Research

Hidden in Plain Sight: Prevalence and Impact of Undiagnosed ADHD (Job Market Paper)

Partisan Mortality Cycles, with Daniel Millimet (Working Paper, Under Review for Publication)

The Labor Market Returns of Adolescent Mental Health Care, with Shuo Qi (Working Paper)

Efficiency in OR Scheduling and Children’s Health, with Vishal Ahuja (Work in Progress)

Twin Epidemics: The Intersection of the Adolescent Mental Health Crisis and the Synthetic Opioid Crisis (Work in Progress)

Mental health is increasingly being recognized as a public health crisis. However, mental illness is more likely than other physical health issues to go untreated. This is particularly true in the case of adolescent mental health, where there has been growing concern about an epidemic of depression and anxiety among teenage students. My dissertation, “Three Essays in the Economics of Child Development and Health Inequities”, primarily explores the intersections of adolescent mental health with education, labor market outcomes, and public health inequities.

In my job market paper, “Hidden in Plain Sight: The Prevalence and Impact of ADHD Underdiagnosis”, I assess the long-term education and labor market effects of missed ADHD diagnoses. Doing so is challenging for two reasons. First, a person’s true ADHD status is unobserved; only their diagnosed status is known. Second, even if diagnostic errors are observed, they are likely akin to non-classical misclassification errors and therefore endogenous. To overcome these empirical challenges, I use and extend on a partial observability model and estimate it with restricted data, including genetic information, from Add Health. I recover an estimate of individuals’ true ADHD status; and their probability of underdiagnosis. Then, I estimate their effect on educational attainment and adult financial outcomes.

The results are striking. First, ADHD is underdiagnosed and there are large diagnostic gaps along the lines of sex, race, ethnicity, and parental socioeconomic status. Second, both ADHD and its underdiagnosis are highly detrimental for human capital development outcomes, including employment and education. Large improvements can be made by correctly diagnosing a child who likely has ADHD, however little to no gains can be made by diagnosing a child who does not have ADHD. Due to the hereditary nature of ADHD, the paper discovers the existence of vicious intergenerational cycles in which inequity in mental health care drives and is driven by socioeconomic inequities. This is perhaps the most striking result of the paper, as it links access to mental health care as a driving determinant for persistent economic inequality. It implies that investment in early childhood human capital development not only improves a child’s adult financial outcomes but has positive downstream effects for future generations. I plan to further explore this result in future work where I test to what extent involuntary mental health capital bequests explain income gaps in a two-sector OLG model. Additional follow-up work includes examining the spillover effects of a student’s ADHD diagnosis on the likelihood that their peers are diagnosed. I plan to submit this paper for publication by the end of the academic year. I have presented it at the American Society of Health Economics, Society for Economic Measurement, and Southern Economic Association conferences; and it won the best third year paper award at SMU.

In, “Partisan Mortality Cycles”, co-authored with Daniel Millimet, we assess partisan politics as a determinant for geographic inequity in mortality. Geographic inequities in mortality rates in the US are pronounced and growing. Yet, the causes of this inequality are not understood. Recently, the focus has turned to the role of place-specific factors. Here, we explore the importance of politics as a place-specific factor contributing to mortality inequality. Specifically, we test for the existence of partisan mortality cycles using panel data on US counties from 1968-2016. We confirm the existence of partisan mortality cycles, finding lower mortality in counties governed by more liberal political regimes. I plan to continue research on geographic determinants of mortality inequality by using the deinstitutionalization of public mental health hospitals to examine the role of mental healthcare access in public health inequities. This paper is currently under review for publication and has been presented at the Canadian Economic Association and Southern Economic Association conferences.

In, “The Labor Market Returns of Adolescent Mental Health Care”, co-authored with Shuo Qi, we explore the importance of counseling take-up in adolescence on adult labor market returns through a structural model of social stigma in peer networks. Using Add Health data, we assess the role of peer networks on the selection into mental health care and estimate the effect of counseling on future wages. We find large financial returns of counseling on future wages. However, these returns diminish as initial levels of a child’s social and cognitive capital rise, or mental health capital declines. We interpret these results as follows: Provided the child sees a counselor, the counselor must decide which capital input to invest time into, seeking to maximize investment into the child’s social and cognitive capital, subject to the constraint that mental health capital is sufficiently high. This creates an inequity where a child with lower initial mental health capital receives less investment into labor market inputs than a child with higher initial mental health capital. We plan to submit this paper for publication by the end of the academic year. It has been presented at the American Society of Health Economics and Southern Economic Association conferences and won best graduate economics presentation during SMU’s research and development week.

I have two works in progress. One is a project examining the role of time efficiency on hospital procedure costs with Vishal Ahuja and the Children’s Medical Center Dallas. In this project, we measure two sides of time inefficiency for physicians, where scheduled time can either exceed or be exceeded by elapsed time. Preliminary results find large and escalating financial costs to a hospital when a procedure goes over its scheduled time, but cost savings when a procedure goes under its scheduled time. We found physician operational experience directly influences both cost savings and reduction in time inefficiencies. The second work in progress explores the intersection of the adolescent mental health crisis with the 3rd wave of the opioid epidemic. These two public health crises can be seen as ‘twin epidemics’, as the onset of both began in 2012 and have seemingly moved in parallel. A common explanation for the mental health crisis has been the rise in social media usage, but the rise in adolescent suicide attempts over the past decade has been more pronounced in the U.S. than in other English-speaking countries which have similar access to social media platforms. One potential determinant is parental opioid usage. One study in JAMA Psychiatry finds 1/6th of the current adolescent suicide epidemic could potentially be attributed to parental opioid usage (Brent, 2019). I plan to first see if a similar measure could be replicated using CDC mortality and opioid dispensing data, and then explore potential mechanisms which connect the two epidemics.