Long-Term Impact of War on Healthcare Costs: An Eight-Country Study

PLoS One

Dusica Lecic-Tosevski¹  Ramon Sabes-Figuera²  Paul McCrone²  Nexhmedin Morina³  Niccolò Colombini⁴  Matthias Schützwohl⁵  Dean Ajdukovic⁶  Mihajlo Popovski⁷  Tanja Franciskovic⁸  Abdulah Kucukalic⁹  Marija Bogic^1,10  Stefan Priebe^1,10 

[1] Belgrade University School of Medicine, Belgrade, Serbia;Centre for the Economics of Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom;Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands;Department of Mental Health, Modena, Italy;Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany;Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia;Institute of Psychology, University of Skopje, Skopje, FYR Macedonia;School of Medicine, University of Rijeka, Rijeka, Croatia;School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina;Unit for Social & Community Psychiatry, Barts' and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom

关键词: Mental health and psychiatry;    Germany;    Anxiety disorders;    Mood disorders;    Employment;    Europe;    Macedonia;    Substance abuse;   

DOI  :  10.1371/journal.pone.0029603

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

Objective Exposure to war can negatively affect health and may impact on healthcare costs. Estimating these costs and identifying their predictors is important for appropriate service planning. We aimed to measure use of health services in an adult population who had experienced war in the former-Yugoslavia on average 8 years previously, and to identify characteristics associated with the use and costs of healthcare. Method War-affected community samples in Bosnia-Herzegovina, Croatia, Kosovo, FYR Macedonia, and Serbia were recruited through a random walk technique. Refugees in Germany, Italy and the UK were contacted through registers, organisations and networking. Current service use was measured for the previous three months and combined with unit costs for each country for the year 2006/7. A two-part approach was used, to identify predictors of service use with a multiple logistic regression model and predictors of cost with a generalised linear regression model. Results 3,313 participants were interviewed in Balkan countries and 854 refugees in Western European countries. In the Balkan countries, traumatic events and mental health status were related to greater service use while in Western countries these associations were not found. Participants in Balkan countries with post traumatic stress disorder (PTSD) had costs that were 63% higher (p = 0.005) than those without PTSD. Distress experienced during the most traumatic war event was associated with higher costs (p = 0.013). In Western European countries costs were 76% higher if non-PTSD anxiety disorders were present (0.027) and 63% higher for mood disorders (p = 0.006). Conclusions War experiences and their effects on mental health are associated with increased health care costs even many years later, especially for those who stayed in the area of conflict. Focussing on the mental health impact of war is important for many reasons including those of an economic nature.

【 授权许可】

CC BY