心理健康对中国劳动力市场结果的影响。

Lu Chunling, Frank Richard G, Liu Yuanli, Shen Jian

Department of Global Health and Social Medicine, Harvard Medical School, 800 Boylston Street-47 th Floor, Boston, MA 02199, USA.

J Ment Health Policy Econ. 2009 Sep;12(3):157-66.

BACKGROUND

Mental illnesses account for 20% of the total burden of disease in China. Yet, health policy in China has not devoted much attention to mental health problems and their impact on Chinese society.

AIMS OF THE STUDY

The objective of this paper is to investigate the impact of mental health status on labour market outcomes, such as employment and income, and provide evidence about some of the economic consequences of mental illnesses.

METHODS

Using the China Health Surveillance Baseline 2001 Survey and an instrumental variables estimation approach, we address possible reverse causation between work and mental health. To estimate the impact of self-reported mental health status, we use the two-part model, the first part estimating a logit equation for the probability of being employed and the second-part estimating an ordinary least squares (OLS) model on the log of individual income condition on being employed. We use a list of symptoms of mental disorders to constitute a measure of mental health status. Our identification strategy relies on instruments that measure average mental health status by zip code other than the observed individual to implement an instrumental variables model.

RESULTS

Both men and women suffer a significant reduction in the employment rate and annual income if the average mental health deteriorates at a population level. The mental health index has a positive and significant effect on the likelihood of being employed. Our findings are consistent with what has been found in industrialised countries.

DISCUSSION

This is the first empirical study that reveals that poor mental health status can be disruptive of labour market activities in China. A rapid rise of mental and behavioural problems in population reflects the transition to a market economy and indicates pressing problems that have gone unrecognised and unaddressed. The negative economic consequences in labour market outcomes suggest a potential gain from preventing and curing the mental disorder. Our study about the impact of mental health on labour market participation adds value to the effort of evidence-based, decision-making process by the Chinese government. IMPLICATIONS FOR HEALTH CARE PROVISION AND POLICIES: A larger effort is required from the Chinese government and society in providing individuals with mental illnesses easier access to mental health care and better treatment. Allocating more resources to prevention and intervention and changing societal attitude towards individuals with mental illnesses should be important components in China's mental health policy. IMPLICATIONS FOR HEALTH CARE RESEARCH: A quantitative analysis on how much economic gain can be achieved from treatment and the trade-off between costs and benefits of treating mental disorders in China needs to be conducted in the future. In addition, further study on understanding the mental health delivery system in China should be conducted. By investigating care seeking, organisation of treatment and financing of care delivery, we may be able to identify high priority investments in mental health care.

背景

在中国，精神疾病占疾病总负担的20%。然而，中国的卫生政策并未过多关注心理健康问题及其对中国社会的影响。

研究目的

本文的目的是调查心理健康状况对劳动力市场结果（如就业和收入）的影响，并提供有关精神疾病一些经济后果的证据。

方法

利用2001年中国健康监测基线调查和工具变量估计方法，我们解决了工作与心理健康之间可能存在的反向因果关系。为了估计自我报告的心理健康状况的影响，我们使用两部分模型，第一部分估计就业概率的logit方程，第二部分在就业条件下对个人收入的对数估计普通最小二乘法（OLS）模型。我们使用一系列精神障碍症状来构成心理健康状况的衡量指标。我们的识别策略依赖于通过邮政编码而非观察到的个体来衡量平均心理健康状况的工具，以实施工具变量模型。

结果

如果总体心理健康状况恶化，男性和女性的就业率和年收入都会显著下降。心理健康指数对就业可能性有积极且显著的影响。我们的研究结果与在工业化国家的发现一致。

讨论

这是第一项实证研究表明，在中国，不良的心理健康状况会扰乱劳动力市场活动。人群中心理和行为问题的迅速增加反映了向市场经济的转型，并表明存在一些未被认识和解决的紧迫问题。劳动力市场结果中的负面经济后果表明，预防和治疗精神障碍可能会带来潜在收益。我们关于心理健康对劳动力市场参与影响的研究为中国政府基于证据的决策过程增添了价值。