The humanistic and economic burden of providing care for a patient with schizophrenia

Csoboth, Csilla; Witt, Edward A.; Villa, Kathleen F.; O’Gorman, Cedric

doi:10.1177/0020764015577844

Cited by 19 publications

(21 citation statements)

References 17 publications

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“…Caregivers of PWEs missed approximately 5 hours weekly due to absenteeism and 13 hours due to presenteeism, resulting in a mean annual cost of $26 188 (± $29 385) and median $17 788 ($3582‐$38 462). For the non‐caregiving population, indirect costs related to absenteeism and presenteeism were significantly lower and estimated to be $5015 ( P < .001) based on a published estimate from 2015 …”

Section: Resultsmentioning

confidence: 99%

“…To identify such a group, we explored other analyses that estimated productivity losses for caregivers and included a comparator group of noncaregivers of approximately the same age as epilepsy caregivers. Although no other analyses estimated the impact of epilepsy caregiving, we did find a study that estimated absenteeism and presenteeism in caregivers of schizophrenia patients . Because patients with schizophrenia are more similar in age to PWEs than those with other conditions who had available data, we selected that study for inclusion.…”

Section: Methodsmentioning

confidence: 99%

“…Other than the stress measure, these instruments have been validated and used extensively, both in the United States and internationally, in a variety of different populations. [12][13][14][15][16] The nine-item PHQ-9 was used to assess depression severity: minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27). 12 The ZBI 13 is a 22-item questionnaire that evaluates the caregiver's health condition, psychological well-being, finances, and social life.…”

Section: Key Pointsmentioning

confidence: 99%

“…Although no other analyses estimated the impact of epilepsy caregiving, we did find a study that estimated absenteeism and presenteeism in caregivers of schizophrenia patients. 18 Because patients with schizophrenia are more similar in age to PWEs than those with other conditions who had available data, we selected that study for inclusion. In that study, schizophrenia caregivers were matched with nonschizophrenia caregivers, and the values for noncaregivers were used in our analysis as reported.…”

Section: Cost Calculationsmentioning

confidence: 99%

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The economic burden of caregiving in epilepsy: An estimate based on a survey of US caregivers

et al. 2020

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Objective The burden of caregiving for persons with epilepsy (PWEs) has not been examined previously in the United States. We assessed the clinical impact and direct and indirect economic costs for caregivers of PWEs. Methods An internet survey of 500 caregivers of PWEs was conducted from May to July 2015 using a combination of validated instruments and questions designed specifically for this survey. Caregivers were stratified by PWE age (adult/child) and disease severity (low: 0 vs high: 1 + seizures in the prior month). Annual self‐reported direct and indirect costs were reported per caregiver and extrapolated to all US caregivers. The economic burden of caregiving for PWEs was defined as the difference between costs for caregivers and the general population. Results Caregivers reported that PWEs averaged 11.4 seizures in the prior month. Eighty percent of respondents were female and the average age was 44.3. Since becoming a caregiver, many reported anxiety (52.8%), depression (41.0%), and insomnia (30.8%). Annual mean direct medical costs for caregivers of children with low vs high seizure frequency were $4344 and $10 162, respectively. Costs for caregivers of adult PWEs were $4936 and $8518. Mean indirect costs associated with caregiving for a child with low vs high seizure frequency were $20 529 and $40 137; those for caregivers of an adult were $13 981 and $28 410. The cost estimates are higher vs the general US population; annual per‐person healthcare utilization costs were $2740 and productivity loss costs were $5015. When extrapolating to the US population of PWE caregivers, annual costs exceeded $62 billion vs $14 billion for the general population, resulting in a caregiver burden of nearly $48 billion. Significance The clinical and economic burden of caregivers for PWE were substantial, and greatest for those caring for children with frequent seizures. The impact on caregivers should be considered when estimating the value of interventions that control epilepsy.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Cost Calculationsmentioning

confidence: 99%

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The economic burden of caregiving in epilepsy: An estimate based on a survey of US caregivers

et al. 2020

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“…Although severe, the course following a first episode of psychosis is rather heterogeneous and outcomes may vary from full recovery to a deteriorating chronic course [27][28][29][30][31][32][33][34][35][36][37][38][39][40]. It has been observed that between two and five years after the first episode, psychotic disorders seem to plateau and follow a more stable course [41], so that a fair prediction of course can be made by year three [42].…”

