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Breaking sad: drug-related homicides and mental well-being in Mexico

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This paper examines the effect of drug-related homicide rates on mental well-being among adults in Mexico, amid a conflict known as the “Mexican Drug War,” during the period 2006–2012. The empirical strategy consists, on the one hand, of a multilevel analysis for mental well-being outcomes at the individual level and, on the other hand, of a difference-in-difference approach for aggregate mental well-being variables at the municipality level. Results suggest no effect of violence on clinical and non-clinical mental well-being for men and on clinical mental well-being for women. Yet, findings indicate a statistically significant effect between 3.5 and 4.9 percentage points of drug-related violence on non-clinical mental well-being of women in Mexico. These results are robust to a variety of specifications, falsification tests and data sources of drug-related homicide rates.

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Fig. 1

Sources: Mexican Intelligence Agencies (2011) and Mexico’s mortality databases from the Bureau of Health Statistics, SINAIS, (Secretaría de Salud 2015)

Fig. 2

Sources: Mexico’s mortality databases from the Bureau of Health Statistics, SINAIS, (Secretaría de Salud 2015)

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  1. A working paper by Michaelsen (2012) analyzes the effect of mental health on labor outcomes between 2002 and 2005, using variation in state-level homicide rates as an instrumental variable. Although Michaelsen’s approach is novel, the first-stage in her analysis misses the spike in drug-related violence (2007–2012). In this paper, I focus exclusively on the effect of drug-related violence on mental well-being during the Mexican Drug War, while accounting for potential endogeneity between drug-related violence and mental well-being.

  2. In Mexico, the percentage of depressed women without a medical diagnosis is 72.8%, while the proportion of non-diagnosed depressed males amounts to 81.0% (Belló et al. 2005).

  3. Based on a set of questions, CES-D computes a depression score that runs from zero to 21, in which higher values indicate more severe depression.


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Correspondence to Jose Roberto Balmori de la Miyar.

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I wish to thank Sharon Tennyson, Ravi Kanbur, Emily Owens, John Cawley, Tatiana Homonoff, Corbin Miller and the attendees of the Cornell Institute for Health Economics, Health Behaviours and Disparities Seminar for their very helpful comments.



See Figs. 3 and 4 and Tables 5 and 6.

Fig. 3
figure 3

Sources: Mexican Intelligence Agencies (2011) and Mexico’s mortality databases from the Bureau of Health Statistics (Secretaría de Salud 2015)

Distribution of drug-related homicide rates.

Fig. 4
figure 4

Sources: National health and nutrition survey (ENSANUT) by Instituto Nacional de Salud Pública (2012)

Relationship between drug-related homicide rates and CES-D for the treatment period.

Table 5 External validity of the selected sample
Table 6 Robustness and falisication checks for the difference-in-difference estimator

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Balmori de la Miyar, J.R. Breaking sad: drug-related homicides and mental well-being in Mexico. Int Rev Econ 67, 513–531 (2020).

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