Presenter:

Stephanie Bernell

Authors:

Stephanie Bernell

Chair: Randall Ellis; Discussant: Didem Bernard Mon June 5, 2006 10:45-12:15 Room 225

Objective: In this study, we evaluate whether persons dually diagnosed as HIV-positive and having mental health problems have differential labor market outcomes than those without mental health problems. The underlying assumption of this study is that mental health can influence employment directly or indirectly through a decreased likelihood of using recommended treatment regimens that could stave off the onset of AIDS.

Empirical Model: In this paper, we specify a bivariate probit model of (1) the decision to work, which we represent as y1, and (2) the decision to use HAART, which we represent as y2, allowing for correlation (ρ) between the two decisions. The underlying assumption of this model is that two related decisions are considered by the same individual. Normally, for a two equation probit model it is assumed that the errors in the two equations (ε1 and ε2) are distributed normally N(0,1) and that the two errors are independent of one another (Cov(ε1,ε2) = 0). When there is reason to believe that the error terms are possibly related, then the bivariate model is appropriate. For example, there may be an underlying factor such as risk preferences that may affect HAART use and employment.

The dependent variables in the model are the following: (1) y1, which equals 1 if employed and 0 otherwise, and (2) y2, which equals 1 if the individual uses HAART and 0 otherwise. The independent variables in the model include demographic measures, exposure route, health measures, mental health status, and usual source of care.

Data: Data from the HIV Cost and Services Utilization Study (HCSUS) were used in this study. HCSUS is a survey of adults with known HIV infection who made at least one visit to a non-military, non-prison medical provider other than an emergency department in the United States during first two months of 1996. HCSUS collected data on 2864 individuals in 180 clinics, hospitals and private practices in 28 urban areas and 24 clusters of rural counties. For this analysis, we used data from the first follow-up interview to categorize mental health and data from the second follow-up interview to obtain data on HAART use, employment status and other demographic information. The appropriate sampling weights were used in all study analyses.

Results: Preliminary evidence demonstrates an interrelationship between HAART use, employment and mental health. More than half (57.7%) of those unemployed at the time of the baseline survey and about one-third (33%) of those employed at the time of the baseline survey had mental health composite score less than the median. However, almost 50% of those using HAART at the time of the baseline survey and 50% of those not using HAART at the time of the baseline survey had a mental health score below the median. The bivariate probit model results indicate that HIV-positive individuals with poor mental health have a reduced probability of working, but do not have generally have a reduced probability of using HAART. Individual with general anxiety disorder do, however, have an increased probability of using HAART.