Marcotte Dave E, Wilcox-Gök Virginia
Department of Public Policy, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
J Ment Health Policy Econ. 2003 Sep;6(3):123-34.
The ability of workers to remain productive and sustain earnings when afflicted with mental illness depends importantly on access to appropriate treatment and on flexibility and support from employers. In the United States there is substantial variation in access to health care and sick leave and other employment flexibilities across the earnings distribution. Consequently, a worker's ability to work and how much his/her earnings are impeded likely depend upon his/her position in the earnings distribution. Because of this, focusing on average earnings losses may provide insufficient information on the impact of mental illness in the labor market.
In this paper, we examine the effects of mental illness on earnings by recognizing that effects could vary across the distribution of earnings.
Using data from the National Comorbidity Survey, we employ a quantile regression estimator to identify the effects at key points in the earnings distribution.
We find that earnings effects vary importantly across the distribution. While average effects are often not large, mental illness more commonly imposes earnings losses at the lower tail of the distribution, especially for women. In only one case do we find an illness to have negative effects across the distribution.
Mental illness can have larger negative impacts on economic outcomes than previously estimated, even if those effects are not uniform. Consequently, researchers and policy makers alike should not be placated by findings that mean earnings effects are relatively small. Such estimates miss important features of how and where mental illness is associated with real economic losses for the ill.
劳动者在患有精神疾病时保持生产力和维持收入的能力，很大程度上取决于能否获得适当的治疗，以及雇主的灵活性和支持。在美国，不同收入群体在获得医疗保健、病假及其他就业灵活性方面存在很大差异。因此，劳动者的工作能力以及其收入受影响的程度可能取决于其在收入分配中的位置。正因如此，关注平均收入损失可能无法充分反映精神疾病对劳动力市场的影响。
在本文中，我们认识到精神疾病对收入的影响可能因收入分配而异，并对此进行研究。
利用全国共病调查的数据，我们采用分位数回归估计量来确定收入分配关键节点上的影响。
我们发现，精神疾病对收入的影响在整个收入分配中差异很大。虽然平均影响通常不大，但精神疾病更常导致收入分配低端的收入损失，尤其是对女性而言。只有一种疾病在整个收入分配中都有负面影响。
精神疾病对经济结果的负面影响可能比先前估计的更大，即使这些影响并不一致。因此，研究人员和政策制定者都不应因平均收入影响相对较小的研究结果而感到安心。此类估计忽略了精神疾病与患者实际经济损失相关的方式和地点的重要特征。
