature on the economics of child mental health. Child mental health is one of the most important determinants of children’s future economic outcomes. The papers in this volume tackle several critical questions including: Does the increase in reported child mental health problems represent an underlying increase in the incidence of these conditions? Are poor economic conditions in childhood a cause of mental health problems, and how much does this contribute to intergenerational associations in mental health? Are there effective interventions? And what role can schools play? By bringing together a broad range of research focused on the critical issue of child mental health, this volume hopes to encourage new research in this emerging area.
--Janet Currie, Princeton University, Special Issue Guest Editor
Table of Contents
Child Mental Health, Family Circumstance, and Long-Term Success: The Effect of Household Income
We use data from a long-running experiment in which American Indian households received income transfers from a casino while other households did not. Using a difference in difference analysis, we find that the treated children had fewer depression and anxiety symptoms at age 30. In adulthood, individuals with more years of treatment exposure also had greater economic well-being around age 30. The untreated children, in adulthood, showed strong persistence in measures of mental health from adolescence through age 30, while in treated children persistence was greatly attenuated. The estimated effects are slightly stronger for treated children who experienced fewer mental health symptoms before the transfers began at ages 16 and 21, but by age 30 all affected children showed reduced symptoms of anxiety and depression and improved economic outcomes.
Domestic Violence Reports and the Mental Health and Well-being of Victims and Their Children
Manudeep Bhuller, Gordon B. Dahl, Katrine V. Løken and Magne Mogstad
We study the costs associated with domestic violence (DV) in Norway by comparing outcomes before and after a DV report, using those who will be victimized in the future as controls. A DV report is associated with increased mental health diagnoses for both victims and their children and reduced financial resources. Victims experience marital dissolution, more doctor visits, lower employment, reduced earnings and higher use of disability insurance. Their children are more likely to receive child protective services and commit a crime. Using a complementary RD design, we find declines in children’s test scores and grade completion.
To What Extent are Trends in Teen Mental Health Driven by Changes in Reporting? The Example of Suicide-Related Hospital Visits
Adriana Corredor-Waldron and Janet Currie
Rising reports of suicidal behaviors in children and adolescents have led to the recognition of a youth mental health crisis. However, reported rates can be influenced by access to screening and changes in reporting conventions, as well as by changes in social stigma. Using data on all hospital visits in New Jersey from 2008-2019, we investigate two inflection points in adolescent suicide-related visits and show that a rise in 2012 followed changes in screening recommendations, while a sharp rise in 2016-2017 followed changes in the coding of suicidal ideation. Rates of other suicidal behaviors including self-harm, attempted suicides, and completed suicides were essentially flat over this period. These results suggest that underlying suicide-related behaviors among children, while alarmingly high, may not have risen as sharply as reported rates suggest. Hence, researchers should approach reported trends cautiously.
The Effect of Household Earnings on Child School Mental Health Designations: Evidence from Administrative Data
Lauren Jones, Mark Stabile, Kourtney Koebel and Jill Furzer
We investigate the impact of household earnings shocks on in-school mental health designations in th context of the Great Recession using a unique data set of linked administrative educational and tax dat and propensity score matching. Relative to children who did not experience recessionary earnings losse the rate of new mental health designations among children with earnings losses was 0.5 percentage poin higher (20 percent) during the recession. The effect of experiencing a recessionary earnings loss : persistent and grows, especially among children who experienced the loss when they were aged 10 or younger.
Societal Disruptions and Childhood ADHD Diagnosis During the COVID-19 Pandemic
Seth Freedman, Kelli Marquardt, Dario Salcedo, Kosali Simon and Coady Wing
We study how the societal disruptions of the COVID-19 pandemic impacted diagnosis of a prevalent childhood mental health condition, Attention Deficit Hyperactivity Disorder (ADHD). Using both nationwide private health insurance claims and a single state’s comprehensive electronic health records, we compare children exposed to the pandemic to same aged children prior to the pandemic. We find the pandemic reduced new ADHD diagnoses by 8.6% among boys and 11.0% among girls nationwide through February 2021. We further show that higher levels of in-person schooling in Fall 2020 dampened the decline for girls but had no moderating effect for boys.
