Fekadu Wubalem, Craig Tom K J, Kebede Derege, Medhin Girmay, Fekadu Abebaw
Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
EClinicalMedicine. 2021 Sep 30;41:101151. doi: 10.1016/j.eclinm.2021.101151. eCollection 2021 Nov.
Severe Mental Disorders (SMDs) affect multiple generations although this is poorly studied. The aim of this study was to investigate the intergenerational and multidimensional impacts of SMD in rural Ethiopia.
This comparative study was nested within an existing population-based cohort study. We collected data from a total 5762 family members of 532 households (266 households with at least one family member with SMD and 266 sex and age matched mentally well controls from the neighborhood) in 2019. The main outcomes were multidimensional poverty, mortality, food insecurity, and family satisfaction.
Multidimensional poverty Index was higher in the households of persons with SMD (74·44%) than the comparison households (38·35%). School attendance was lower in children of people with SMD (63·28%) than children of the comparisons (78·08%). The median years of schooling was also lower among children of people with SMD than the controls. This lower attendance was also true among siblings of people with SMD (35·52%) than the comparisons (49·33%). Over the course of 20 years, family members who have a person with SMD in their household had 23% increased risk of death compared to family members who did not have a person with SMD in their household. Severe food insecurity was also higher in the SMD households (20·68%) than the comparison (13·53%) while family satisfaction was lower.
Families of people with SMD experience pervasive multidimensional and intergenerational impacts. Interventions should consider the broader family social and healthcare needs of the broader family.
严重精神障碍（SMD）会影响多代人，尽管对此研究较少。本研究旨在调查SMD在埃塞俄比亚农村地区的代际和多维度影响。
这项比较研究嵌套于一项现有的基于人群的队列研究中。2019年，我们从532户家庭的5762名家庭成员中收集了数据（266户家庭中至少有一名家庭成员患有SMD，266户家庭为来自邻里的性别和年龄匹配的精神健康对照家庭）。主要结果包括多维度贫困、死亡率、粮食不安全和家庭满意度。
患有SMD者的家庭中多维度贫困指数（74.44%）高于对照家庭（38.35%）。患有SMD者的子女上学率（63.28%）低于对照家庭的子女（78.08%）。患有SMD者的子女受教育年限中位数也低于对照组。患有SMD者的兄弟姐妹上学率（35.52%）也低于对照家庭的兄弟姐妹（49.33%）。在20年的时间里，家中有SMD患者的家庭成员死亡风险比家中没有SMD患者的家庭成员高23%。SMD家庭中严重粮食不安全状况（20.68%）也高于对照家庭（13.53%），而家庭满意度较低。
患有SMD者的家庭经历了普遍的多维度和代际影响。干预措施应考虑更广泛家庭的社会和医疗需求。
