Effect of antidepressants on employment of women with HIV in the HAART era: 1995-2004
- Presenter:
Chair: Randall Ellis; Discussant: Cynthia Perry Mon June 5, 2006 10:45-12:15 Room 225
Background: Since the mid-1990s highly active antiretroviral treatment (HAART) has extended the lives, and the ability to work for individuals living with HIV in the United States. During the same period, antidepressants have become some of the most widely prescribed drugs. Employment of persons living with HIV depends on several factors including physical and mental health status, as well as local area labor market characteristics.
Data: This paper investigates the effect of antidepressants on the chances of being employed, using data from the Women’s Interagency HIV Study (WIHS). Started in 1995, the WIHS is a prospective cohort of 3,768 participants to study comprehensively the effects of HIV on women. About 80 percent of the participants are from racial minority groups in Bronx and Brooklyn (New York), Chicago (Illinois), Los Angeles and San Francisco (California), and Washington, D.C. Participant follow-up visits are scheduled every six months.
Rationale: There may be two channels for depression treatment to affect the labor market outcomes of persons living with HIV. First, a direct channel by which antidepressants may reduce depression symptoms and thus may improve the likelihood of being employed. Second, an indirect channel by which antidepressants may improve adherence to HAART regime, improving physical health, and then lead to better employment outcomes.
Methods: The methodological challenge is that more depressed persons are more likely to receive treatment, but they are also more likely to be unemployed. This paper uses the econometric method of instrumental variables to identify the treatment effect of antidepressants on employment. The main instrument is a measure of the generosity of the Medicaid program at the State level in terms of coverage of a particular class of antidepressants: selective serotonin reuptake inhibitors (SSRIs). The instrument helps to predict treatment choice independently of individual confounders, and thus reduce the bias in estimation.
Results: The empirical results from linear, non-linear, and auto-regressive models (under fixed and random effects assumptions) for panel data suggest that antidepressants may have a positive effect on the employment probability for the women’s sample. Conditional on receiving HAART, and controlling for individual and local area labor market characteristics, women who use antidepressants may have at least a seven-percentage-point higher probability of being employed than women who do not use antidepressants.
Policy Implications: The findings suggest that increasing efforts to improve screening, diagnosis, and treatment of depression in specific high-risk groups may be warranted not only for the physical and mental health benefits, but also as an avenue to increase employment. Furthermore, since the majority of the HIV care is financed by public funds, expanded access to depression treatment through the Medicaid and Ryan White CARE Act formularies may potentially improve labor market outcomes of persons living with HIV.
