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

Autor(es)

Porto Chiavegatto Filho, Alexandre Dias ^[1] ; Wang, Yuan-Pang ^[2] ; Coelho Campino, Antonio Carlos ^[3] ; Malik, Ana Maria ^[4] ; Viana, Maria Carmen ^[2] ; Andrade, Laura Helena ^[2]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Publ Hlth, Dept Epidemiol, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Inst Psychiat, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Econ Business Adm & Accounting, Dept Econ, Sao Paulo - Brazil

^[4] Fundacao Getulio Vargas, Dept Business Adm, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: BMC PUBLIC HEALTH; v. 15, AUG 5 2015.
• Citações Web of Science: 3

Resumo

Background: 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. Methods: We analyzed the results from a representative sample survey of residents of the Metropolitan Region of Sao Paulo (n = 2,920; Sao 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. Results: 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). Conclusions: 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. (AU)

• Processo FAPESP: 03/00204-3 - Estudo epidemiológico dos transtornos psiquiátricos na região metropolitana de São Paulo: prevalências, fatores de risco e sobrecarga social e econômica
• Beneficiário: Laura Helena Silveira Guerra de Andrade Burdmann
• Linha de fomento: Auxílio à Pesquisa - Temático
• Processo FAPESP: 14/05363-7 - Cidades e saúde mental: determinantes sociais dos distúrbios mentais em grandes centros urbanos em uma análise multicêntrica do World Mental Health Survey Initiative
• Beneficiário: Alexandre Dias Porto Chiavegatto Filho
• Linha de fomento: Auxílio à Pesquisa - Regular