Publikation: Causes of Mental Health - The Role of Institutions and Policy Measures
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In this dissertation, I examine the causes of mental health and in particular the role that institutions and policies play in three independent chapters. In doing so, I work with a variety of primary and secondary data and provide new data sets.
The first chapter “Structured evidence on school closures in Germany during the COVID-19 pandemic” is a technical report on a self-compiled centralized database of school closures during the COVID-19 pandemic in Germany. School closures are one of the most frequently introduced and debated non-pharmaceutical interventions to contain the spread of the virus (UNESCO, 2023b). Here, unintended costs, such as negative effects on education (Engzell et al., 2021) are juxtaposed with the effectiveness in containing the spread of the virus (Fukumoto et al., 2021). Nevertheless, the causal cost-effectiveness analysis of this measure faces limitations caused by the lack of variation in school closure strategies (Alfano, 2022; Jack and Oster, 2023; Wu et al., 2022). The main issue here lies in isolating the effects of school closures from all other simultaneously introduced measures (N. Haug et al., 2020). Here, the low variation of measures between and within countries leading to collinear relationships plays a key role (Hale et al., 2021). The federal policy measures in Germany stand out from the international community and represent a unique quasi-experimental variation during the first lockdown. I collected the first data set of this variation as well as data on the available emergency care. For this purpose, I screened around 300 Corona Protection Ordinances from all 16 federal states, as well as other relevant state announcements and newspaper articles. While all facilities were closed for in-person attendance at the state level from mid-March 2020, the reopening process was conducted groupwise using the three identifying variables of state, school type, and grade level. Overall, I observe a variation in the length of school closure between 4.7 to 15.3 weeks. Comparing very similar groups that differ only in one of the variables determining school closure, I find high discontinuities in the length of school closure. Generally, the data in this chapter contribute indirectly to expanding the cost-effectiveness analysis of school closure policies when combined with other data. I hope that using these data will therefore contribute to the development of optimal recovery programs and response plans for future pandemics in the long term.
In the second chapter “The youth mental health crisis: Quasi-experimental evidence on the role of school closures”, published in Science Advances, I investigate, together with my co-authors, the impact of school closures during the COVID-19 pandemic on youth mental health. The already increasing mental health problems among children and adolescents, were further exacerbated by the pandemic (American Academy of Pediatrics et al., 2021; Racine et al., 2021). Nevertheless, studies investigating the role played by different aspects of the pandemic and in particular its containment measures are rare and, if at all, only of a correlational nature (Kishida et al., 2021; Tang et al., 2021; Viner et al., 2022). We address this open question by combining unique survey data on adolescent mental health and high-frequency data from the largest crisis helpline for children and adolescents in Germany with the data on school closure strategies from Chapter 1. To isolate the consequences of school closures from those of the pandemic itself as well as other measures, we use the quasi-experimental variation in the length of school closures described in Chapter 1. For the causal analysis, we use a two-way fixed effects approach. Overall, we show that longer school closures lead to a significant deterioration in adolescents’ health-related quality of life and early signs of mental health problems. Boys, younger adolescents, and families with limited living space were most affected. We also provide evidence that family problems are a major issue that adolescents struggled with when denied access to school. In total, school closures largely explain the deterioration in adolescents’ mental health during the f irst wave of the pandemic. With these results, we contribute to the cost-effectiveness analysis of the pandemic measures. We interpret our findings as a call for caution in considering school closures as a measure, as well as a call to action to address the needs of youth and their families struggling with the negative consequences of school closures (Coker et al., 2023).
n my third chapter “Reflection and mental health: Experimental evidence from Germany”, forthcoming in the working papers series of the Cluster of Excellence "The Politics of Inequality", I examine, together with my co-authors, the effects of (self-)reflection on mindful behavior, mental health and well-being, as well as academic performance of university students. In doing so, we study the first cohort to return to face-to-face teaching after university closures and thus provide an opportunity to address the consequences of the pandemic and its measures taken. Globally, university students are disproportionately often affected by mental health problems (Institute of Health Metrics and Evaluation, 2022; The Gallup Organization Ltd., 2021) alongside an existing gap in mental health services (Ebert et al., 2019; Eisenberg et al., 2007). To address this gap, both the uptake of these services and their provision need to be increased. To do so, we developed a very low-cost soft-touch intervention that is easy to integrate into daily university life. In a randomized controlled trial in Germany, we guide students towards (self-)reflection. As part of a thought experiment, the treatment group reflected for ten minutes on questions about stressors and how to deal with them. In contrast, the placebo group was asked questions about the architecture of a university building. Combining survey data and administrative data from the University, we find significant improvements in students’ mindful behavior, mental health and well-being as well as higher perseverance in academic performance as a result of the reflection intervention. Our findings demonstrate the potential of a cost-effective soft-touch intervention for how universities as institutions can provide support to students.
Overall, in this dissertation, I conduct a data-driven investigation of the impact of institutions dropping out or adding new programs to institutions, particularly on mental health and well-being as well as on academic performance. These findings offer opportunities for policy adjustments in the everyday life of institutions and the handling of exceptional situations.
