{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T18:53:24Z","timestamp":1778871204287,"version":"3.51.4"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,3,9]],"date-time":"2020-03-09T00:00:00Z","timestamp":1583712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>This study examines the level and distribution of service costs\u2014and their association with functional impairment at baseline and over time\u2014for persons with mental disorder receiving integrated primary mental health care. The study was conducted over a 12-month follow-up period in five low- and middle-income countries participating in the Programme for Improving Mental health carE study (Ethiopia, India, Nepal, South Africa and Uganda). Data were drawn from a multi-country intervention cohort study, made up of adults identified by primary care providers as having alcohol use disorders, depression, psychosis and, in the three low-income countries, epilepsy. Health service, travel and time costs, including any out-of-pocket (OOP) expenditures by households, were calculated (in US dollars for the year 2015) and assessed at baseline as well as prospectively using linear regression for their association with functional impairment. Cohort samples were characterized by low levels of educational attainment (Ethiopia and Uganda) and\/or high levels of unemployment (Nepal, South Africa and Uganda). Total health service costs per case for the 3 months preceding baseline assessment averaged more than US$20 in South Africa, $10 in Nepal and US$3\u20137 in Ethiopia, India and Uganda; OOP expenditures ranged from $2 per case in India to $16 in Ethiopia. Higher service costs and OOP expenditure were found to be associated with greater functional impairment in all five sites, but differences only reached statistical significance in Ethiopia and India for service costs and India and Uganda for OOP expenditure. At the 12-month assessment, following initiation of treatment, service costs and OOP expenditure were found to be lower in Ethiopia, South Africa and Uganda, but higher in India and Nepal. There was a pattern of greater reduction in service costs and OOP spending for those whose functional status had improved in all five sites, but this was only statistically significant in Nepal.<\/jats:p>","DOI":"10.1093\/heapol\/czz182","type":"journal-article","created":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T20:18:35Z","timestamp":1582921115000},"page":"567-576","source":"Crossref","is-referenced-by-count":8,"title":["Health service costs and their association with functional impairment among adults receiving integrated mental health care in five low- and middle-income countries: the PRIME cohort study"],"prefix":"10.1093","volume":"35","author":[{"given":"Dan","family":"Chisholm","sequence":"first","affiliation":[{"name":"Department of Mental Health and Substance Abuse , World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Garman","sequence":"additional","affiliation":[{"name":"Alan J Flisher Centre for Public Mental Health , Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Breuer","sequence":"additional","affiliation":[{"name":"Alan J Flisher Centre for Public Mental Health , Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abebaw","family":"Fekadu","sequence":"additional","affiliation":[{"name":"Centre for Global Mental Health , Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King\u2019s College London, De Crespigny Park, SE5, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Hanlon","sequence":"additional","affiliation":[{"name":"Centre for Global Mental Health , Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King\u2019s College London, De Crespigny Park, SE5, London, UK"},{"name":"Department of Psychiatry , School of Medicine, College of Health Sciences, Addis Ababa University, Arat Kilo, 1176, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Jordans","sequence":"additional","affiliation":[{"name":"Centre for Global Mental Health , Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King\u2019s College London, De Crespigny Park, SE5, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tasneem","family":"Kathree","sequence":"additional","affiliation":[{"name":"School of Psychology , University of KwaZulu Natal, Umbilo Road, Congella 4013, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Butabika Mental Hospital , Plot 2, Butabika Road, P.O. Box 7017, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nagendra","family":"Luitel","sequence":"additional","affiliation":[{"name":"Transcultural Psychosocial Organization (TPO) Nepal , Baluwatar 44600, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girmay","family":"Medhin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry , School of Medicine, College of Health Sciences, Addis Ababa University, Arat Kilo, 1176, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vaibhav","family":"Murhar","sequence":"additional","affiliation":[{"name":"Sangath , 120, Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh 462016, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inge","family":"Petersen","sequence":"additional","affiliation":[{"name":"School of Psychology , University of KwaZulu Natal, Umbilo Road, Congella 4013, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sujit D","family":"Rathod","sequence":"additional","affiliation":[{"name":"Department of Population Health , London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Shidhaye","sequence":"additional","affiliation":[{"name":"Centre for Mental Health , Public Health Foundation of India, Unit No. 316, 3rd Floor, Rectangle -1 Building, Plot No. D-4, District Centre Saket, New Delhi-110017, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Ssebunnya","sequence":"additional","affiliation":[{"name":"Butabika Mental Hospital , Plot 2, Butabika Road, P.O. 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