Rajkumar Ravi P
Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND.
Cureus. 2022 Aug 22;14(8):e28284. doi: 10.7759/cureus.28284. eCollection 2022 Aug.
Background Governmental investment in mental health is of vital importance for the implementation and maintenance of educational, preventive, and therapeutic services related to mental illness, particularly in low- and middle-income countries (LMICs). However, mental health expenditures represent only a small portion of total health spending in many countries. Little is known about the economic, social, or health-related factors that may influence variations in governmental spending in this sector. Methods Data on government expenditure on mental health as a percentage of total healthcare expenditure, collected by the WHO from 78 countries and regions in the period 2013-2014, was available for study. These data were analyzed in relation to key economic, social, and health-related indicators. The selection of these indicators was based on prior national and regional research and expert opinion as reported in the existing literature. Results Government spending on mental health was below 1% of health expenditure in 24.4% of the countries studied. A number of economic, social, and health-related indicators were significantly associated with variations in spending on mental health. Based on the partial correlation, sub-group, and multivariate linear regression analyses, the variables most significantly associated with low government spending on mental health were the burden of communicable diseases (β = -.47, = .001) and cultural collectivism (β = -.37, = .008). Conclusions These results suggest that low government investment in mental health may be associated not only with economic or political factors but also with variations in disease burden and in cultural attitudes across countries. Though no direct assumption regarding causation can be made, such findings may be of value when advocating for greater public investment in mental health, particularly in non-Western cultures with a high competing burden of infectious diseases.
背景 政府对精神卫生的投资对于实施和维持与精神疾病相关的教育、预防和治疗服务至关重要，尤其是在低收入和中等收入国家（LMICs）。然而，在许多国家，精神卫生支出仅占卫生总支出的一小部分。对于可能影响该部门政府支出差异的经济、社会或健康相关因素，人们了解甚少。方法 世界卫生组织在2013 - 2014年期间从78个国家和地区收集的关于政府精神卫生支出占医疗保健总支出百分比的数据可供研究。这些数据与关键的经济、社会和健康相关指标进行了分析。这些指标的选择基于现有文献中报道的先前国家和地区研究以及专家意见。结果 在被研究的国家中，24.4%的国家政府在精神卫生方面的支出低于卫生支出的1%。一些经济、社会和健康相关指标与精神卫生支出的差异显著相关。基于偏相关、亚组和多元线性回归分析，与政府在精神卫生方面低支出最显著相关的变量是传染病负担（β = -0.47，P = 0.001）和文化集体主义（β = -0.37，P = 0.008）。结论 这些结果表明，政府在精神卫生方面的低投资可能不仅与经济或政治因素有关，还与各国疾病负担和文化态度的差异有关。尽管无法直接做出关于因果关系的假设，但在倡导增加对精神卫生的公共投资时，特别是在传染病竞争负担高的非西方文化中，这些发现可能具有价值。
