Household economic costs associated with mental, neurological and substance use disorders: a cross-sectional survey in six low- and middle-income countries

Abstract

Background: Little is known about the household economic costs associated with mental, neurological and substance use (MNS) disorders in low- and middle-income countries.

Aims: To assess the association between MNS disorders and household education, consumption, production, assets and financial coping strategies in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.

Method: We conducted an exploratory cross-sectional household survey in one district in each country, comparing the economic circumstances of households with an MNS disorder (alcohol-use disorder, depression, epilepsy or psychosis) (n = 2339) and control households (n = 1982).

Results: Despite some heterogeneity between MNS disorder groups and countries, households with a member with an MNS disorder had generally lower levels of adult education; lower housing standards, total household income, effective income and non-health consumption; less asset-based wealth; higher healthcare expenditure; and greater use of deleterious financial coping strategies.

Conclusions: Households living with a member who has an MNS disorder constitute an economically vulnerable group who are susceptible to chronic poverty and intergenerational poverty transmission.

Declaration of interest: D.C. is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.

Keywords: Economic costs; household; low and middle-income countries; mental illness.

Fig. 1

Flow chart of participants in each country.

Fig. 2

Kernel densities of asset scores by country for mental, neurological and substance use (MNS) disorder and control (non-mental health) household groups.