Economic Burden of Schizophrenia and Bipolar Disorders in Ethiopia
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Date
2008-07-22
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Addis Ababa University
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.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 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
Key words: schizophrenia; bipolar disorder; caregiver burden; family burden; economic
burden; panel data; population average generalized estimating equation; time-series
generalized least squares, Ethiopia
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Keywords
Schizophrenia, Bipolar Disorder, Caregiver Burden, Population Average Generalized Estimating Equation, Economic Burden