Literature Review

1. AN ANALYSIS OF THE BURDEN OF
SCHIZOPHRENIA AND RELATED
SUICIDE IN AUSTRALIA
Access Economics Report for Sane Australia 2002
An Analysis for Cost Benefit Literature Review with
some Updated Information

2. PURPOSE OF REVIEW
• Summarise and comment on content and
methodology of 2001 Access Economics
report into schizophrenia and suicide
• Update some of the information in the report
to as recent as possible, such as graphs and
tables
2

3. WHAT IS THIS REPORT ABOUT?
• 2001 report written for SANE
• Specifically about schizophrenia and suicide
• Costs is the focus of the report
• Financial costs and effects for individuals
• Health costs in particular
3

4. Location On Web
Sane Australia. (2002). Schizophrenia: costs: an analysis of the burden of
schizophrenia and related suicide in Australia. An Access Economics report.
http://www.aftercare.com.au/wp-content/uploads/2012/11/Schizophrenia-4

5. TOPICS
• Overview of report (executive summary)
• Schizophrenia and Suicide Issues
• Prevalence and Direct Health Costs
• Indirect Costs and Burdens
• Conclusions
• Methodology
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6. BRIEFLY ABOUT
SCHIZOPHRENIA
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7. WHAT IS SCHIZOPHRENIA?
A long-term mental disorder of a type involving a
breakdown in the relation between thought, emotion, and
behaviour, leading to faulty perception, inappropriate
actions and feelings, withdrawal from reality and personal
relationships into fantasy and delusion, and a sense of
mental fragmentation. 7

8. What Comprises It (Generally)
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9. 9

10. TOPIC 1
OVERVIEW
(EXECUTIVE SUMMARY)
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11. EXECUTIVE SUMMARY
• Schizophrenia is cost
• Direct and indirect costs are enormous
• Real financial costs of illness - $1.85 Billion, 0.3% of
GDP
• $50,000 on average for each of more 37,000 Australians
with schizophrenia
*2001 figures 11

12. EXECUTIVE SUMMARY
DIRECT COSTS
• Direct health system costs 2001 - $661 million
• 60% Hospital Costs
• 22% Community Mental Health Services
• 6% Medical Costs (GP’s and Specialists)
• 4% Nursing Homes
• 2% Pharmaceuticals
12

13. $18,000 per person with
schizophrenia
1.2% of national health spending
6 times spending on average
Australian’s health care
13

14. EXECUTIVE SUMMARY
INDIRECT COSTS
• Total $722 million
• $488 million lost earnings from not being able to work
• $94 million premature deaths
• $88 million carer costs
• $52 million prison, police legal costs
14

15. EXECUTIVE SUMMARY
TRANSFER COSTS
• $190 million of lost tax revenue (patients and carers)
• $274 million in welfare payments – mostly disability
support pensions
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16. EXECUTIVE SUMMARY
THE BURDEN OF DISEASE
• 22,616 years of healthy life lost to do schizophrenia in
2001
• 3.323 years lost due to suicide and self-inflicted injury
• 55% mostly males
• 74% young people 15-34
• 129 Australians in 2001 suicided because of it
• 2.5 times risk of death than the average Australian 16

17. One-year prevalence is low (1.92 per 1000 globally
in range of 1 to 7.5), lifetime prevalence is around
10 per 1000
Direct costs are likely to be underestimated for
pharmaceuticals
Burden of disease does not estimate suffering of
families as they care for those with it
Public health spending in Australia is low as
Australians with schizophrenia are missing out on
effective treatments
17

18. EXECUTIVE SUMMARY
COST-EFFECTIVE INTERVENTIONS THAT NEED
INVESTMENT
• Prevention and early intervention programs
• Newer improved medications
• Career education and training
• Psychosocial rehabilitation strategies
• Treatment of co-existing substance abuse
• Research into causes and more effective treatments
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19. TOPIC 2
Schizophrenia and
Suicide
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20. SCHIZOPHRENIA – CLINICAL PICTURE
• Diagnosis is complex based on observations of behaviours and
one’s thinking process (DSM-IV OR ICD-10 classification)
• Symptoms vary for every person but may be:
 Hallucinations – Especially voices, tactile and visual
 Delusions – False beliefs, ideas of grandiosity or persecution
 Disordered Thinking – Abnormalities in language
 Abnormal Affect – Depressed mood, low motivation, withdrawal
• Onset of it is either acute (days or weeks) or insidious (gradual
transition)
• Onset is earlier in males especially in 20’s, females early 30’s
20