Effects of School-Based Mental Health Services on Youth Outcomes
Ezra Golberstein, Irina Zainullina, Aaron Sojourner and Mark A. Sander
School-based mental health services (SBMH) may increase students’ access to care, which could yield benefits for mental health status and human capital-related outcomes. This paper uses a difference-in-differences design with 19 years of survey and administrative data to estimate the impacts of SBMH on a range of K-12 student outcomes. SBMH increases average outpatient mental health service use and reduces self-reported suicide attempts. There is weaker evidence that SBMH reduces suspensions and juvenile justice involvement, and no evidence that SBMH affects average attendance, standardized test scores, or self-reported substance use.
Adverse Impacts of Mental Health Needs Assessment on Jail Outcomes: Evidence from Transition Age Youth and Adults
Scott Cunningham, Jonathan A. Seward, Karen Clay and Vivian S. Vigliotti
We investigate the causal impact of jail mental health needs scores, assigned by clinicians, on youth and adult outcomes. Utilizing an instrumental variable (IV) approach leveraging quasi-random assignment of intake clinicians, we find that worse scores increase incarceration duration and suicide attempts in both groups and recidivism in adults. For the marginal person, worse scores may lead to consequences like prolonged jail stays, which counteract potential benefits. We discuss possible mechanisms, including the existence of a mental health docket for misdemeanors, and effects of scores on bond posting, mental healthcare, type of housing within the jail, and length of stay.
Improving Mental Health of Adolescent Girls in Low- and Middle-Income Countries: Causal Evidence from Life Skills Programming
Manisha Shah, Sarah Baird, Jennifer Seager, Benjamin Avuwadah, Joan Hamory, Shwetlena Sabarwal and Amita Vyas
This study provides causal evidence on the impact of life skills programming on the mental health of adolescent girls aged 10-19 in three distinct low- and middle-income countries: Tanzania, Bangladesh, and Ethiopia. Life skills interventions significantly improved a component of mental health in all three contexts, with reductions in depression in Tanzania, and improvements in socio-emotional development in Bangladesh and Ethiopia. However, findings suggest substantial heterogeneity in impact. Programs that target both adolescent boys and girls appear more effective than those that target girls alone, and existing supportive environments are a necessary condition for programs to improve mental health.
In-Person Schooling and Youth Suicide: Evidence from School Calendars and Pandemic School Closures
Benjamin Hansen, Joseph J. Sabia and Jessamyn Schaller
This study explores the effect of in-person schooling on youth suicide in the United States. We show that youth suicide rates historically declined during summers and rose again earlier in counties with an August school starting date. We document a departure from this pattern at the onset of the COVID19 pandemic: youth suicides fell 25 percent in March 2020, when schools closed, and remained low throughout summer. Leveraging county variation in the timing of reopening, we find that returning to in-person instruction increased youth suicides by 12-18 percent. Analysis of Google search data suggests that bullying is a likely mechanism.
Trajectories of Early Childhood Skill Development and Maternal Mental Health
Dilek Sevim, Victoria Baranov, Sonia Bhalotra, Joanna Maselko and Pietro Biroli
We investigate the impacts of a perinatal psychosocial intervention on trajectories of maternal mental health and child skills, from birth to age 3. We find improved maternal mental health and functioning (0.17 to 0.29 SD), modest but imprecisely estimated improvements in parenting (0.07 to 0.11 SD), and transitory improvements in child socioemotional development (0.06 to 0.39 SD). The intervention had negligible influence on physical health and cognition. Estimates of a skill production function reveal the intervention attenuated the negative association between maternal depression and child outcomes, and narrowed outcome gaps between mothers who were and were not depressed in pregnancy.
(Breaking) Intergenerational Transmission of Mental Health
Aline Bütikofer, Rita Ginja, Krzysztof Karbownik and Fanny Landaud
We estimate health associations across generations using information on healthcare visits from administrative data for the entire Norwegian population. A parental mental health diagnosis is associated with a 9.3 percentage point (40%) higher probability of a mental health diagnosis of their adolescent child. Intensive margin physical and mental health associations are similar, and extended family estimates account for 42% of the intergenerational persistence. We also show that a policy targeting additional health resources for the young children of adults diagnosed with mental health conditions reduced the parent-child mental health association by 39%.