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Title: ECONOMIC BURDEN OF SCHIZOPHRENIA AND BIPOLAR DISORDERS IN ETHIOPIA
Authors: Ababi, Zergaw
Advisors: Damen Hailemariam, MD., MPH., Ph.D.,
Keywords: schizophrenia; bipolar disorder; caregiver burden
family burden; economic burden; panel data
population average generalized estimating equation
time-series generalized least squares, Ethiopia
Copyright: Jul-2008
Date Added: 6-May-2012
Abstract: ABSTRACT In Ethiopia, economic burden of schizophrenia and bipolar disorders was a virgin area of research untapped for the last many decades. On the other hand sporadic epidemiological studies indicate that mental health problems are major public health concern in the country. However, despite high magnitude of the problems, the extent and the longitudinal time change of family and caregiver burden due to schizophrenia and bipolar disorders is unknown. Therefore, this dissertation has tried to give answers to the following research questions: What is the extent of economic burden of schizophrenia and bipolar disorders in Ethiopia? How does burden change overtime in families of patients with schizophrenia and bipolar disorders? Are families with a member with schizophrenia and bipolar disorder face different disease burden compared to families with physical disorders? To answer these research questions one year longitudinal prospective study with economic and family caregiver burden measurements on families of 249 schizophrenia, 190 bipolar, 55 diabetes, hypertension and asthma patients and 659 families who are with other sickness in the community was carried out. Population average generalized estimating equation and time series generalized least squares analyses were used to estimate the extent and the change over time of burden in the families of patients with schizophrenia and bipolar disorders. iii Using the prevalence based and the human capital approach, economic burden estimations at societal level were also made. As a result in the analysis of six waves of data, families of patients with schizophrenia were found to experience persistent burden for about eighty-three percent of the year. The change in family burden due to time was statistically significant with a mean family burden score of 3.10 (z = -20.86, P>|z|= 0.001). In terms of caregiver characteristics, female caregivers, caregivers in farming occupation, whose monthly living expenses were very little, who had paid more out-ofpocket for mental health services, who were angry at the patient, who were worried about the patient, who were over involved in controlling the patient, and who had lost more days of work were found to be more burdened. Overall in 2005, the total burden of schizophrenia to families in Ethiopia ranged approximately between $2.12 million to $9.97 million. As observed in families of patients with schizophrenia, in a comparative analysis, bipolar patient family caregivers were also found to be more burdened for about 8 to 10 months of the year than family caregivers of patients with diabetes, hypertension and asthma and sick controls in the community. The average difference in family caregiver burden score between bipolar and diabetes, hypertension and asthma patient family caregivers was 4.36 (z = -8.75, P>|z|= 0.001); while the difference due to time between the two groups was 3.42 (z= -4.27, P>|z|= 0.001). Similarly, the average difference in family caregiver burden score between family caregivers of bipolar patient and sick controls in the community was 3.7 (z= -4.88, P>|z| 0.001). In terms of longitudinal caregiver burden difference, bipolar patients family caregivers were found to be more burdened than family caregivers of sick controls in the community with a burden score iv difference of 2.97 (z= -5.17, P>|z|= 0.001). Over the year, patients with bipolar disorder lost a mean of 93.52 cumulative days of work. Consequently, in the year 2005, bipolar disorder patents living in a community under clinical follow-up lost 112.8 million days of work. In sum the total economic burden of schizophrenia and bipolar disorders in Ethiopia ranged approximately $378.62 to $469.47 million. Out of this total economic burden the direct cost was found to be 1.25 percent to 3.66 percent of the country’s public health expenditure in the year 2005. This amount of burden is very huge for poor countries like Ethiopia. It is a hidden economic loss. Generally the figure shows that the country’s health care system should try to reduce the high level of hidden sufferings of families and caregivers so as to keep the level of burden low. Future studies need to focus more on how to devise feasible intervention strategies to lessen economic and family burden due to schizophrenia and bipolar disorders
URI: http://hdl.handle.net/123456789/2723
Appears in:Thesis - Philosophy

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