ArticleInternational journal of mental health systems2019
Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia.
Article in International journal of mental health systems, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 5 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 5 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Access to health insurance amongst people with disabilities and its association with healthcare use, health status and financial protection in low- and middle-income countries: a systematic review.International journal for equity in health · 2024Pooled it
- Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis.Bulletin of the World Health Organization · 2022Pooled it
- The burden of household out-of-pocket healthcare expenditures in Ethiopia: a systematic review and meta-analysis.International journal for equity in health · 2022Pooled it
- Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review.PloS one · 2022Pooled it
- A Conceptual Framework for Understanding the Cultural and Contextual Factors on Autism Across the Globe.Autism research : official journal of the International Society for Autism Research · 2020Pooled it
- 'Mental health was always the last; always an afterthought': policy analysis of domestic financing and prioritisation for mental health in Ghana.BJPsych open · 2026Review
- The triple burden: A systematic review and meta-analysis of essential medicine availability, price, and affordability across Ethiopian health facilities.Exploratory research in clinical and social pharmacy · 2025Review
- Depression and associated factors among patients with common eye diseases at the University of Gondar Comprehensive and Specialized Hospital Northwest Ethiopia.Discover mental health · 2025Article
- Mental health and catastrophic health expenditures in conflict-affected regions of Colombia before and during COVID-19: an inequalities perspective.International journal for equity in health · 2025Article
- Mental health conditions of young ethiopians who use substances: a cross-sectional study in West Arsi zone.BMC psychiatry · 2025Article
- The dynamics of mental health policy in Iran over the last century.BMC psychology · 2025Article
- Consumer Financial Protection Versus Catastrophic Healthcare Expenditure in Zambia.Public health challenges · 2024Article
- Catastrophic out-of-pocket payments related to non-communicable disease multimorbidity and associated factors, evidence from a public referral hospital in Addis Ababa Ethiopia.BMC health services research · 2024Article
- Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper.PloS one · 2024Article
- Impact of the COVID-19 pandemic on mental health care and people with mental health conditions in Ethiopia: the MASC mixed-methods study.International journal of mental health systems · 2023Article
- Availability, Price and Affordability of Psychotropic Medicines in Addis Ababa, Ethiopia.Risk management and healthcare policy · 2023Article
- Tracheostomy care quality improvement in low- and middle-income countries: A scoping review.PLOS global public health · 2023Article
- Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE) cluster-randomised controlled trial: An exploratory analysis of impact on food insecurity, underweight, alcohol use disorder and depressive symptoms.Global mental health (Cambridge, England) · 2023Article
- Health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia: an interpretive description.BMC health services research · 2022Article
- Observational
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 4 countries.
Funding
Abstract
backgroundThere are limited data on healthcare spending by households containing a person with severe mental disorder (SMD) in low- and middle-income countries (LMIC). This study aimed to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) payments and coping strategies implemented by households with and without a person with SMD in a rural district of Ethiopia.
methodsA comparative cross-sectional community household survey was carried out from January to November 2015 as part of the Emerald programme (emerging mental health systems in low- and middle-income countries). A sample of 290 households including a person with SMD and 289 comparison households without a person with SMD participated in the study. An adapted and abbreviated version of the World Health Organization SAGE (Study on global Ageing and adult health) survey instrument was used. Households were considered to have incurred catastrophic health expenditure if their annual OOP health expenditures exceeded 40% of their annual non-food expenditure. Multiple logistic regression was used to explore factors associated with catastrophic expenditure and types of coping strategies employed.
resultsThe incidence of catastrophic OOP payments in the preceding 12 months was 32.2% for households of a person with SMD and 18.2% for comparison households (p = 0.006). In households containing a person with SMD, there was a significant increase in the odds of hardship financial coping strategies (p < 0.001): reducing medical visits, cutting down food consumption, and withdrawing children from school. Households of a person with SMD were also less satisfied with their financial status and perceived their household income to be insufficient to meet their livelihood needs (p < 0.001).
conclusionsCatastrophic OOP health expenditures in households of a person with SMD are high and associated with hardship financial coping strategies which may lead to poorer health outcomes, entrenchment of poverty and intergenerational disadvantage. Policy interventions aimed at financial risk pooling mechanisms are crucial to reduce the intensity and impact of OOP payments among vulnerable households living with SMD and support the goal of universal health coverage.
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