The causal impact of mental health on tobacco and alcohol consumption: an instrumental variables approach

Abstract

The reciprocal relationship between psychiatric and substance use disorders is well-known, yet it remains largely unknown whether mental health morbidity causally leads to addictive behaviours. This paper utilises a fixed effects instrumental variables model, which is identified by time-varying sources of plausibly exogenous variations in mental health, and a nationally representative panel dataset from Australia to present robust evidence on the causal impact of mental distress on cigarette smoking and alcohol drinking behaviours. We find that mental distress significantly increases the prevalence and intensity of either cigarette or alcohol consumption. Further analysis reveals that mental distress also substantially increases household monetary expenditures on either tobacco or alcohol. The impact is greater for lower educated individuals or children of smokers, and is slightly higher for males. Our findings highlight the importance of mental health screening and treatment programs, especially among lower educated individuals or children of smokers, to assist in the prevention of addictive activities.

Mental health and obesity

“…This is consistent with the finding that a greater sense of well-being, including mental health, tends to encourage healthier behaviours (e.g. Boehm et al , 2012; Yang and Zikos, 2023; Mitrou et al , 2023).…”

“…Using these responses, a dummy variable that equals 1 is created if the death of a close friend happened within the previous year. The death of a friend as an instrument for mental health is supported by the literature examining the effect of mental health on employment (Frijters et al , 2014), physical health (Yang and Zikos, 2022) and health behaviours (Yang and Zikos, 2023; Mitrou et al , 2023).…”

“…Overall, we find that greater mental well-being may increase the chance of being overweight while reducing the chance of being in any of the obesity classes. Several studies document that a greater sense of well-being encourages healthier behaviours (Boehm et al , 2012; Yang and Zikos, 2023; Mitrou et al , 2023). Our results bring more nuance to the literature, suggesting that the positive association between mental well-being and healthier behaviours holds for some but certainly not all groups of individuals when it comes to the incidence of overweight and obesity.…”

“…Our main identification strategy relies on the recent death of a close friend and a serious injury or illness to a family member as exogenous shocks to mental health. This follows the empirical approach proposed by Frijters et al (2014) in their study of the effect of mental health on employment and other related contributions within the same field of inquiry (Yang and Zikos, 2022, 2023; Mitrou et al , 2023). Although obtaining causal estimates can be a difficult empirical challenge, the identified effects can help policymakers design more targeted interventions to combat obesity.…”

How to Determine the Optimal Number of Cardiologists in a Region?

“…The consumption of health services by the population leads to positive externalities. For example, healthier individuals are more likely to be more productive, start new businesses, make scientific discoveries, and achieve other successes that benefit the rest of society [62]. The presence of positive externalities in consumption means that market equilibrium without government intervention will result in the amount of services consumed being less than the optimal amount in terms of maximising public welfare.…”