Opoku-Boateng Yaw Nyarko, Kretchy Irene A, Aryeetey Genevieve Cecilia, Dwomoh Duah, Decker Sybil, Agyemang Samuel Agyei, Tozan Yesim, Aikins Moses, Nonvignon Justice
National Health Insurance Authority, Accra, Ghana.
Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
BMC Health Serv Res. 2017 Dec 4;17(Suppl 2):697. doi: 10.1186/s12913-017-2642-0.
Low and middle income countries face many challenges in meeting their populations' mental health care needs. Though family caregiving is crucial to the management of severe mental health disabilities, such as schizophrenia, the economic costs borne by family caregivers often go unnoticed. In this study, we estimated the household economic costs of schizophrenia and quality of life of family caregivers in Ghana.
We used a cost of illness analysis approach. Quality of life (QoL) was assessed using the abridged WHO Quality of Life (WHOQOL-BREF) tool. Cross-sectional data were collected from 442 caregivers of patients diagnosed with schizophrenia at least six months prior to the study and who received consultation in any of the three psychiatric hospitals in Ghana. Economic costs were categorized as direct costs (including medical and non-medical costs of seeking care), indirect costs (productivity losses to caregivers) and intangible costs (non-monetary costs such as stigma and pain). Direct costs included costs of medical supplies, consultations, and travel. Indirect costs were estimated as value of productive time lost (in hours) to primary caregivers. Intangible costs were assessed using the Zarit Burden Interview (ZBI). We employed multiple regression models to assess the covariates of costs, caregiver burden, and QoL.
Total monthly cost to caregivers was US$ 273.28, on average. Key drivers of direct costs were medications (50%) and transportation (27%). Direct costs per caregiver represented 31% of the reported monthly earnings. Mean caregiver burden (measured by the ZBI) was 16.95 on a scale of 0-48, with 49% of caregivers reporting high burden. Mean QoL of caregivers was 28.2 (range: 19.6-34.8) out of 100. Better educated caregivers reported lower indirect costs and better QoL. Caregivers with higher severity of depression, anxiety and stress reported higher caregiver burden and lower QoL. Males reported better QoL.
These findings highlight the high household burden of caregiving for people living with schizophrenia in low income settings. Results underscore the need for policies and programs to support caregivers.
低收入和中等收入国家在满足其民众的精神卫生保健需求方面面临诸多挑战。尽管家庭照护对于精神分裂症等严重精神残疾的管理至关重要，但家庭照护者所承担的经济成本往往未被注意到。在本研究中，我们估算了加纳精神分裂症的家庭经济成本以及家庭照护者的生活质量。
我们采用疾病成本分析方法。使用简化的世界卫生组织生活质量量表（WHOQOL-BREF）评估生活质量（QoL）。收集了442名在研究前至少六个月被诊断为精神分裂症且在加纳三家精神病医院中的任何一家接受过咨询的患者的照护者的横断面数据。经济成本分为直接成本（包括寻求治疗的医疗和非医疗成本）、间接成本（照护者的生产力损失）和无形成本（耻辱感和痛苦等非货币成本）。直接成本包括医疗用品、咨询和交通费用。间接成本估计为主要照护者损失的生产时间（以小时计）的价值。使用扎里特负担访谈量表（ZBI）评估无形成本。我们采用多元回归模型来评估成本、照护者负担和生活质量的协变量。
照护者每月的总成本平均为273.28美元。直接成本的主要驱动因素是药物（50%）和交通（27%）。每位照护者的直接成本占报告月收入的31%。照护者的平均负担（通过ZBI测量）在0至48的量表上为16.95，49%的照护者报告负担较重。照护者的平均生活质量在100分制中为28.2（范围：19.6 - 34.8）。受教育程度较高的照护者报告的间接成本较低且生活质量较好。抑郁、焦虑和压力严重程度较高的照护者报告的照护者负担较重且生活质量较低。男性报告的生活质量较好。
这些发现凸显了低收入环境中精神分裂症患者家庭照护负担之重。结果强调了制定政策和方案以支持照护者的必要性。
