|Equation||(# participants) x (% participants receiving care due to program) x (Q: Impact of program on depression) x (% decrease in earnings prevented as a result of the treatment) x ($ average annual earnings for low-income population)|
|Explanation||This metric estimates the impact of mental health care treatment for transgender individuals leading on increased earnings.
Number of participants: Reported by program.
Percentage of individuals who receive mental health care due to program: [0.52]. This is the percent of transgender patients, reported in a sample survey, who showed evidence of psychological distress but had not received mental health services in the past year (Shiperd et al., 2010).
Q: Impact of program on depression: [0.27]. First, we estimate the mean effect size using the formula:
In this formula, OR is the odds ratio showing the impact of receiving timely transgender-specific mental health on depression [3.08] (Seelman, et al., 2017). This results in an effect size of ln(3.08)/1.65 = 0.68. Then, we estimate the number of impacted participants using the formula:
In this formula, ES is the effect size estimated from Seelman, et al. (2017) [0.68] and the base percentage is the percent of transgender individuals with depression [44%] (Seelman, et al., 2017).
Percentage decrease in earnings prevented as a result of the treatment: [20%], the estimated 20 percent increase in earnings as a result of PTSD treatment is based on the work of Berndt et al. (2000) and Kessler (2000), which shows that PTSD and depression both reduce days worked per month by about 3.6 days, or about 43 days per year, representing about 17 percent of the work year. We round up to 20 percent. This estimate of lost wages is very conservative because it does not consider the more structural aspects of lost opportunity and unstable employment. Moreover, PTSD typically lasts three years for those who get treatment (Kessler, 2000). We do not extend this cost over the lifetime but conservatively apply the cost only to the current year.
Average annual earnings of low-income population: [$8,600 – $24,300], counterfactual earnings calculated from ACS 5-year estimates (U.S Census Bureau, 2016). $8,600 is the average annual earnings of the population in the Twin Cities under 180% of poverty for all earners and non-earners. $24,300 is the average annual earnings for individuals with high school diplomas. The Constellation Fund staff will determine which counterfactual is appropriate for the grantee.
Example: Assuming average annual earnings of $24,300, the value of the lost work time is approximately $3,000 or about 13% of the average annual income. Other researchers have found similar results (Kaya & Chan, 2017; McIntyre, Liauw, & Valerie, 2011). These benefits are already discounted to present value. Note that this effect does not include potential job loss due to illness or as consequence of work absences.
|References||Berndt, E., et al. (2000). Lost human capital from early-onset chronic depression. The American Journal of Psychiatry, 157(6), 940–947.
Shipherd, J. C., Green, K. E., & Abramovitz, S. (2010). Transgender clients: Identifying and minimizing barriers to mental health treatment. Journal of Gay & Lesbian Mental Health, 14(2), 94-108.
Kessler, R. C. (2000). Posttraumatic stress disorder: The burden to the individual and to society. Journal of Clinical Psychiatry, 61(5).
Seelman, K., Colón-Diaz, M., Lecroix, R., Xavier-Brier, M., & Kattari, L. (2017). Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults. Transgender Health, 2(1), 17-28.
U.S. Census Bureau. (2016). American Community Survey 5-year estimates – public use microdata sample, 2012-2016. Generated using Public Use Microdata Area (PUMA) in the Seven-county Twin Cities Metropolitan Area.