An instrumental variables evaluation of the effect of antidepressant use on employment among HIV-infected women using antiretroviral therapy in the United States: 1996-2004

Abstract

Depression is a common condition among patients with HIV. This paper uses panel data for 1234 participants from the Women's Interagency HIV Study to estimate the effect of antidepressant use on the likelihood of being employed among women receiving highly active antiretroviral therapy (HAART) in the United States from 1996 to 2004. We show that naive regressions of antidepressant use on employment generally result in negative or non-significant coefficients, whereas the instrumental variables (IVs) approach shows a positive and significant effect of antidepressant use on the employment probability of women living with HIV. We use IVs to predict antidepressant use independently of outcomes, thus addressing potential biases (e.g. more depressed women are more likely to receive antidepressant treatment, but they are also more likely to be unemployed). The results are consistent for linear (random and fixed effects) as well as non-linear (bivariate probit) specifications. Among women receiving HAART, and controlling for individual and local area labor market characteristics, the use of antidepressants is associated with a 29-percentage-point higher probability of being employed. Improved efforts to test, diagnose and treat depression among HIV-positive patients may improve not only clinical indicators but also labor market outcomes.