Economic Burden Of Schizophrenia And Bipolar Disorders In Ethiopia

In Ethiopia, economic burden of schizophrenia and bipolar disorders was a virginrnarea of research untapped for the last many decades. On the other hand sporadicrnepidemiological studies indicate that mental health problems are major public healthrnconcern in the country. However, despite high magnitude of the problems, the extent andrnthe longitudinal time change of family and caregiver burden due to schizophrenia andrnbipolar disorders is unknown. Therefore, this dissertation has tried to give answers to thernfollowing research questions: What is the extent of economic burden of schizophreniarnand bipolar disorders in Ethiopia? How does burden change overtime in families ofrnpatients with schizophrenia and bipolar disorders? Are families with a member withrnschizophrenia and bipolar disorder face different disease burden compared to familiesrnwith physical disorders?rnTo answer these research questions one year longitudinal prospective study withrneconomic and family caregiver burden measurements on families of 249 schizophrenia,rn190 bipolar, 55 diabetes, hypertension and asthma patients and 659 families who are withrnother sickness in the community was carried out. Population average generalizedrnestimating equation and time series generalized least squares analyses were used tornestimate the extent and the change over time of burden in the families of patients withrnschizophrenia and bipolar disorders.Using the prevalence based and the human capital approach, economic burdenrnestimations at societal level were also made. As a result in the analysis of six waves ofrndata, families of patients with schizophrenia were found to experience persistent burdenrnfor about eighty-three percent of the year. The change in family burden due to time wasrnstatistically significant with a mean family burden score of 3.10 (z = -20.86, P>|z|=rn0.001). In terms of caregiver characteristics, female caregivers, caregivers in farmingrnoccupation, whose monthly living expenses were very little, who had paid more out-ofpocketrnfor mental health services, who were angry at the patient, who were worried aboutrnthe patient, who were over involved in controlling the patient, and who had lost morerndays of work were found to be more burdened. Overall in 2005, the total burden ofrnschizophrenia to families in Ethiopia ranged approximately between $2.12 million torn$9.97 million.rnAs observed in families of patients with schizophrenia, in a comparative analysis,rnbipolar patient family caregivers were also found to be more burdened for about 8 to 10rnmonths of the year than family caregivers of patients with diabetes, hypertension andrnasthma and sick controls in the community. The average difference in family caregiverrnburden score between bipolar and diabetes, hypertension and asthma patient familyrncaregivers was 4.36 (z = -8.75, P>|z|= 0.001); while the difference due to time betweenrnthe two groups was 3.42 (z= -4.27, P>|z|= 0.001). Similarly, the average difference inrnfamily caregiver burden score between family caregivers of bipolar patient and sickrncontrols in the community was 3.7 (z= -4.88, P>|z| 0.001). In terms of longitudinalrncaregiver burden difference, bipolar patients family caregivers were found to be morernburdened 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 disorderrnlost a mean of 93.52 cumulative days of work. Consequently, in the year 2005, bipolarrndisorder patents living in a community under clinical follow-up lost 112.8 million days ofrnwork.rnIn sum the total economic burden of schizophrenia and bipolar disorders inrnEthiopia ranged approximately $378.62 to $469.47 million. Out of this total economicrnburden the direct cost was found to be 1.25 percent to 3.66 percent of the country’s publicrnhealth expenditure in the year 2005. This amount of burden is very huge for poorrncountries like Ethiopia. It is a hidden economic loss. Generally the figure shows that therncountry’s health care system should try to reduce the high level of hidden sufferings ofrnfamilies and caregivers so as to keep the level of burden low. Future studies need to focusrnmore on how to devise feasible intervention strategies to lessen economic and familyrnburden due to schizophrenia and bipolar disordersrnKey words: schizophrenia; bipolar disorder; caregiver burden; family burden; economicrnburden; panel data; population average generalized estimating equation; time-seriesrngeneralized least squares, Ethiopia

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