Responsible Researcher: Eduarda Miller Figueiredo
Original Title: Early Life Circumstance and Adult Mental Health
Authors: Achyuta Adhvaryu, James Fenske and Anant Nyshadham
Location of the Intervention: Ghana
Sample Size: 7.741 individuals
Sector: Health Insurance
Primary Variable of Interest: Mental Suffering
Type of Intervention: Events in early life
Methodology: Measurement Analysis
Summary
This study aimed to investigate how early life circumstances affect psychological distress in adulthood. Early life trauma can have disproportionate impacts on low-income populations, whose income smoothing and coping mechanisms are often limited. The results indicate a negative impact of price shocks at birth on the logarithm of the K10 score. Furthermore, economic factors such as monetary savings and self-employment appear to contribute more to the overall treatment effect than literacy, height, and BMI. In conclusion, low cocoa prices at birth substantially increase the incidence of severe mental distress.
- Policy Problem
Mental health disorders account for 13% of the global burden of disease. Even with such a high percentage of mental illnesses, which lead to significant economic losses, investment in prevention and treatment remains relatively low (Collins et al., 2011).
As a growing segment of the literature on fetal origins has documented, early life trauma can have disproportionate impacts on low-income populations, whose income smoothing and coping mechanisms are often limited. Therefore, smallholder farming families in the developing world are exposed to frequent income fluctuations (Maccini and Yang, 2009).
This study aims to investigate how early life circumstances affect psychological distress in adulthood. The choice to observe early life stems from the fact that recent literature has shown that shocks and interventions in the early life period have large and lasting impacts on health, as well as on the formation of human capital (Almond and Currie, 2011; Heckman, 2007).
- Implementation and Evaluation Context
The fetal origins hypothesis states that access to nutrition early in life has long-term effects on an individual's health and well-being. Changes in fetal programming can have various effects, such as on physical health (Hoynes et al., 2012), educational performance (Bharadwaj et al., 2013), and the labor market (Bhalotra and Venkataramani, 2012). Furthermore, medical evidence suggests that some components of mental health are encoded during gestation (Shonkoff et al., 2012).
Cocoa is Ghana's main agricultural export product, and its price is a determining factor in family incomes in the regions where it is grown. Wide and persistent fluctuations in the price of cocoa directly affect the livelihoods of smallholder farmers, leaving families vulnerable to the harmful effects of price shocks.
- Policy/Program Details
Families in Ghana's cocoa-producing region experience changes in the real price of cocoa as income shocks, while families in non-cocoa-producing regions are not affected by these fluctuations. Children born into families in cocoa-producing regions during periods of high cocoa prices will have more resources due to higher family incomes.
Figure 1 shows a map of Ghana with the regions shaded according to the percentage of area dedicated to cocoa cultivation. The figure on the left shows the fraction of land planted with cocoa in each region, while the figure on the right shows the proportion of all land in the region that is suitable for cocoa cultivation.
Figure 1: Cocoa Production and Suitable Soils for Cocoa by Region
Source: Adhvaryu et al. (2018)
- Assessment Method
For this research, the authors used a data source on real cocoa prices at the producer level, from Teal (2002), which reproduces the true real prices to cocoa producers. This represents a variable income opportunity over time, available to families in cocoa-producing regions of Ghana, but not available in other regions of the country. Cocoa production data were extracted from... EGC-ISSER Socioeconomic Panel Survey, for the period between November 2009 and April 2010 for all of Ghana.
The main health measure is calculated using the questions from Kessler Psychological Distress Scale (K10), as a measure of mental distress on the anxiety-depression spectrum. The questionnaire consists of 10 questions about negative emotional states experienced during the last 4 weeks.
The study analyzed individuals born in Ghana, aged between 15 and 65 at the time of the research, totaling a sample of 7.741 individuals.
The authors added an additional vector of controls to the model ( x
), where the set of controls interacts the fixed effects vector of the birth region with a birth year variable, to allow for specific time trends for the birth region. Specific temporal trends for the birth region were also added, as well as precipitation and temperature measurements.
The authors also conducted a measurement analysis using inverse likelihood weighting (Heckman et al., 2013; Huber, 2014), which involves estimating the degree to which the impacts of shocks on mental distress vary according to the values of the factors considered as mediation.
