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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Incremental health expenditure and lost days of normal activity for individuals with mental disorders: results from the São Paulo Megacity Study

BMC Public Health > Ausgabe 1/2015
Alexandre Dias Porto Chiavegatto Filho, Yuan-Pang Wang, Antonio Carlos Coelho Campino, Ana Maria Malik, Maria Carmen Viana, Laura Helena Andrade
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

All the authors have made substantive intellectual contributions to the study. ADPCF, YPW, AMM, MCV and LHA have made substantial contributions to the conception, design and acquisition of data. ADPCF and ACCP made substantial contributions to the analysis and interpretation of data. ADPCF drafted the manuscript and ACCP, YPW and LHA revised it critically for important intellectual content. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors read and approved the final manuscript.



With the recent increase in the prevalence of mental disorders in developing countries, there is a growing interest in the study of its consequences. We examined the association of depression, anxiety and any mental disorders with incremental health expenditure, i.e. the linear increase in health expenditure associated with mental disorders, and lost days of normal activity.


We analyzed the results from a representative sample survey of residents of the Metropolitan Region of São Paulo (n = 2,920; São Paulo Megacity Mental Health Survey), part of the World Mental Health (WMH) Survey Initiative, coordinated by the World Health Organization and performed in 28 countries. The instrument used for obtaining the individual results, including the assessment of mental disorders, was the WMH version of the Composite International Diagnostic Interview 3.0 (WMH-CIDI 3.0) that generates psychiatric diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Statistical analyses were performed by multilevel generalized least squares (GLS) regression models. Sociodemographic determinants such as income, age, education and marital status were included as controls.


Depression, anxiety and any mental disorders were consistently associated with both incremental health expenditure and missing days of normal activity. Depression was associated with an incremental annual expenditure of R$308.28 (95 % CI: R$194.05-R$422.50), or US$252.48 in terms of purchasing power parity (PPP). Anxiety and any mental disorders were associated with a lower, but also statistically significant, incremental annual expenditure (R$177.82, 95 % CI: 79.68–275.97; and R$180.52, 95 % CI: 91.13–269.92, or US$145.64 and US$147.85 in terms of PPP, respectively). Most of the incremental health costs associated with mental disorders came from medications. Depression was independently associated with higher incremental health expenditure than the two most prevalent chronic diseases found by the study (hypertension and diabetes).


The fact that individuals with mental disorders had a consistent higher health expenditure is notable given the fact that Brazil has a universal free-of-charge healthcare and medication system. The results highlight the growing importance of mental disorders as a public health issue for developing countries.
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