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We use miscarriage as a biological shock to fertility to estimate the effect of the first three children on women’s and men’s labor market outcomes. For women, we find that the effect is almost the same for the first, second and third child in the short run. The reduction in female earnings in the three first years after birth is on average 28 percent for the first child, 29 percent for the second child and 22 percent for the third child. The reduction is caused by drops in labor supply at the intensive margin and the extensive margin, concentrated among women in the middle part of the income distribution. There is considerable catching up after five years, but effects of the first two children persist ten years later, although they are imprecisely estimated. For men, we find evidence of increased labor supply and earnings after the first two children. We also find indications that having the first child increases take-up of health-related welfare benefits, such as disability insurance, for women, and that having a second and/or a third child increases couple stability.

Objectives Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry‐based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency. Methods By using the natural variation in health providers' preference for compulsory care as a source of quasi‐randomisation we will estimate causal effects of compulsory care on short‐ and long‐term trajectories. Conclusions This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group.

BackgroundPsychiatric comorbidity is frequent among persons with attention-deficit/hyperactivity disorder (ADHD). Whether pharmacological treatment of ADHD influences the incidence of psychiatric comorbidity is uncertain.ObjectiveTo investigate associations and causal relations between pharmacological treatment of ADHD and incidence of subsequent comorbid psychiatric diagnoses.MethodsWe employed registry data covering all individuals aged 5–18 years in Norway who were diagnosed with ADHD during 2009–2011 (n=8051), followed until 2020. We used linear probability models (LPM) and instrumental variable (IV) analyses to examine associations and causal effects, respectively, between pharmacological treatment and subsequent comorbidity.FindingsFrom time of ADHD diagnosis to 9 years of follow-up, 63% of patients were registered with comorbid psychiatric disorders. For males, LPM showed associations between ADHD medication and several incident comorbidities, but strength and direction of associations and consistency over time varied. For females, no associations were statistically significant. IV analyses for selected categories isolating effects among patients ‘on the margin of treatment’ showed a protective effect for a category of stress-related disorders in females and for tic disorders in males for the first 2 and 3 years of pharmacological treatment, respectively.ConclusionsOverall, LPM and IV analyses did not provide consistent or credible support for long-term effects of pharmacological treatment on later psychiatric comorbidity. However, IV results suggest that for patients on the margin of treatment, pharmacological treatment may initially reduce the incidence of certain categories of comorbid disorders.Clinical implicationsClinicians working with persons with ADHD should monitor the effects of ADHD medication on later psychiatric comorbidity.Trial registration number ISRCTN11891971.

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is among the most common mental disorders in children and adolescents, and it is a strong risk factor for several adverse psychosocial outcomes over the lifespan. There are large between-country and within-country variations in diagnosis and medication rates. Due to ethical and practical considerations, a few studies have examined the effects of receiving a diagnosis, and there is a lack of research on effects of medication on long-term outcomes.Our project has four aims organised in four work packages: (WP1) To examine the prognosis of ADHD (with and without medication) compared with patients with other psychiatric diagnoses, patients in contact with public sector child and adolescent psychiatric outpatient clinics (without diagnosis) and the general population; (WP2) Examine within-country variation in ADHD diagnoses and medication rates by clinics’ catchment area; and(WP3) Identify causal effects of being diagnosed with ADHD and (WP4) ADHD medication on long-term outcomes.Method and analysisOur project links several nationwide Norwegian registries. The patient sample is all persons aged 5–18 years that were in contact with public sector child and adolescent psychiatric outpatient clinics in 2009–2011. Our comparative analysis of prognosis will be based on survival analysis and mixed-effects models. Our analysis of variation will apply mixed-effects models and generalised linear models. We have two identification strategies for the effect of being diagnosed with ADHD and of receiving medication on long-term outcomes. Both strategies rely on using preference-based instrumental variables, which in our project are based on provider preferences for ADHD diagnosis and medication.Ethics and disseminationThe project is approved by the Regional Ethics Committee, Norway (REC number 2017/2150/REC south-east D). All papers will be published in open-access journals and results will be presented in national and international conferences.Trial registration numbersISRCTN11573246 and ISRCTN11891971.

This paper aims to estimate the causal effect of sick leave on subsequent earnings and employment, using an administrative dataset for Norway. To obtain experiment-like variation in sick leave among otherwise similar workers, the leniency of these workers' physicians—certifying sickness absences—is used as an instrumental variable for sick leave. A 1 percentage point increase in a worker's sick leave rate is found to reduce his earnings by 1.2% 2 years later. Around half of the reduction in earnings can be explained by a reduction of 0.5 percentage points in the probability of being employed.