Section: Relatives Of Patients With Psychosis Are Likelymentioning

confidence: 99%

Differences by Retrospective Illness Course on Burden,Expressed Emotion, Psychological Distress and Quality of Life in Relatives of Mexican Outpatients with Psychosis: A Cross-Sectional Study

GÃÂÃÂ3mez-de-Regil¹

2017

Neuropsychiatry

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Patients' illness might also affect their relatives' psychological state. The present crosssectional study aimed at assessing the levels of burden, expressed emotion, psychological distress and quality of life in a sample of relatives of Mexican outpatients with psychosis and the possible effect of illness course assessed retrospectively. Sample included 65 participants: 73.8% female; mean age of 48.7 years. Relatives self-responded the following scales: the Caregiver Burden Interview, the Family Questionnaire, the WHOQOL-BREF and the GHQ-28. Mean scores were compared by groups according to the retrospective illness course of patients (diagnosis, residual symptoms, relapses) with one tailed Mann-Whitney tests. Levels of burden, expressed emotion, psychological distress, and poor quality of life were low, significantly related and particularly influenced by patient residual symptoms. It is important to involve relatives not only as care providers but also as individuals whose psychological well-being is at risk, particularly when their ill relative present residual symptoms.

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Development and Validation of a Machine Learning Individualized Treatment Rule in First-Episode Schizophrenia

et al. 2020

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IMPORTANCE Little guidance exists to date on how to select antipsychotic medications for patients with first-episode schizophrenia. OBJECTIVE To develop a preliminary individualized treatment rule (ITR) for patients with firstepisode schizophrenia. DESIGN, SETTING, AND PARTICIPANTS This prognostic study obtained data from Taiwan's National Health Insurance Research Database on patients with prescribed antipsychotic medications, ambulatory claims, or discharge diagnoses of a schizophrenic disorder between January 1, 2005, and December 31, 2011. An ITR was developed by applying a targeted minimum loss-based ensemble machine learning method to predict treatment success from baseline clinical and demographic data in a 70% training sample. The model was validated in the remaining 30% of the sample. The probability of treatment success was estimated for each medication for each patient under the model. The analysis was conducted between July 16, 2018, and July 15, 2019. EXPOSURES Fifteen different antipsychotic medications. MAIN OUTCOMES AND MEASURES Treatment success was defined as not switching medication and not being hospitalized for 12 months. RESULTS Among the 32 277 patients in the analysis, the mean (SD) age was 36.7 (14.3) years, and 15 752 (48.8%) were male. In the validation sample, the treatment success rate (SE) was 51.7% (1.0%) under the ITR and was 44.5% (0.5%) in the observed population (Z = 7.1; P < .001). The estimated treatment success if all patients were given a prescription for 1 medication was significantly lower for each of the 13 medications than under the ITR (Z = 4.2-16.8; all P < .001). Aripiprazole (3088 [31.9%]) and amisulpride (2920 [30.2%]) were the medications most often recommended by the ITR. Only 1054 patients (10.9%) received ITR-recommended medications. Observed treatment success, although lower than the success under the ITR, was nonetheless significantly higher than if medications had been randomized (44.5% [SE, 0.55%] vs 41.3% [SE, 0.4%]; Z = 6.9; P < .001), although only marginally higher than if medications had been randomized in their observed population proportions (44.5% [SE, 0.5%] vs 43.5% [SE, 0.4%]; Z = 2.2; P = .03]). CONCLUSIONS AND RELEVANCE These results suggest that an ITR may be associatded with an increase in the treatment success rate among patients with first-episode schizophrenia, but experimental evaluation is needed to confirm this possibility. If confirmed, model refinement that investigates biomarkers, clinical observations, and patient reports as additional predictors in iterative pragmatic trials would be needed before clinical implementation.

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The humanistic and economic burden of providing care for a patient with schizophrenia

Cited by 19 publications

References 17 publications

The economic burden of caregiving in epilepsy: An estimate based on a survey of US caregivers

The economic burden of caregiving in epilepsy: An estimate based on a survey of US caregivers

Differences by Retrospective Illness Course on Burden,Expressed Emotion, Psychological Distress and Quality of Life in Relatives of Mexican Outpatients with Psychosis: A Cross-Sectional Study

Development and Validation of a Machine Learning Individualized Treatment Rule in First-Episode Schizophrenia

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