- Main results
The main estimates show that there is a negative impact of the price shock at birth on the logarithm of the respondent's K10 score in adulthood. The magnitudes of the effects on the logarithm of the K10 score are moderate, while the impacts on severe distress are large.
The actual producer price varied greatly over time, and a 1 standard deviation increase in the logarithmic price is equivalent to 0,55 logarithmic points. That is, for an individual born in a cocoa-producing region, this already represents a reduction in the log K10 score of approximately 1% of the average. For severe difficulties, a price shock leads to a reduction of about 3 percentage points in severe difficulties, which is almost half the average.
Individuals who experienced beneficial shocks in the price of cocoa in their birth year are less likely to report being the type of person who is depressed. Similarly, they are more likely to identify as relaxed. According to the authors, these are the expected characteristics of individuals less likely to experience mental distress as a result of favorable early life events.
Based on the measurement analysis, the contribution of each factor to the effects on mental distress was calculated, as shown in Figure 2. The results indicate that economic factors, such as cash savings and self-employment, appear to contribute more to the total treatment effect than literacy, height, and BMI. Furthermore, cash savings influence the effect on mental distress more strongly than the value of physical assets.
Figure 2: Measurement Analysis
Source: Adhvaryu et al (2018).
All six factors together account for approximately 10% of the total treatment effects on severe distress. The remaining 90% of the treatment effects on mental health are either the direct effect of the shock or mediated by other channels not measured for this sample.
Other outcomes were also estimated for adults. The authors found positive impacts on labor force participation and substantial impacts on agricultural self-employment. In addition, positive impacts were found on housing quality (electricity and piped water) and human capital accumulation (English, literacy, and years of schooling).
Therefore, in cocoa-producing regions, low cocoa prices at birth substantially increase the incidence of severe mental distress, raising the probability of severe mental distress by 3 percentage points, or almost 50% of the average incidence of severe distress, when compared to those born in other regions of Ghana.
- Lessons in Public Policy
The authors' findings suggest two mutually compatible interpretations of the impacts on mental health. First, mental health could be a mechanism that partially explains other economic problems stemming from shocks experienced early in life. Second, mental health is an end outcome that depends, in part, on these economic and health-related outcomes.
References
Almond, D. and Currie, J. (2011). Killing me softly: The fetal origins hypothesis. The Journal of Economic Perspectives, 25(3):153-172.
Bhalotra, S. and Venkataramani, A. (2012). Shadows of the captain of the men of death: Early life health interventions, human capital investments, and institutions. Unpublished manuscript, University of Bristol.
Bharadwaj, P., Loken, K., and Neilson, C. (2013). Early life health interventions and academic achievement. American Economic Review, 103(5):1862-1891.
Collins, PY, Patel, V., Joestl, SS, March, D., Insel, TR, Daar, AS, Bordin, IA, Costello, EJ, Durkin, M., Fairburn, C., et al. (2011). Grand challenges in global mental health. Nature, 475(7354):27-30.
Heckman, J. J. (2007). The economics, technology, and neuroscience of human capability formation. Proceedings of the National Academy of Sciences, 104(33):13250-13255.
Heckman, J., Pinto, R., and Savelyev, P. (2013). Understanding the mechanisms through which an inuential early childhood program boosted adult outcomes. The American Economic Review, 103(6):1-35.
Hoynes, H. W., Schanzenbach, D. W., and Almond, D. (2012). Long run impacts of childhood access to the safety net. National Bureau of Economic Research Working Paper No. w18535.
Huber, M. (2014). Identifying causal mechanisms (primarily) based on inverse probability weighting. Journal of Applied Econometrics, 29(6):920-943.
Maccini, S. and Yang, D. (2009). Under the weather: Health, schooling, and economic consequences of early-life rainfall. American Economic Review, 99(3):1006-1026.
Shonkoff, J.P., Garner, A.S., Siegel, B.S., Dobbins, M.I., Earls, M.F., McGuinn, L., Pascoe, J., Wood, D.L., et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1):e232-e246.
Teal, F. (2002). Export growth and trade policy in Ghana in the twentieth century. The World Economy, 25(9):1319-1337.
