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Incremental health expenditure and lost days of normal activity for individuals with mental disorders: results from the Sao Paulo Megacity Study.

ABSTRACT: With the recent increase in the prevalence of mental disorders in developing countries, there is a growing interest in the study of its consequences. We examined the association of depression, anxiety and any mental disorders with incremental health expenditure, i.e. the linear increase in health expenditure associated with mental disorders, and lost days of normal activity.We analyzed the results from a representative sample survey of residents of the Metropolitan Region of São Paulo (n = 2,920; São Paulo Megacity Mental Health Survey), part of the World Mental Health (WMH) Survey Initiative, coordinated by the World Health Organization and performed in 28 countries. The instrument used for obtaining the individual results, including the assessment of mental disorders, was the WMH version of the Composite International Diagnostic Interview 3.0 (WMH-CIDI 3.0) that generates psychiatric diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Statistical analyses were performed by multilevel generalized least squares (GLS) regression models. Sociodemographic determinants such as income, age, education and marital status were included as controls.Depression, anxiety and any mental disorders were consistently associated with both incremental health expenditure and missing days of normal activity. Depression was associated with an incremental annual expenditure of R$308.28 (95% CI: R$194.05-R$422.50), or US$252.48 in terms of purchasing power parity (PPP). Anxiety and any mental disorders were associated with a lower, but also statistically significant, incremental annual expenditure (R$177.82, 95% CI: 79.68-275.97; and R$180.52, 95% CI: 91.13-269.92, or US$145.64 and US$147.85 in terms of PPP, respectively). Most of the incremental health costs associated with mental disorders came from medications. Depression was independently associated with higher incremental health expenditure than the two most prevalent chronic diseases found by the study (hypertension and diabetes).The fact that individuals with mental disorders had a consistent higher health expenditure is notable given the fact that Brazil has a universal free-of-charge healthcare and medication system. The results highlight the growing importance of mental disorders as a public health issue for developing countries.

SUBMITTER: Chiavegatto Filho AD

PROVIDER: S-EPMC4526297 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Incremental health expenditure and lost days of normal activity for individuals with mental disorders: results from the São Paulo Megacity Study.

Chiavegatto Filho Alexandre Dias Porto AD Wang Yuan-Pang YP Campino Antonio Carlos Coelho AC Malik Ana Maria AM Viana Maria Carmen MC Andrade Laura Helena LH

BMC public health 20150805

<h4>Background</h4>With the recent increase in the prevalence of mental disorders in developing countries, there is a growing interest in the study of its consequences. We examined the association of depression, anxiety and any mental disorders with incremental health expenditure, i.e. the linear increase in health expenditure associated with mental disorders, and lost days of normal activity.<h4>Methods</h4>We analyzed the results from a representative sample survey of residents of the Metropol ...[more]

PMID: 26243284

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Project description:BackgroundWorld population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders.Methods and resultsA representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year.DiscussionAdults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.

Project description:AimsImportant transformations in psychiatric healthcare (HC) delivery have been implemented in Latin America during the beginning of 21st century. However, information on current service uses patterns is scant, obstructing the estimates and proper planning of service needs for general population. The current investigation aims to describe patterns and estimates predictors of 12-month HC use by individuals with mental disorders in São Paulo metropolitan area, Brazil.MethodData are from São Paulo Mental Health Survey, a cross-sectional multistage representative study. Participants were face-to-face interviewed in their household, using a structured diagnostic interview, the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. A total of 5037 respondents, non-institutionalised, aged 18 years and older were interviewed. The response rate was 81.3%. We determined the percentages of individuals with 12-month DSM-IV anxiety, mood and substance disorders that received treatment in the 12 months prior to assessment in main service sectors (specialty mental health, general medicine, human services (HS), and complementary and alternative medicine). The number of visits and percentage of individuals who received treatment at minimally adequacy also was estimated. Multilevel regression controlled contextual variables that influenced the use of service and treatment adequacy.ResultsOnly 10.1% of respondents used some HC service in the 12 months prior to assessment for their psychiatric problems, including 3.9% of them being treated either by a psychiatrist, 3.5% by a non-psychiatrist mental health specialist, 3.3% by a general medical (GM) provider, 1.5% by a HS provider and 1.4% by a complementary and alternative medical provider. In general, those participants who received service in the mental health specialty sector reported more visits than those in the GM sector (median 3.9 v. 1.5 visits). The cases seen in specialty sector outnumber those visiting GM treatment in terms of minimally adequate treatment (54.6 v. 23.2%). The likelihood of receiving treatment was significantly greater among individuals diagnosed with any anxiety and mood disorder, presenting more severe disorders, and with possession of HC insurance.ConclusionsThe great majority of individuals with an active mental disorder in São Paulo were either untreated or insufficiently treated. Awareness and training programmes to GM professionals are advocated to improve recognition, care take and referral to specialty care when needed. Proper integration among HC sectors is recommended.

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Incremental health expenditure and lost days of normal activity for individuals with mental disorders: results from the Sao Paulo Megacity Study.

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Incremental health expenditure and lost days of normal activity for individuals with mental disorders: results from the São Paulo Megacity Study.

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