Impact of boom-and-bust economies from oil and gas development on psychiatric hospitalizations among Medicaid beneficiaries

An estimated 18 million Americans reside within 1.6 km (1 mile) of an oil and gas development (OGD) facility. OGD often creates cycles of economic boom-and-busts, resulting in precarious employment, social disruptions, and environmental stressors, which may have mental health consequences. Among counties with OGD, we used Medicaid claims data to calculate annual county-level counts of inpatient hospitalizations with psychiatric diagnoses (n = 3.6 million hospitalizations, 2001-2011). Each county-year combination was classified by the trajectory of OGD resource production: boom (economic growth), bust (economic decline), and status quo (comparison group). Using a quasi-experimental panel data study design, we observed a small increase in annual county-level inpatient psychiatric hospitalization rates for the bust period (incidence rate ratio [IRR]: 1.05, 95% CI: 1.00, 1.11) but not the boom period (IRR: 1.02, 95% CI: 0.96, 1.07). Associations in the bust period were stronger among beneficiaries who identified as White race, resided in rural areas, and lived in a county with the lowest tertile of median household income. In cause-specific models, the size of the effect estimate was larger among the categories for attention disorders, anxiety disorders, and mood disorders. Stratified models by sociodemographic characteristics and cause-specific hospitalizations were broadly null in the boom period. Our results suggest that cycles of economic boom-and-busts, as measured by oil and gas production, may have deleterious impacts in the bust period on the mental health of the Medicaid population. However, future research is needed to elucidate the complex impacts of boom-and-bust cycles for resource-dependent communities.