Evidence map›Paper›PMID 40186214›Full record

ArticleInternational journal of mental health systems2025

The effect of expanded access to mental health care on economic status of households with a person with a mental disorder in rural Ethiopia: a controlled before-after study.

Yohannes Hailemichael, Damen Hailemariam, Kebede Tirfessa, Sumaiyah Docrat, Atalay Alem, Girmay Medhin, Abebaw Fekadu, Crick Lund, Dan Chisholm, Charlotte Hanlon

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Article in International journal of mental health systems, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Yohannes HailemichaelArmauer Hansen Research Institute, Addis Ababa, Ethiopia. yohannes.h.michael@gmail.com.
Damen HailemariamDepartment of Reproductive Health and Health Services Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Kebede TirfessaCollege of Education and Behavioral Studies, Kotebe Metropolitan University, Addis Ababa, Ethiopia.
Sumaiyah DocratHealth Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Atalay AlemDepartment of Psychiatry, School of Medicine, College of Health Sciences, WHO Collaborating Centre for Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia.
Girmay MedhinAklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
Abebaw FekaduDepartment of Psychiatry, School of Medicine, College of Health Sciences, WHO Collaborating Centre for Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia.
Crick LundDepartment of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, , University of Cape Town, Cape Town, South Africa.
Dan ChisholmDepartment of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
Charlotte HanlonDepartment of Psychiatry, School of Medicine, College of Health Sciences, WHO Collaborating Centre for Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia.

Funding

Wellcome TrustWorld Health Organization 001
6 · The paper itself

Abstract

backgroundPoverty and mental illness are strongly associated. The aim of this study was to investigate the economic impact of implementing a district level integrated mental healthcare plan for people with severe mental disorders (SMD) and depression compared to secular trends in the general population in a rural Ethiopian setting.

methodsA community-based, controlled before-after study design was used to assess changes in household economic status and catastrophic out-of-pocket (OOP) payments in relation to expanded access to mental health care. Two household samples were recruited, each with a community control group: (1) SMD sub-study and (2) depression sub-study. In the SMD sub-study, 290 households containing a member with SMD and 289 comparison households without a person with SMD participated. In the depression sub-study, 129 households with a person with depression and 129 comparison households. The case and comparison cohorts were followed up over 12 months. Propensity score matching and multivariable regression analyses were conducted.

resultsProvision of mental healthcare in the district was associated with a greater increase in income (Birr 919.53, 95% CI: 34.49, 4573.56) but no significant changes in consumption expenditure (Birr 176.25, 95% CI: -1338.19, 1690.70) in households of people with SMD compared to secular trends in comparison households. In households of people with depression, there was no significant change in income (Birr 227.78, 95% CI: -1361.21, 1816.79) or consumption expenditure (Birr - 81.20, 95% CI: -2572.57, 2410.15). The proportion of households incurring catastrophic OOP health expenditure (COOPHE) at the ≥ 10% and ≥ 40% thresholds were significantly reduced after the intervention in the SMD (from 20.3 to 9.0%, p = 0.002, and 31.9-14.9%, p < 0.001) and in the depression intervention (from 19.6 to 5.3%, p = 0.003, and 25.2-11.8%, p = 0.015). Similarly, COOPHE has declined in the comparison households for SMD (from 15.6% (T1) to 8.2% (T2) (p = 0.035) and for depression comparison households (from12.1-4.1%(p = 0.069). However, there was no significant difference in the proportion of households experiencing catastrophic OOP health care expenditure in the SMD, depression and the comparison groups (p = 0.808 and p = 0.779 ). Despite improvement in income and COOPHE, households of persons with SMD or depression remained impoverished relative to comparison groups at follow-up. Households of people with SMD and depression were significantly less likely to be enrolled in community-based health insurance (CBHI) than comparison households.

conclusionsThe District mental health care plan intervention increased household income and reduced catastrophic out-of- pocket payment. Our findings support global initiatives to scale up mental healthcare as part of universal health coverage initiatives, alongside interventions to support social inclusion and targeted financial protection for vulnerable households.

Indexed as

Controlled before-after studyDepressionMental health interventionsSevere mental disordersTask-shiftingUniversal health coverage

Identifiers

PMID40186214
PMCPMC11969764

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.