Spousal Peer Effects in Specialty Behavioral Health Services Use: Do Spillovers Vary by Gender, Subscriber Status and Sexual Orientation?

This paper fills gaps in the literature on spousal peer effects in mental health outcomes by investigating spousal spillover effects in a potential mediator, health investment decisions. We relate the subject’s behavioral healthcare use to her partner’s lagged decision, and exploit the rich set of characteristics available (including the subject’s past use and diagnoses) to control for assortative mating. Given that spillover effects may be asymmetric, we stratify analyses by subscriber’s status, gender and couple type. Results show positive significant spousal peer effects in behavioural healthcare use, driven primarily by individual psychotherapy visits. Spillover effects are stronger for females than males in heterosexual couples and for males in same-sex vs. heterosexual couples. Estimates are robust to various sensitivity analyses. Spousal spillover effects in individual psychotherapy use represent up to 76% of the impact of depression for female in heterosexual couples and up 91% for men who are in same-sex couples.