Physical Health Shock and Mental Health

Wei Song

Supervisors: Panos Kasteridis, Rowena Jacobs

Thesis Advisory Panel: Rita Santos, Nigel Rice

Logo 1 Logo 2

[1.0] Overview

  • Chapter 1, survey data that links experience of PHS to increased risk for depression
  • Chapter 2, admin data that links experience of PHS to altered utilisation in community and inpatient mental health care

[1.1] Where we were

  • The experience of PHS does not cause secondary mental health care utilisation from otherwise naive population
  • Overall effect of PHS seems to reduce care in secondary setting
  • Why is PHS protective for mental health? Could displacement be present?

[2.0] Data and methods

  • Hospital Episode Statistics (HES): Admitted Patient Care (APC)
  • Mental Health Services Data Set (MHSDS)
Data Chart
  • Treatment: first experience of heart attack, shock, or first diagnosis of cancer
  • Outcome: days spent in mental health care
  • Covariates: age group, sex, ethnicity group, IMD, Elixhauser, mental health cluster

[2.1] Data and methods (cont.)

Data Chart

[3.0] Econometric framework

Data Chart

\( y_{it} = \alpha_0 + \alpha X_i + \beta d_i + \gamma \lambda + \color{orange}{\delta d_i \lambda} \) + \( u_{it} \)

[3.1] Multi-timepoint design

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Each \( \lambda \) represents a three-month period

[3.2] Stacked DiD

Data Chart

\( y_{it} = \alpha_0 + \alpha X_i + \beta d_i + \sum_{t=2}^{T} \gamma_t \lambda_t + \sum_{t=T_s}^{T} \delta_t(d_i \lambda_t) + u_{it} \)

[3.3] Treatment intensity

Data Chart

\( y_{it} = \alpha_0 + \alpha X_i + \sum_{k=1}^{K} \beta_k d_{ik} + \sum_{t=2}^{T} \gamma_t \lambda_t + \sum_{k=1}^{K} \sum_{t=T_s}^{T} \delta_{tk}(d_{ik} \lambda_t) + u_{it} \)

[4.0] Results, inpatient

Data Chart
  • Total number of inpatient bed-days: 7.4m for 2016/17, 7.5m for 2019/20
  • Average number of inpatient bed-days: 7 to 8 days per quarter
  • Higher utilisation in July to December time

[4.1] Inpatient (cont.)

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[4.2] Inpatient (cont.)

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[4.3] Inpatient (cont.)

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[4.4] Inpatient (cont.)

Men

Data Chart Men

[5.0] Results, outpatient

Data Chart
  • Total number of days spent in community care: 151m 2016/17, 135m 2019/20
  • Average number of days range from 20 to 25 days per quarter

[5.1] Outpatient (cont.)

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[5.2] Outpatient (cont.)

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[5.3] Outpatient (cont.)

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[5.4] Outpatient (cont.)

Men

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[6.0] Results, mental health care in physical setting (HES IP)

Data Chart

[6.1] HES IP

Men

Data Chart Men

[7.0] Discussion

Concerns from before:

Displacement Overall reduction Window of catchment

Endogeneity

Underestimation of TE: cancer

Staggered design

Heterogeneity of TE

Interaction terms Sub-group analysis

[8.0] Final chapter

  • Estimating the Incremental Cost in Primary and Secondary Mental Health Care in NHS England Following the Primary Event of an Acute Physical Health Shock

[8.1] Primary care

Table Image 1

[8.2] Final chapter (cont.)

Table Image 3

Thank you.