We use miscarriage as a biological shock to fertility to estimate the effect of the first three children on women’s and men’s labor market outcomes. For women, we find that the effect is almost the same for the first, second and third child in the short run. The reduction in female earnings in the three first years after birth is on average 28 percent for the first child, 29 percent for the second child and 22 percent for the third child. The reduction is caused by drops in labor supply at the intensive margin and the extensive margin, concentrated among women in the middle part of the income distribution. There is considerable catching up after five years, but effects of the first two children persist ten years later, although they are imprecisely estimated. For men, we find evidence of increased labor supply and earnings after the first two children. We also find indications that having the first child increases take-up of health-related welfare benefits, such as disability insurance, for women, and that having a second and/or a third child increases couple stability.

We estimate the effect of family size on various measures of labor market outcomes over the whole career until retirement, using instrumental variables estimation in data from Norwegian administrative registers. Parents' number of children is instrumented with the sex mix of their first two children. We find that having additional children causes sizable reductions in labor supply for women, which fade as children mature and even turn positive for women without a college degree. Among women with a college degree, there is evidence of persistent and even increasing career penalties of family size. Having additional children reduces these women's probability of being employed by higher-paying firms, their earnings rank within the employing firm, and their probability of being the top earner at the workplace. Some of the career effects persist long after labor supply is restored. We find no effect of family size on any of men's labor market outcomes in either the short or long run.

We evaluate the 2011 comprehensive reform of Norwegian early retirement institutions using a parsimonious random utility choice model. Conditional on employment at age 60, we estimate a three-state conditional logit model to explain the realized labor market state at age 63 among the alternatives of employment, retirement, and disability program participation. The reform radically changed work incentives and/or pension access age for some (but not all) workers, such that the influence of economic incentives can be identified based on reform-generated variation only. We find that improved work incentives caused employment rates to rise considerably at the expense of early retirement and exit through disability insurance. Improved liquidity through a lower age to access own pension funds on actuarially neutral terms caused a small increase in employment and a large drop in disability program participation. Properly designed pension reforms thus need to take the interplay between old-age pension and disability insurance programs into account.

Preference-based instrumental variables (PP IV) designs can identify causal effects when patients receive treatment due to variation in providers’ treatment preference. We offer a systematic review and methodological assessment of PP IV applications in health research. We included studies that applied PP IV for evaluation of any treatment in any population in health research (PROSPERO: CRD42020165014). We searched within four databases (Medline, Web of Science, ScienceDirect, SpringerLink) and four journals (including full-text and title and abstract sources) between January 1, 1998, and March 5, 2020. We extracted data on areas of applications and methodology, including assumptions using Swanson and Hernan's (2013) guideline. We included 185 of 1087 identified studies. The use of PP IV has increased, being predominantly used for treatment effects in cancer, cardiovascular disease, and mental health. The most common PP IV was treatment variation at the facility-level, followed by physician- and regional-level. Only 12 percent of applications report the four main assumptions for PP IV. Selection on treatment may be a potential issue in 46 percent of studies. The assumptions of PP IV are not sufficiently reported in existing work. PP IV-studies should use reporting guidelines.

Rates of ADHD diagnosis vary across regions in many countries. However, no prior study has investigated how much within-country geographic variation in ADHD diagnoses is explained by variation in ADHD symptom levels. We examine whether ADHD symptom levels explain variation in ADHD diagnoses among children and adolescents using nationwide survey and register data in Norway. Geographical variation in incidence of ADHD diagnosis was measured using Norwegian registry data from the child and adolescent mental health services for 2011–2016. Geographical variation in ADHD symptom levels in clinics’ catchment areas was measured using data from the Norwegian mother, father and child cohort study for 2011–2016 (n = 39,850). Cross-sectional associations between ADHD symptom levels and the incidence of ADHD diagnoses were assessed with fractional response models. Geographical variation in ADHD diagnosis rates is much larger than what can be explained by geographical variation in ADHD symptoms levels. Treatment in the Norwegian child and adolescent mental health services is free, universally available upon referral, and practically without competition from the private sector. Factors beyond health care access and unequal symptom levels seem responsible for the geographical variation in ADHD diagnosis.