CCHE Seminar Series: Diagnostic errors in child mental health: Assessing treatment selection and its long-term consequences

Jill Furzer
University of Toronto

Friday October 9, 2020, 10am-12pm, Zoom

Abstract: The subjectivity of mental health diagnosing may cause missed diagnoses in some children and over-treatment in others. To test this, using a nationally representative health survey, I estimate an ensemble learning prediction of latent mental health risk across childhood. I calculate over-treatment by constructing risk-conditional diagnostic discontinuities, induced by a child’s school starting age. I find marginally diagnosed young-for-grade children have lower predicted mental health risks. At the same time, male diagnostic predictions are over-weighted due to a higher prevalence of externalized mental health symptoms and females’ under-weighted because of pro-social behaviours leading to symptom masking. These results suggest a risk misperception in the diagnostic process, driving both low-risk diagnoses and missed high-risk patients. Using variation in predicted and realized diagnosis over time, I then estimate risk-based mental health treatment effects on adverse health outcomes and human capital via linked tax records. I find adverse treatment effects on education, social assistance receipt and income – concentrated in over-treated individuals. Mental health treatments improve these outcomes for high-risk, diagnosed children and accrue sizable improvements for workplace injuries and suicide ideation. Diagnosis timed with late elementary school years proves most beneficial for maximizing treatment benefits. These results suggest broader screening would reduce medical access inequities and downstream socioeconomic inequalities.

Jill Furzer is a Ph.D. Candidate at the Institute of Health Policy, Management, and Evaluation at the University of Toronto. She holds an M.A. in Economics from the University of Toronto and received her B.A. Honours in Economics at the University of Alberta. Her research interests are in the intersection of health and education economics with a focus on mental health and human capital.