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THE EFFECT OF ANTIDEPRESSANTS ON THE LABOR MARKET OUTCOMES OF HIV-INFECTED PERSONS USING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN THE UNITED STATES

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THE EFFECT OF ANTIDEPRESSANTS ON THE LABOR MARKET OUTCOMES OF HIV-INFECTED PERSONS USING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN THE UNITED STATES: by Omar Galárraga A dissertation submitted to the Johns Hopkins University in conformity with the requirements for the degree of Doctor...

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Uploaded on July 26, 2024
Number of pages 145
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Institution ANTIRETROVIRAL
Course ANTIRETROVIRAL

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THE EFFECT OF ANTIDEPRESSANTS ON THE LABOR MARKET OUTCOMES OF HIV-INFECTED PERSONS USING HIGHLY ACTIVE ANT IRETROVIRAL THERAPY IN THE UNITED STATES: 1996-2004 by Omar Galárraga A dissertation submitted to the Johns Hopkins University in conformity with the requ irements for the degree of Doctor of Philosophy Baltimore, Maryland August 2006 © Omar Galárraga 2006 All rights reserved ii ABSTRACT OBJECTIVE: To examine the association between antidepressant use and the likelihood of being employed among HIV-positive persons receiving highly active antiretroviral therapy (HAART). DATA SOURCES: Panel (longitudinal), semi-annual data (from 1996 to 2004) from the Women’s Interagency HIV St udy (WIHS), a cohort study of 3,768 women in Bronx and Brooklyn (New York), Chicago (Illinois), Los Angeles and San Francisco (California), and Washington, D.C.; and the Multicenter AIDS Cohort Study (MACS), a cohort of 6,973 men in Baltimore (Maryland), Chicago (Illinois), Los Angeles (California), and Pittsburgh (Pennsylvania). METHODS: Regression analyses models of employment (linear, non-linear, and dynamic, under fixed an d random effects assumptions), conditioning on the use of HAART at every prior calendar visit. The regressions control for: demographic characteristics (age, race, education); clinical indicators (CD4 cell co unt, viral load); physi cal and mental health summary measures (physical component of the SF -36 or quality of life index; and CES-D); and local area characteristics (unemployment ra te, real weekly earnings, and employment ratios). Different measures of State Medicaid coverage fo r antidepressants are used as instrumental variables to predict antidepressant use independently of outcomes; thus, addressing potential sources of bias -- more depressed persons tend to receive antidepressant treatment, but they are also more likely to be unemployed. iiiPRINCIPAL FINDINGS: The proposed instrumental variables can be used to identify antidepressant use in the WIHS population. Results show that antidepressant use has a positive effect on the employment probability of women living with HIV. Among women receiving HAART, and controlling for in dividual and local area labor market characteristics, use of antidepressants is a ssociated with a higher probability of being employed. On the other hand, the proposed instruments do not perform well on the MACS sample. The treatment probability can be predicted only weakly. With the current instruments, we cannot find a positive effect of antidepressant use on employment for the participants in the MACS. CONCLUSIONS: Increasing efforts to improve screening, diagnosis, and treatment of depression in specific high-risk HIV positive pop ulations, particularly low-income women, is warranted not only for the physi cal and mental health benefits , but also as an avenue to increase employment. Advisor: David Salkever Readers: Stephen Gange, Darrell Gaskin, Robert Moffitt, Pi erre Alexandre, Kevin Frick ivTABLE OF CONTENTS ACKNOWLEDGME NTS..................................................................................ix GLOSSARY .......................................................................................................xi 1. INTRODUCTION........................................................................................... 1 2. LITERATURE REVI EW AND CONCEPTUAL FRAMEWORK.............. 3 2.1 HIV Care in the United States................................................................. 3 2.2 Depression and Antidepressants ............................................................. 5 2.3 Labor Market Issues .............................................................................. 12 2.4 Conceptual Framework ......................................................................... 13 3. DESCRIPTION OF THE DATA.................................................................. 17 3.1 WIHS Study Particip ants and Data....................................................... 17 3.2 MACS Study Particip ants and Data...................................................... 18 4. ANALYTICAL METHODS......................................................................... 20 4.1 Linear Probab ility Model ...................................................................... 21 4.2 Non-Linear Model................................................................................. 23 4.3 Dynamic Models ................................................................................... 24 4.4 Instrumental Variables .......................................................................... 26 5. EFFECT OF ANTID EPRESSANT USE ON EMPLOYMENT FOR THE WOMEN’S INTERAGENCY HIV STUDY ................................. 31 5.1 WIHS Descriptive Statistics.................................................................. 31 5.2 WIHS First Stage Regressions.............................................................. 34 5.3 WIHS Linear Probability Model Results.............................................. 36

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Exam (elaborations)

THE EFFECT OF ANTIDEPRESSANTS ON THE LABOR MARKET OUTCOMES OF HIV-INFECTED PERSONS USING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN THE UNITED STATES

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