Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa.
Soc Psychiatry Psychiatr Epidemiol. 2013 May;48(5):845-51. doi: 10.1007/s00127-012-0587-5. Epub 2012 Sep 25.
Little is known regarding the links between mental disorder and lost income in low- and middle-income countries. The purpose of this study was to investigate the association between mental disorder and lost income in the first nationally representative psychiatric epidemiology survey in South Africa.
A probability sample of South African adults was administered the World Health Organization Composite International Diagnostic Interview schedule to assess the presence of mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, version IV.
The presence of severe depression or anxiety disorders was associated with a significant reduction in earnings in the previous 12 months among both employed and unemployed South African adults (p = 0.0043). In simulations of costs to individuals, the mean estimated lost income associated with severe depression and anxiety disorders was $4,798 per adult per year, after adjustment for age, gender, substance abuse, education, marital status, and household size. Projections of total annual cost to South Africans living with these disorders in lost earnings, extrapolated from the sample, were $3.6 billion. These data indicate either that mental illness has a major economic impact, through the effect of disability and stigma on earnings, or that people in lower income groups are at increased risk of mental illness. The indirect costs of severe depression and anxiety disorders stand in stark contrast with the direct costs of treatment in South Africa, as illustrated by annual government spending on mental health services, amounting to an estimated $59 million for adults.
The findings of this study support the economic argument for investing in mental health care as a means of mitigating indirect costs of mental illness.
在中低收入国家，人们对精神障碍与收入损失之间的关联知之甚少。本研究旨在调查南非首次全国性精神流行病学调查中精神障碍与收入损失之间的关联。
采用概率抽样方法对南非成年人进行世界卫生组织复合国际诊断访谈表调查，以评估《精神障碍诊断与统计手册》第四版中定义的精神障碍的存在情况。
严重抑郁或焦虑障碍的存在与南非就业和失业成年人在过去 12 个月中收入显著减少有关（p=0.0043）。在个体成本模拟中，经年龄、性别、物质滥用、教育、婚姻状况和家庭规模调整后，严重抑郁和焦虑障碍相关的平均估计收入损失为每位成年人每年 4798 美元。根据从样本中推断出的这些障碍导致的南非人在收入损失方面的总年度成本预计为 36 亿美元。这些数据表明，精神疾病要么通过对收入的残疾和耻辱感对经济产生重大影响，要么表明收入较低的人群患精神疾病的风险增加。严重抑郁和焦虑障碍的间接成本与南非精神卫生服务的直接治疗成本形成鲜明对比，如政府每年用于精神卫生服务的支出估计为 5900 万美元。
本研究的结果支持将精神卫生保健投资作为减轻精神疾病间接成本的经济论据。
