Household economic costs associated with mental, neurological and substance use disorders: a cross-sectional survey in six low- and middle-income countries

Abstract

BackgroundLittle is known about the household economic costs associated with mental, neurological and substance use (MNS) disorders in low- and middle-income countries.AimsTo assess the association between MNS disorders and household education, consumption, production, assets and financial coping strategies in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.MethodWe conducted an exploratory cross-sectional household survey in one district in each country, comparing the economic circumstances of households with an MNS disorder (alcohol-use disorder, depression, epilepsy or psychosis) (n = 2339) and control households (n = 1982).ResultsDespite some heterogeneity between MNS disorder groups and countries, households with a member with an MNS disorder had generally lower levels of adult education; lower housing standards, total household income, effective income and non-health consumption; less asset-based wealth; higher healthcare expenditure; and greater use of deleterious financial coping strategies.ConclusionsHouseholds living with a member who has an MNS disorder constitute an economically vulnerable group who are susceptible to chronic poverty and intergenerational poverty transmission.Declaration of interestD.C. is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.

Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal

“…Our results demonstrate that people with probable depression in Central Nepal used more healthcare and incurred greater OOP expenditures than people without depression, and that both utilization and OOP expenditure increased significantly with increasing depression screening scores. People with probable depression incurred total mean expenditures of $118 (SD 29) USD/year OOP on healthcare, which is likely to represent a substantial proportion of household budgets considering that median annual income for adults with depression in this area has been estimated to be $501 [17]. The association between higher PHQ-9 score and total healthcare utilization and OOP costs was attributable to outpatient rather than inpatient service use, and was not modified by relative wealth.…”

“…We then asked participants to report the number of times, if any, they had visited outpatient services for any health problem (including but not exclusively for depression) over the previous 3 months including seven types of healthcare providers: traditional healers, community workers, nurse/midwives, pharmacists, general doctors, specialist doctors, and psychiatrists and other mental health workers. In order to make comparisons between inpatient and outpatient healthcare utilization and to calculate an estimate of total utilization, we standardized the number of visits in 3 months to reflect annual outpatient healthcare utilization as reported in similar analyses [10,17,38]. We also recorded data on the presenting health complaint.…”

“…However, it is unknown whether this finding is generalisable to other countries with vastly different health systems. In LMIC, where healthcare is predominantly financed by OOP payments [15], any increased utilization can lead to impoverishment, itself a major risk factor for depression [16], and can result in the poorest individuals foregoing necessary care [17].…”

Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal

“…People with probable depression incurred total mean expenditures of $118 (SD 29) USD/year OOP on healthcare, which is likely to represent a substantial proportion of household budgets considering that median annual income for adults with depression in this area has been estimated to be $501. 17 The association between higher PHQ-9 score and total healthcare utilization and OOP costs was attributable to outpatient rather than inpatient service use, and was not modified by relative wealth.…”

“…In order to make comparisons between inpatient and outpatient healthcare utilization and to calculate an estimate of total utilization, we standardized the number of visits in 3 months to reflect annual outpatient healthcare utilization as reported in similar analyses. 10,17,38 We also recorded data on the presenting health complaint.…”