Exploring Behavioral/Economic Interventions to Improve Health Outcomes among Adolescents in Poor Countries
- Presenter:
Mon June 5, 2006 9:30-10:45 Room Alumni Lounge
Rationale: While the medical literature has previously shown an association between maternal depression and poor pediatric asthma outcomes in children, it has not yet addressed the causal question of whether treating maternal depression leads to an improvement in child health management in the case of a chronic disease such as asthma. There are in fact many reasons (e.g., poor social networks) why we might find maternal depression in the same households with poor child health management, and most of these would not be expected to change with the treatment of depression.
Objectives: The objective of this paper is to compare asthmatic children whose mothers are offered treatment for depression with asthmatic children whose mothers are not offered treatment for depression to determine whether there is evidence of improvements in child health management following the offer of treatment.
Methodology: This project uses Florida Medicaid Claims data. A concern with these data is that mothers are not randomized into a depression diagnosis. In particular, child health utilization can positively affect the probability that maternal depression is identified by a physician. Because this could bias the results of a direct pre-post analysis, I use an instrumental variables technique that uses differential propensities to diagnose depression among primary care physicians to predict whether a child’s mother is diagnosed.
Results: OLS results suggest no improvement in child health management with the offer of depression treatment. But these results likely confound women who are diagnosed for depression precisely because their children have high health care utilization with women who are diagnosed for reasons unrelated to their child’s health. The high health care utilization (that is unrelated to maternal depression) of the former group can swamp the possible improvements of the latter group. Using the instrumental variables strategy to predict which mothers are likely to be diagnosed with depression, I find a reduction in ER visits for asthma care in the post-diagnosis period. I also estimate an overall reduction in total asthma spending in the post-diagnosis period.
Conclusion: These results suggest that in the case of mothers of asthmatic children, improving the ability of primary care physicians to detect depression could yield a cost offsets from better asthma management. Further research is necessary to determine whether similar benefits are present in the case of other chronic childhood diseases.
