Economic burden of caregiving for persons with severe mental illness in sub-Saharan Africa: A systematic review

Abstract

BackgroundOver the past two decades, the focus of mental health care has shifted from institutionalisation to community-based programs and short hospital stays. This change means that there is an increased role for caregivers, mostly family members, in managing persons with mental illness. Although there is evidence to support the benefits of deinstitutionalisation of mental health care, there are also indications of substantial burden experienced by caregivers; the evidence of which is limited in sub-Saharan Africa. However, knowledge of the nature and extent of this burden can inform the planning of mental health services that will not only benefit patients, but also caregivers and households.ObjectiveTo systematically review the available evidence on the economic burden of severe mental illness on primary family caregivers in sub-Saharan Africa.MethodsA comprehensive search was conducted in Pubmed, CINAHL, Econlit and Web of Science with no date limitations up to September 2016 using keywords such as "burden", "cost of illness" and "economic burden" to identify relevant published literature. Articles were appraised using a standardised data extraction tool covering themes such as physical, psychological and socioeconomic burden.ResultsSeven papers were included in the review. Caregivers were mostly family members with a mean age of 46.34, female and unemployed. Five out of seven studies (71%) estimated the full economic burden of severe mental illness on caregivers. The remainder of studies just described the caregiver burden. All seven papers reported moderate to severe caregiver burden characterised by financial constraint, productivity loss and lost employment. The caregiver’s level of income and employment status, severity of patient's condition and duration of mental illness were reported to negatively affect the economic burden experienced by caregivers.ConclusionThere is paucity of studies reporting the burden of severe mental illness on caregivers in sub-Saharan Africa. Further research is needed to present the nature and extent of this burden to inform service planning and policymaking.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

“…The direct medical costs associated with BD can be high because of the appreciable use of medical services [66,67,106], often exacerbated by misdiagnosis and frequent psychiatric comorbidities [107]. However, there are few published studies on the costs of BD in LMICs although we are aware that there have been reviews examining the economic burden of caregiving for persons with severe mental illness in sub-Saharan Africa [97,108,109]. The cost of medicines will be a key cost component in LMICs in line with other disease areas [31].…”

Health-related quality of life among patients with bipolar disorder in rural southwestern Uganda: a hospital based cross sectional study

“…Several factors have been shown to contribute to the decline in functioning among people with bipolar disorder including lack of social support and poor healthseeking behaviour [29,43]. In sub-Sahara Africa, the quality of life of patients with bipolar disorder may be worse given the numerous challenges encountered in the management and support of individuals with mental illness [44,45]. For example, in Uganda, with a population of approximately 40 million people [46], there are less than 30 psychiatrists, meaning that for every 1.3 million people, there is one psychiatrist.…”

A Cross-Sectional Survey of Employment Status in Patients with Schizophrenia and its Association with Caregivers’ Burden and Quality of Life

“…Indeed, other studies have also found that financial problems were Figure 2: Categories of primary caregiver burden of the study sample using the BFS according to the patients' employment status. among the highest objective burden experienced by caregivers (Yu et al 2017;Addo et al 2018). Financial difficulties faced by caregivers may be contributed by the caregivers assuming sick family members' responsibilities, the length of time taking up in caregiving, particularly in attending to the ill relatives' behavioural disturbances, and also missed work.…”

“…Mitsonis and colleagues (2012) found that among the strong predictors of distress were female sex of caregivers, duration of illness and positive and negative symptomatology. In most developing countries, it is also associated with caregiver economic liability (Addo et al 2018).…”