Ezra Golberstein

Prevalence and Correlates of Depression, Anxiety, and Suicidality Among University Students

Mental health among university students represents an important and growing public health concern for which epidemiological data are needed. A Web-based survey was administered to a random sample at a large public university with a demographic profile similar to the national student population. Depressive and anxiety disorders were assessed with the Patient Health Questionnaire (R. L. Spitzer, K. Kroenke, J. B. W. Williams, & the Patient Health Questionnaire Primary Care Study Group, 1999). Nonresponse weights were constructed with administrative data and a brief non-respondent survey. The response rate was 56.6% (N = 2,843). The estimated prevalence of any depressive or anxiety disorder was 15.6% for undergraduates and 13.0% for graduate students. Suicidal ideation in the past 4 weeks was reported by 2% of students. Students reporting financial struggles were at higher risk for mental health problems (odds ratios = 1.6-9.0). These findings highlight the need to address mental health in young adult populations, particularly among those of lower socioeconomic status. Campus communities reach over half of young adults and thus represent unique opportunities to address mental health issues in this important age group.

Stigma and help seeking for mental health among college students

Mental illness stigma has been identified by national policy makers as an important barrier to help seeking for mental health. Using a random sample of 5,555 students from a diverse set of 13 universities, we conducted one of the first empirical studies of the association of help-seeking behavior with both perceived public stigma and people’s own stigmatizing attitudes (personal stigma). There were three main findings: (a) Perceived public stigma was considerably higher than personal stigma; (b) personal stigma was higher among students with any of the following characteristics: male, younger, Asian, international, more religious, or from a poor family; and (c) personal stigma was significantly and negatively associated with measures of help seeking (perceived need and use of psychotropic medication, therapy, and nonclinical sources of support), whereas perceived stigma was not significantly associated with help seeking. These findings can help inform efforts to reduce the role of stigma as a barrier to help seeking.

Persistence of mental health problems and needs in a college student population

BACKGROUND Cross-sectional studies indicate a high prevalence of mental health problems among college students, but there are fewer longitudinal data on these problems and related help-seeking behavior. METHODS We conducted a baseline web-based survey of students attending a large public university in fall 2005 and a two-year follow-up survey in fall 2007. We used brief screening instruments to measure symptoms of mental disorders (anxiety, depression, eating disorders), as well as self-injury and suicidal ideation. We estimated the persistence of these mental health problems between the two time points, and determined to what extent students with mental health problems perceived a need for or used mental health services (medication or therapy). We conducted logistic regression analyses examining how baseline predictors were associated with mental health and help-seeking two years later. RESULTS Over half of students suffered from at least one mental health problem at baseline or follow-up. Among students with at least one mental health problem at baseline, 60% had at least one mental health problem two years later. Among students with a mental health problem at both time points, fewer than half received treatment between those time points. LIMITATIONS Mental health problems are based on self-report to brief screens, and the sample is from a single university. CONCLUSIONS These findings indicate that mental disorders are prevalent and persistent in a student population. While the majority of students with probable disorders are aware of the need for treatment, most of these students do not receive treatment, even over a two-year period.

Mental Health and Academic Success in College

Abstract Mental health problems represent a potentially important but relatively unexplored factor in explaining human capital accumulation during college. We conduct the first study, to our knowledge, of how mental health predicts academic success during college in a random longitudinal sample of students. We find that depression is a significant predictor of lower GPA and higher probability of dropping out, particularly among students who also have a positive screen for an anxiety disorder. In within-person estimates using our longitudinal sample, we find again that co-occurring depression and anxiety are associated with lower GPA, and we find that symptoms of eating disorders are also associated with lower GPA. This descriptive study suggests potentially large economic returns from programs to prevent and treat mental health problems among college students, and highlights the policy relevance of evaluating the impact of such programs on academic outcomes using randomized trials.

