abstract: 'Background: Research examining mental health outcomes following economic

  downturns finds both pro-cyclic and countercyclic associations.

  Pro-cyclic findings (i.e. economic downturns correspond with decline in

  illnesses) invoke increase in leisure time and risk-averse behavior as

  underlying drivers of reduction in harmful consumption during economic

  recessions. By contrast, counter-cyclic evidence (i.e. economic

  downturns correspond with increase in illnesses) suggests increase in

  mental illness with economic decline owing to heightened stress and loss

  of resources. particularly among certain age and socioeconomic groups.

  Aim of the Study: To examine the relation between monthly aggregate

  employment decline and psychiatric emergency department visits across 96

  counties within 49 Metropolitan Statistical Areas in the United States.

  Methods: For this study, data on all psychiatric outpatient Emergency

  Department (ED) visits for 4 US states (Arizona, California, New Jersey

  and New York) were retrieved from the State Emergency Department

  Database (SEDD) and aggregated by county-month, for the time period of

  2006 to 2011. Exposure to recession was operationalized as

  population-level employment change in a Metropolitan Statistical Area

  (MSA). This information was obtained from MSA-level employment provided

  by the US Bureau of Labor Statistics. Brief exposure time lags of 0 to 3

  months were specified to estimate proximate responses to MSA-level

  economic decline. Income level was approximated based on insurance

  status (private insurance= high-income, public insurance = low-income).

  Linear regression analysis was used to test whether monthly decline in

  aggregate employment in an MSA corresponds with (i) changes in

  population rates of psychiatric ED visits and (ii) whether the relation

  between the outcome and exposure varies by insurance status (private,

  public) and age group (children. age < 20 years; working-age adults, age

  20 to 64 years; elderly adults, age > 64 years). Regression methods

  controlled for region. year and month fixed effects, and state-specific

  linear time trends.

  Results: Linear regression results indicate that overall, psychiatric ED

  visits (per 100,000 population) decline with decline in monthly

  employment at exposure lag 0 (coefficient: 0.54, p < 0.001) and lag 2

  (coefficient: 0.52, p < 0.001). Privately insured (high-income) groups

  also show a decline in psychiatric ED visits following decline in

  aggregate employment. Conversely, publicly insured children show an

  increase in psychiatric ED visit rates one month (i.e. lag 1) following

  employment decline (coefficient: -0.35, p value < 0.01). Exploratory

  analyses by disorder groups show that the population-level decline in

  psychiatric ED visits concentrates among visits for alcohol use

  disorders at 0, 1 and 2 month lags of employment decline.

  Discussion: This study''s findings provide evidence of pro- as well as

  counter-cyclic trends in psychiatric emergency visits following

  aggregate employment decline in an MSA. Whereas declines in psychiatric

  emergencies support a risk-averse response to economic recessions, these

  aggregate trends may mask countervailing trends among vulnerable groups.

  Limitations of this study include the absence of sex-specific analyses

  and lack of information on emergent or non-emergent nature of

  psychiatric ED visits.

  Implications for Health Care Provision and Use: Psychiatric ED visits

  during recessions may vary by age and income groups.

  Implications for Health Policies: Findings from this study may serve to

  develop targeted policies for low-income groups during macroeconomic

  downturns.

  Implications for Further Research: Future research may examine trends in

  emergent versus non-emergent psychiatric ED visits following economic

  recessions.'
affiliation: 'Singh, P (Corresponding Author), Univ Calif Irvine, Program Publ Hlth,
  Anteater Instruct \& Res Off AIRB, 653 E Peltason Dr Suite 2010,2nd Floor, Irvine,
  CA 92697 USA.

  Singh, Parvati, Univ Calif Irvine, Program Publ Hlth, Anteater Instruct \& Res Off
  AIRB, 653 E Peltason Dr Suite 2010,2nd Floor, Irvine, CA 92697 USA.'
author: Singh, Parvati
author-email: parvatis@uci.edu
author_list:
- family: Singh
  given: Parvati
da: '2023-09-28'
eissn: 1099-176X
files: []
issn: 1091-4358
journal: JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS
keywords-plus: 'MENTAL-HEALTH-SERVICES; GREAT RECESSION; TIME-SERIES; UNEMPLOYMENT;

  ANTECEDENTS; DISPARITIES; DEPRESSION; ACT'
language: English
month: MAR
number: '1'
number-of-cited-references: '66'
pages: 13-30
papis_id: e43e63e7ad9e9c23fc7f2df56673c80e
ref: Singh2021psychiatricemergenci
times-cited: '0'
title: 'Psychiatric Emergencies Following the 2008 Economic Recession: An Ecological
  Examination of Population-Level Responses in Four US States'
type: article
unique-id: WOS:000626637300003
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '24'
web-of-science-categories: Health Policy \& Services; Psychiatry
year: '2021'