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. 2024 Dec 2;21(12):e1004486.
doi: 10.1371/journal.pmed.1004486. eCollection 2024 Dec.

Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme

Camila Bonfim  1 , Flávia Alves  1   2 , Érika Fialho  1 , John A Naslund  2 , Maurício L Barreto  1 , Vikram Patel  2 , Daiane Borges Machado  1   2
Affiliations

Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme

Camila Bonfim et al. PLoS Med. .

Abstract

Background: Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders.

Methods and findings: This cohort study utilised Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation with a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to International Classification of Diseases 10th Revision (ICD-10). Cox proportional hazards models estimated the hazard ratio (HR) for overall mortality and competing risks models estimated the HR for specific causes of death, both associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60.5%), and 26,556 (37.99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (HR 0.93, 95% CI 0.87,0.98, p 0.018) and mortality due to natural causes (HR 0.89, 95% CI 0.83, 0.96, p < 0.001). Reduction in suicide (HR 0.90, 95% CI 0.68, 1.21, p = 0.514) was observed, although it was not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals. In addition, 4% of deaths could have been prevented if BFP had been present (population attributable risk (PAF) = 4%, 95% CI 0.06, 7.10).

Conclusions: BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of the study population.
BFP, Bolsa Família Programme.
See this image and copyright information in PMC

References

    1. Momen NC, Plana-Ripoll O, Agerbo E, Christensen MK, Iburg KM, Laursen TM, et al.. Mortality Associated With Mental Disorders and Comorbid General Medical Conditions. JAMA Psychiatry. 2022;79(5):444–453. https://pubmed.ncbi.nlm.nih.gov/35353141/. [cited 2023 Mar 11]. doi: 10.1001/jamapsychiatry.2022.0347 - DOI - PMC - PubMed
    1. Plana-Ripoll O, Pedersen CB, Agerbo E, Holtz Y, Erlangsen A, Canudas-Romo V, et al.. A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet. 2019;394(10211):1827–1835. https://pubmed.ncbi.nlm.nih.gov/31668728/. [cited 2023 Mar 11]. doi: 10.1016/S0140-6736(19)32316-5 - DOI - PubMed
    1. GBD. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;9(2):137–150. https://pubmed.ncbi.nlm.nih.gov/35026139/. [cited 2023 Apr 15]. doi: 10.1016/S2215-0366(21)00395-3 - DOI - PMC - PubMed
    1. Krupchanka D, Mladá K, Winkler P, Khazaal Y, Albanese E. Mortality in people with mental disorders in the Czech Republic: a nationwide, register-based cohort study. Lancet Public Health. 2018;3(6):e289–e295. https://pubmed.ncbi.nlm.nih.gov/29884434/. [cited 2023 Apr 15]. doi: 10.1016/S2468-2667(18)30077-X - DOI - PubMed
    1. Starace F, Mungai F, Baccari F, Galeazzi GM. Excess mortality in people with mental illness: findings from a Northern Italy psychiatric case register. Soc Psychiatry Psychiatr Epidemiol. 2018;53(3):249–257. https://pubmed.ncbi.nlm.nih.gov/29273912/. [cited 2023 Jun 11]. doi: 10.1007/s00127-017-1468-8 - DOI - PubMed