Economic instability and mental health diagnosis, MH-CLD 2022
This project explores the relationship between economic instability and mental health diagnoses using client-level treatment data from 2022: the Mental Health Client-Level Data (MH-CLD) set, covering individuals who received services through state mental health agencies.
The question going in: do housing instability and low income increase the likelihood of a mental health disorder diagnosis, and if so, which disorders concentrate in high-risk populations?
MH-CLD 2022 includes demographics, service utilization, diagnoses, and National Outcome Measures for roughly seven million cases. Values arrive survey-encoded as numbers; the cleaning pass applied the encoding parameters back to readable labels, then binned each client into a risk category built from housing, employment, and education stability.
Does housing instability or low income predict higher odds of a mental health diagnosis? Among those experiencing economic instability, which conditions are most frequently diagnosed? And do housing and employment status interact to compound risk?
Logistic regression, with risk category as the predictor. A base model tested the odds of receiving a secondary diagnosis; five further binomial models split the response by disorder family: mood, anxiety, psychotic, substance use, and neurodevelopmental, each tested against a null model by chi-squared ANOVA.
elevated vs low risk reduced vs low risk
The expected story, instability raises diagnosis across the board, is not what the data shows. High-risk clients are substantially more likely to carry substance-use and psychotic diagnoses, the conditions that produce visible crises and institutional contact, and less likely to carry mood, anxiety, and neurodevelopmental diagnoses, the conditions that require consistent access and screening to be seen at all.
Economic stability predicts not just whether someone is diagnosed, but what kind of diagnosis they are likely to receive.
Instability doesn't only change outcomes; it changes what the system is able to observe.