Poster #24 - Pre-Existing Mental Health Conditions and the Timing of Disability Insurance Uptake: Evidence from the HRS

• In Event: Friday Poster Reception

Abstract

Social Security Disability Insurance (SSDI) serves as a critical income support program for Americans who become unable to work due to disability. Despite the well-documented prevalence of mental health conditions among SSDI applicants, little is known about how pre-existing psychiatric burden shapes the timing of disability insurance uptake following a health shock. This paper examines whether individuals with pre-existing mental health conditions apply for and receive SSDI faster than those without, and whether this accelerator effect persists after controlling for physical health severity.

Using data from the Health and Retirement Study (HRS, Waves 1–15), I construct a sample of adults aged 50–64 who experience a new work-limiting health shock during the observation window. The analytic sample (N=7,093) excludes individuals with pre-existing SSDI receipt and those whose disability onset predates HRS observation, ensuring that the onset date is identified within the observation window. Pre-existing mental health conditions (MHC) are defined using information strictly prior to the health shock wave, combining psychiatric diagnosis history and clinically significant depressive symptoms (CES-D ≥ 4 on the 8-item HRS scale, corresponding to the standard clinical cutoff of ≥ 16 on the full 20-item scale). I estimate Cox proportional hazard models for two outcomes: time from health shock onset to SSDI application, and time from onset to SSDI receipt, with controls for age, sex, race, education, income, wealth, physical health conditions, and ADL limitations at the shock wave.

Results indicate that individuals with pre-existing MHC exhibit meaningfully different SSDI application and receipt timing compared to those without, after controlling for physical health at the shock wave. Preliminary estimates suggest faster application and receipt among those with pre-existing MHC, with hazard ratios in the range of 1.25–1.35 for application and 1.20–1.30 for receipt across alternative specifications. These patterns are robust across five alternative MHC definitions ranging from psychiatric diagnosis alone to broader depressive symptom thresholds, and the receipt finding remains consistent even when including left-censored cases whose onset predates the observation window. The application effect attenuates when self-rated health is added as a control, consistent with the interpretation that MHC operates partly through perceived functional limitation rather than objective physical burden alone. Final estimates are subject to ongoing refinement of the analytic sample and sensitivity analyses.

These findings challenge the narrative that mental health conditions primarily serve as barriers to SSDI access. Instead, pre-existing psychiatric burden appears to intensify the urgency of benefit-seeking following a health shock, consistent with both greater economic vulnerability among individuals with mental health histories and the cumulative functional burden of co-occurring physical and psychiatric conditions. The receipt finding further suggests that SSA adjudicators respond to the combined disability burden, as comorbid mental health conditions are explicitly considered in disability determination. This paper contributes first systematic survival analysis evidence on mental health as an accelerator of SSDI uptake, with implications for program design, outreach, and the targeting of mental health supports for vulnerable disability insurance applicants.

Author

• Eunjin Choi, Syracuse University
  Presenting Author