Cumulative exposure to neighborhood context: Consequences for health transitions over the adult life course

Over the last two decades, research has assessed the relationship between neighborhood socioeconomic factors and individual health. However, existing research is based almost exclusively on cross-sectional data, ignoring the complexity in health transitions that may be shaped by long-term residential exposures. We address these limitations by specifying distinct health transitions over multiple waves of a 15-year study of American adults. We focus on transitions between a hierarchy of health states, (free from health problems, onset of health problems, and death), not just gradients in a single health indicator over time, and use a cumulative measure of exposure to neighborhoods over adulthood. We find that cumulative exposure to neighborhood disadvantage has significant effects on functional decline and mortality. Research ignoring a persons’ history of exposure to residential contexts over the life course runs the risk of underestimating the role of neighborhood disadvantage on health.

Peer effects on risky behaviors: New evidence from college roommate assignments

Social scientists continue to devote considerable attention to spillover effects for risky behaviors because of the important policy implications and the persistent challenges in identifying unbiased causal effects. We use the natural experiment of assigned college roommates to estimate peer effects for several measures of health risks: binge drinking, smoking, illicit drug use, gambling, having multiple sex partners, suicidal ideation, and non-suicidal self-injury. We find significant peer effects for binge drinking but little evidence of effects for other outcomes, although there is tentative evidence that peer effects for smoking may be positive among men and negative among women. In contrast to prior research, the peer effects for binge drinking are significant for all subgroups defined by sex and prior drinking status. We also find that pre-existing risky behaviors predict the closeness of friendships, which underscores the significance of addressing selection biases in studies of peer effects.

California's Early ACA Expansion Increased Coverage And Reduced Out-Of-Pocket Spending For The State's Low-Income Population.

The Affordable Care Act (ACA) expanded eligibility for Medicaid to millions of low-income adults. While many expanding states implemented their expansion in 2014, five states and the District of Columbia expanded eligibility as early as 2010 by taking advantage of provisions in the ACA and Medicaid waivers. We used restricted data from the National Health Interview Survey to examine the impact of Californias Low Income Health Program, an early expansion program that began in 2011. Our study demonstrates that the county-by-county rollout of expanded public insurance coverage in California significantly increased coverage, by 7 percentage points, and significantly reduced the likelihood of any family out-of-pocket medical spending in the previous year, by 10 percentage points, among low-income adults.

Effect of Medicare Home Health Care Payment on Informal Care

This paper assesses the effect of payment caps for Medicare home health care on the use of informal care by older adults with functional limitations. We find that individuals exposed to more restrictive payment caps offset reductions in Medicare home health care with increased informal care, although we only observe this effect for lower-income individuals. This suggests that home care payment restrictions may have increased the caregiving burden on some low-income families, but that many higher-income families were able to either forgo the care or finance it privately. Home care payment policies should recognize these effects, balancing costs of the program with the desire to protect families from the burdens associated with providing informal home care.

The long-term impacts of Medicaid exposure in early childhood: Evidence from the program's origin

This paper examines the long-term impact of exposure to Medicaid in early childhood on adult health and economic status. The staggered timing of Medicaids adoption across the states created meaningful variation in cumulative exposure to Medicaid for birth cohorts that are now in adulthood. Analyses of the Panel Study of Income Dynamics suggest exposure to Medicaid in early childhood (age 0-5) is associated with statistically significant and meaningful improvements in adult health (age 25-54), and this effect is only seen in subgroups targeted by the program. Results for economic outcomes are imprecise and we are unable to come to definitive conclusions. Using separate data we find evidence of two mechanisms that could plausibly link Medicaids introduction to long-term outcomes: contemporaneous increases in health services utilization for children and reductions in family medical debt.

Income and the utilization of long-term care services: Evidence from the Social Security benefit notch

This paper estimates the impact of income on the long-term care utilization of elderly Americans using a natural experiment that led otherwise similar retirees to receive significantly different Social Security payments based on their year of birth. Using data from the 1993 and 1995 waves of the AHEAD, we estimate instrumental variables models and find that a positive permanent income shock lowers nursing home use but increases the utilization of paid home care services. We find some suggestive evidence that the effects are due to substitution of home care for nursing home utilization. The magnitude of these estimates suggests that moderate reductions in post-retirement income would significantly alter long-term utilization patterns among elderly individuals.