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VORNBERGER, Judith, 2024. Causes of Mental Health - The Role of Institutions and Policy Measures [Dissertation]. Konstanz: Universität KonstanzBibTex
@phdthesis{Vornberger2024Cause-72009, title={Causes of Mental Health - The Role of Institutions and Policy Measures}, year={2024}, author={Vornberger, Judith}, address={Konstanz}, school={Universität Konstanz} }
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In doing so, I work with a variety of primary and secondary data and provide new data sets. The first chapter “Structured evidence on school closures in Germany during the COVID-19 pandemic” is a technical report on a self-compiled centralized database of school closures during the COVID-19 pandemic in Germany. School closures are one of the most frequently introduced and debated non-pharmaceutical interventions to contain the spread of the virus (UNESCO, 2023b). Here, unintended costs, such as negative effects on education (Engzell et al., 2021) are juxtaposed with the effectiveness in containing the spread of the virus (Fukumoto et al., 2021). Nevertheless, the causal cost-effectiveness analysis of this measure faces limitations caused by the lack of variation in school closure strategies (Alfano, 2022; Jack and Oster, 2023; Wu et al., 2022). The main issue here lies in isolating the effects of school closures from all other simultaneously introduced measures (N. Haug et al., 2020). Here, the low variation of measures between and within countries leading to collinear relationships plays a key role (Hale et al., 2021). The federal policy measures in Germany stand out from the international community and represent a unique quasi-experimental variation during the first lockdown. I collected the first data set of this variation as well as data on the available emergency care. For this purpose, I screened around 300 Corona Protection Ordinances from all 16 federal states, as well as other relevant state announcements and newspaper articles. While all facilities were closed for in-person attendance at the state level from mid-March 2020, the reopening process was conducted groupwise using the three identifying variables of state, school type, and grade level. Overall, I observe a variation in the length of school closure between 4.7 to 15.3 weeks. Comparing very similar groups that differ only in one of the variables determining school closure, I find high discontinuities in the length of school closure. Generally, the data in this chapter contribute indirectly to expanding the cost-effectiveness analysis of school closure policies when combined with other data. I hope that using these data will therefore contribute to the development of optimal recovery programs and response plans for future pandemics in the long term. In the second chapter “The youth mental health crisis: Quasi-experimental evidence on the role of school closures”, published in Science Advances, I investigate, together with my co-authors, the impact of school closures during the COVID-19 pandemic on youth mental health. The already increasing mental health problems among children and adolescents, were further exacerbated by the pandemic (American Academy of Pediatrics et al., 2021; Racine et al., 2021). Nevertheless, studies investigating the role played by different aspects of the pandemic and in particular its containment measures are rare and, if at all, only of a correlational nature (Kishida et al., 2021; Tang et al., 2021; Viner et al., 2022). We address this open question by combining unique survey data on adolescent mental health and high-frequency data from the largest crisis helpline for children and adolescents in Germany with the data on school closure strategies from Chapter 1. To isolate the consequences of school closures from those of the pandemic itself as well as other measures, we use the quasi-experimental variation in the length of school closures described in Chapter 1. For the causal analysis, we use a two-way fixed effects approach. Overall, we show that longer school closures lead to a significant deterioration in adolescents’ health-related quality of life and early signs of mental health problems. Boys, younger adolescents, and families with limited living space were most affected. We also provide evidence that family problems are a major issue that adolescents struggled with when denied access to school. In total, school closures largely explain the deterioration in adolescents’ mental health during the f irst wave of the pandemic. With these results, we contribute to the cost-effectiveness analysis of the pandemic measures. We interpret our findings as a call for caution in considering school closures as a measure, as well as a call to action to address the needs of youth and their families struggling with the negative consequences of school closures (Coker et al., 2023). n my third chapter “Reflection and mental health: Experimental evidence from Germany”, forthcoming in the working papers series of the Cluster of Excellence "The Politics of Inequality", I examine, together with my co-authors, the effects of (self-)reflection on mindful behavior, mental health and well-being, as well as academic performance of university students. In doing so, we study the first cohort to return to face-to-face teaching after university closures and thus provide an opportunity to address the consequences of the pandemic and its measures taken. Globally, university students are disproportionately often affected by mental health problems (Institute of Health Metrics and Evaluation, 2022; The Gallup Organization Ltd., 2021) alongside an existing gap in mental health services (Ebert et al., 2019; Eisenberg et al., 2007). To address this gap, both the uptake of these services and their provision need to be increased. To do so, we developed a very low-cost soft-touch intervention that is easy to integrate into daily university life. In a randomized controlled trial in Germany, we guide students towards (self-)reflection. As part of a thought experiment, the treatment group reflected for ten minutes on questions about stressors and how to deal with them. In contrast, the placebo group was asked questions about the architecture of a university building. Combining survey data and administrative data from the University, we find significant improvements in students’ mindful behavior, mental health and well-being as well as higher perseverance in academic performance as a result of the reflection intervention. Our findings demonstrate the potential of a cost-effective soft-touch intervention for how universities as institutions can provide support to students. Overall, in this dissertation, I conduct a data-driven investigation of the impact of institutions dropping out or adding new programs to institutions, particularly on mental health and well-being as well as on academic performance. 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