Are we overdiagnosing mental illnesses? Evidence from randomly assigned doctors

Almost two in 10 adults in the U.S. and Europe are, at any moment in time, diagnosed with a mental illness. This paper asks whether mental illness is over- (or under-) diagnosed, by looking at its causal effect on individuals at the margin of diagnosis. We follow all Swedish men born between 1971 and 1983 matched to administrative panel data on health, labor market, wealth and family outcomes to estimate the impact of a mental illness diagnosis on subsequent outcomes. Exploiting the random assignment of 18-year-old men to doctors during military conscription, we find that a mental illness diagnosis for people at the margin increases the future likelihood of death, hospital admittance, being sick from work, and unemployment, while lowering the probability of being married. Using a separate identification strategy, we measure the effect of military service on the same set of outcomes to rule out that the effect of diagnosis in our setting is primarily mediated by altering the probability of serving. Our findings are consistent with the potential over-diagnosis of mental illness.