Elisavet Iliadi: Life Transitions and Mental Health – From Childhood to Parenthood: Essays in Health Economics

Abstract

Essay I (with Emma Fransson, Erik Grönqvist, Stavros Iliadis and Erica Lindahl): This essay examines how the transition to parenthood affects mental ill-health among Swedish first-time mothers and fathers. Using population-wide administrative data, we follow parents from five years before to ten years after the birth of their first child and measure mental ill-health through antidepressant use and psychiatric hospitalizations. We estimate event-study effects using recent difference-in-differences methods that account for heterogeneity in treatment timing, defined by age at first childbirth. Parenthood has sharply different implications for mothers and fathers. Mothers’ use of mental health care declines around childbirth, particularly during pregnancy and the first years after birth. In the longer run, mothers’ antidepressant use rises above pre-childbirth levels, while hospitalization rates only increase moderately. Fathers, in contrast, experience a steady increase in both antidepressant use and psychiatric hospitalizations after becoming parents. These patterns suggest important gender differences in mental health trajectories and in the use of mental health care following the transition to parenthood. The results are similar by education and income level and parental birth cohorts, indicating that the mental health risks of parenthood are broadly shared. This essay contributes by providing a comprehensive account of mental ill-health across severity levels and care settings, by documenting effects for fathers, a group often underexamined in prior research, and by addressing methodological limitations in conventional event-study designs.

Essay II: Do oral contraceptives affect young women’s mental health? To investigate this question, I use population-wide Swedish registry data from 2005 to 2017 for women aged 14–25 and implement an event-study difference-in-differences design following Callaway and Sant’Anna (2021). The design compares initiators of oral contraceptives with not-yet-treated peers born in the same year and quarter who initiate first-time use one or two years later, thus strengthening the credibility of the counterfactual. The results show that oral contraceptive initiation is followed by a rise in antidepressant prescriptions, with effects concentrated among older adolescents and young adults. For women aged 17–19 and 20–25, I find increases of roughly 9 and 19 percent, respectively, relative to the quarter before initiation. In contrast, the youngest group (ages 14–16) exhibits pronounced pre-trends, consistent with selection into early initiation. Further analysis indicates that the pre-trends in the youngest group of initiators (aged 14-16) are largely driven by women with ADHD. For the older groups (ages 17–19 and 20–25), I find no clear evidence that the effects differ by oral contraceptive type, and the main results are not driven by women whose initiation coincides with a gynaecological condition that may itself affect mental health. Using rich Swedish administrative data and a modern difference-in-differences design with a credible counterfactual, this essay shows that the educational and labour-market gains from contraceptive access may come at a cost to women’s mental health, particularly among early initiators with pre-existing vulnerabilities, and highlights the role of initiation motives in women’s mental health.

Essay III (with Erik Grönqvist, Caroline Hall and Erica Lindahl) : This essay studies the rise in ADHD medication and its implications for children’s grade 9 GPA. We first document changes in the characteristics of children receiving ADHD medication. Over time, children with immigrant background become increasingly underrepresented among medicated children, and average predicted predisposition for ADHD symptoms declines. The decline in average predicted predisposition is consistent with diagnostic criteria being applied more broadly over time. We then estimate the impact of growing up in a more generous ADHD medication regime relative to a less generous regime. A more generous regime increases the probability of receiving ADHD medication for both boys and girls. For GPA, the estimates suggest a small negative effect for girls with native background, especially those with low predicted predisposition for ADHD symptoms. Girls with native background are also more likely to receive antidepressants in a more generous regime. More research is needed to understand the mechanism, including whether the negative estimate reflects adverse side effects of medication or a less efficient allocation of school resources.