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Abstract
This dissertation focuses on the impact of chronic condition diagnostic information on mental health diagnosis and treatment. Using administrative claims data, I exploit lab test results related to the diagnosis of rheumatoid arthritis (RA) and diabetes to examine the effect of increased diagnostic certainty on mental health.
In the first chapter I study the effect of diagnostic certainty on mental health during the search for an RA diagnosis. I estimate two-way fixed effects difference-in-differences models, combined with coarsened exact matching, comparing mental health outcomes of those with positive lab test results (and hence, increased diagnostic certainty) to those with negative lab test results. The estimates suggest a 13 percent and 19 percent decline in anxiety and depression diagnoses, respectively, and an 11 percent decline in anti-anxiety prescription utilization for individuals with positive lab test results compared to negative lab test results. The improvements in mental health are driven by females, who make up the majority of RA patients.The second chapter explores the impact of a diabetes diagnosis on mental health outcomes among otherwise similar individuals. I estimate a fuzzy regression discontinuity design comparing mental health outcomes of individuals just above the diabetes diagnosis threshold with individuals just below the diagnosis threshold. I find receiving a diabetes diagnosis is associated with a 50 percent increase in psychotherapy claims in the six months following the lab test among males. I also find that individuals with no mental health claims in the twelve months before the lab test experience a 48 percent increase in psychotherapy claims and a 55 percent increase in adjustment reaction diagnosis claims following a lab test result just above the diagnosis threshold compared to just below the threshold.
The results imply that uncertainty during the diagnostic search process and the receipt of a chronic condition diagnosis can significantly impact mental health. The findings suggest that differences in diagnostic certainty, length of diagnostic search, and symptom and treatment intensity across chronic conditions have important effects on mental health diagnosis and treatment.
In the first chapter I study the effect of diagnostic certainty on mental health during the search for an RA diagnosis. I estimate two-way fixed effects difference-in-differences models, combined with coarsened exact matching, comparing mental health outcomes of those with positive lab test results (and hence, increased diagnostic certainty) to those with negative lab test results. The estimates suggest a 13 percent and 19 percent decline in anxiety and depression diagnoses, respectively, and an 11 percent decline in anti-anxiety prescription utilization for individuals with positive lab test results compared to negative lab test results. The improvements in mental health are driven by females, who make up the majority of RA patients.The second chapter explores the impact of a diabetes diagnosis on mental health outcomes among otherwise similar individuals. I estimate a fuzzy regression discontinuity design comparing mental health outcomes of individuals just above the diabetes diagnosis threshold with individuals just below the diagnosis threshold. I find receiving a diabetes diagnosis is associated with a 50 percent increase in psychotherapy claims in the six months following the lab test among males. I also find that individuals with no mental health claims in the twelve months before the lab test experience a 48 percent increase in psychotherapy claims and a 55 percent increase in adjustment reaction diagnosis claims following a lab test result just above the diagnosis threshold compared to just below the threshold.
The results imply that uncertainty during the diagnostic search process and the receipt of a chronic condition diagnosis can significantly impact mental health. The findings suggest that differences in diagnostic certainty, length of diagnostic search, and symptom and treatment intensity across chronic conditions have important effects on mental health diagnosis and treatment.