81 Appendix 10: Social externalities Appendices Depression Capturing the full economic cost of mental illness is difficult because not all mental disorders have a correlation with education. For this reason, we only examine the economic costs associated with major depressive disorder (MDD), which are comprised of medical and pharmaceutical costs, workplace costs such as absenteeism, and suicide-related costs.58 Figure A10.4 summarizes the prevalence of MDD among adults by education level, based on data provided by the CDC.59 As shown, people with some college are most likely to have MDD compared to those with other levels of educational attainment. People with a high school diploma or less, along with college graduates, are all fairly similar in the prevalence rates. Drug abuse The burden and cost of illicit drug abuse is enormous in the U.S., but little is known about the magnitude of costs and effects at a national level. What is known is that the rate of people abusing drugs is inversely proportional to their education level. The higher the education level, the less likely a person is to abuse or depend on illicit drugs. The probability that a person with less than a high school diploma will abuse drugs is 3.9%, twice as large as the probability of drug abuse for college graduates (1.7%). This relationship is presented in Figure A10.5 based on data supplied by SAMHSA.60 Similar to alcohol abuse, prevalence does not strictly decline at every education level. Health costs associated with illegal drug use are also available from SAMSHA, with costs to state government representing 40%of the total cost related to illegal drug use.61 Crime As people achieve higher education levels, they are statistically less likely to commit crimes. The analysis identifies the following three types of crime-related expenses: 1) criminal justice expenditures, including police protection, judicial and legal, and corrections, 2) victim costs, and 3) productivity lost as a result of time spent in jail or prison rather than working. 58 Greenberg, Paul, Andree-Anne Fournier, Tammy Sisitsky, Crystal Pike, and Ronald Kesslaer. “The Economic Burden of Adults with Major Depressive Disorder in the United States (2005 and 2010)” Journal of Clinical Psychiatry 76:2, 2015. 59 National Survey on Drug Use and Health. “Table 8.40B: Major Depressive Episode (MDE) or MDE with Severe Impairment in Past Year among Persons Aged 18 or Older, and Receipt of Treatment for Depression in Past Year among Persons Aged 18 or Older with MDE or MDE with Severe Impairment in Past Year, by Geographic, Socioeconomic, and Health Characteristics: Numbers in Thousands, 2017 and 2018.” 60 Substance Abuse and Mental Health Services Administration. “Table 5.3B—Illicit Drug Use Disorder in Past Year among Persons Aged 12 or Older, by Age Group and Demographic Characteristics: Percentages, 2017 and 2018.” SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2017 and 2018. 61 Substance Abuse and Mental Health Services Administration. “Table A.2. Spending by Payer: Levels and Percent Distribution for Mental Health and Substance Abuse (MHSA), Mental Health (MH), Substance Abuse (SA), Alcohol Abuse (AA), Drug Abuse (DA), and All-Health, 2014.” Behavioral Health Spending & Use Accounts, 1986–2014. HHS Publication No. SMA-16-4975, 2016. Figure A10.4: Prevalence of major depressive episode by education level Source: National Survey on Drug Use and Health 8% 6% 4% 2% 0% 65 + 68 + 100 + 71 College graduate Less than high school High school graduate Some college or technical school Figure A10.5: Prevalence of illicit drug dependence or abuse by education level Source: Substance Abuse and Mental Health Services Administration 100 + 90 + 90 + 44 College graduate Less than high school High school graduate Some college or technical school 5% 3% 2% 1% 0% 4%
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