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Out-of-Pocket expenditure for depression among patients attending private community psychiatric clinics in Pakistan.

BACKGROUND
Depression is a serious public health problem in Pakistan because of the disabilities it causes and the cost burden for the family. About 6% of the Pakistani population suffers from this illness and approximately 50% ofthose affected seek treatment. The health budget of the country is very low, average per capita income is 430 US dollars and 35% of the population falls below the poverty line. It follows that depression puts a heavy economic burden on its sufferers.


AIM
The aim of this study was to estimate the economic burden on patients suffering from depression who were attending community psychiatry clinics.


METHODS
This is a prevalence-based analysis of mental health care expenditure in a sample of 200 patients with an ICD-X diagnosis of depression. The patients attended four private community clinics, run on a once-a-week basis, with all care paid for by the patients out of pocket. A questionnaire was designed with a view to gathering information on out-of-pocket treatment and travel expenditures. The data was subjected to SPSS analysis.


RESULTS
Among the subjects enrolled in the study (n=200), 85% were spending over Rs. 3,133 (51.40 US dollars) per month as general expenses on health. Sixty-five percent of the subjects were earning below Rs. 5,000 ( 86.00 US dollars). The majority used the public bus for transportation, costing the family Rs. 83 (1.40 US dollars) per trip. Laboratory investigation costs were negligible as there is a lesser emphasis on lab tests in psychiatry.


DISCUSSION
The high cost of depression keeps a vast majority of the population away from ongoing treatment, which contributes to the misery of the illness and the associated loss of productivity. The national budget is very low, the average income for the majority is far from satisfactory, and though partial support from charitable organizations, public sector hospitals, insurance cover and medical facilities is available, the majority of needs are unmet. It is essential to increase the health budget and enhance efforts toward preventive strategies. Further research on health economics is needed along with an appropriate government database.