Working Paper: NBER ID: w27711
Authors: Christopher J. Cronin; Matthew P. Forsstrom; Nicholas W. Papageorge
Abstract: Evidence across disciplines suggests that talk therapy is more curative than antidepressants for mild-to-moderate depression and anxiety. Yet, few patients use it. We develop a dynamic choice model to analyze patient demand for the treatment of depression and anxiety. The model incorporates myriad potential impediments to therapy use along with links between mental health improvements and earnings. The estimated model reveals that mental health improvements are valuable, directly through utility and indirectly through earnings. However, patient reluctance to use therapy is nearly impervious to reasonable counterfactual policies (e.g., lowering prices or removing other costs). Patient behavior might reflect stigma, biases in beliefs about the effectiveness of therapy, or a distaste for discussing personal or painful issues with a stranger. More broadly, the benefits of therapy estimated in randomized trials tell only half the story. If patients do not use treatments outside of an experimental setting—and we fail to understand why or how to get them to—estimated treatment effects cannot be leveraged.
Keywords: mental health; therapy; antidepressants; treatment choices; dynamic choice model
JEL Codes: I10; I12; J22; J24
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| negative utility cost (L97) | patients show a reluctance to utilize therapy (I11) |
| counterfactual policies aimed at lowering costs or removing barriers to therapy use (E65) | actual utilization rates (L97) |
| mental health improvements (I19) | increased earnings and utility (D11) |
| reluctance to engage in therapy (D91) | persistence of negative treatment effects (D91) |
| individual experiences with therapy (C90) | future decisions about seeking therapy (D91) |
| understanding and addressing the reasons behind therapy reluctance (D91) | improving mental health outcomes at a population level (I14) |
| talk therapy is more effective than antidepressants for treating mild to moderate depression and anxiety (D91) | patients show a reluctance to utilize therapy (I11) |
| benefits of therapy as indicated by randomized trials (C90) | increased usage in real-world settings (C90) |