21. According to ICD-10 criteria*:
1.53.8% of people with psychoses had schizophrenia
2.10.8% Schizoaffective Disorder
3.11.8% Bi Polar and/or mania
4.8.4% depressive psychosis
5.15.3% other psychosis
SCHIZOPHRENIA IS THE MOST COMMON TYPE OF
PSYCHOSIS, REPRESENTING OVER HALF OF ALL
PSYCHOTIC PATIENTS.
21 * International Statistical Classification of Diseases and Related Health Problems (ICD)

22. SCHIZOPHRENIA – CLINICAL PICTURE
Aetiology (Cause/s of Disease)
• It is a group of brain disorders
• Strong evidence that genetic and environmental factors
impact on early brain development leading to an
increased risk of development of it
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23. SCHIZOPHRENIA – CLINICAL PICTURE - FACTORS
• Heredity/Genetics
• Physical Abnormality of the Brain
• Chemical Imbalance
• Environment
• Note: it is not considered a stress-related illness but
stressful life events and use of drugs can precipitate a
psychotic episode or first onset of it
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24. SCHIZOPHRENIA – CLINICAL PICTURE – ILLNESS
PROGRESSION
• 45% of patients have complete or partial recovery after
one or more episodes
• 20% poor outcomes and 35% varying degrees of
remission and exacerbation
• World Health Organisation based categories
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25. SCHIZOPHRENIA – MORBIDITY
• Disability is experienced by those with it
• Self-care is particularly of concern especially hygiene
• 30% in Low Prevalence Disorders Study (LPDS)
suffered impairment with 3.6% self-neglect
• Occupational performance – study, housework,
employment) is largely affected
25
Morbidity - refers to the state of being diseased or unhealthy within a population.

26. SCHIZOPHRENIA – MORBIDITY – WORK AND
EDUCATIONAL LIMITATIONS, SOCIAL-ECONOMIC
DISADVANTAGE
• People with schizophrenia are socio-economically
disadvantaged with over 70% of people with psychosis in
Australia not working at all
• Nearly half have no school or tertiary education
• People with schizophrenia who had employment
experience high rates of losing it with 53% had lost
nearly 15% of their work-weeks during the due due to
illness-related absence
26

27. SCHIZOPHRENIA – MORBIDITY – SOCIAL STIGMA
• This is referred to as social mistreatment
• Many forms with de-stigmatizing psychotic illness as a
challenge
• Includes negative labelling, pejorative language
• Barriers to housing, employment, social services, social
interactions, friendships with lower self-esteem and
reluctance to obtain treatment
27

28. SCHIZOPHRENIA – MORBIDITY – SOCIAL ISOLATION
• Tend to want to be isolated
• 31% live alone
• 59% have an impaired ability to socialise
• 35% have no face-to-face contact with close relative
• 39% have no ‘best’ friend, 12% no friends at all, 64%
single
28

29. SCHIZOPHRENIA – VIOLENCE AND CRIMINALITY
• Rate of violence can be more if substance abuse or
previous criminal activity are present
• Medications being discontinued is also a risk
• More people in the prison system worldwide of those
with psychotic illness – 3.7% males, 4.0% females
• Also those with schizophrenia more likely to be victims of
crime
29

30. SCHIZOPHRENIA – CO-MORBIDITIES
• Higher risk of other mental illnesses – 25%-30% chance
of clinical depression
• More anxiety, paranoia of being attacked due to
persecutory delusions or worry about having an episode
• Can also be prone to physical disorders due to
unhealthier lifestyles and effects of anti-psychotic drugs
30

31. SCHIZOPHRENIA – OTHER ISSUES AND HIGH RISK OF
MORTALITY
• Substance abuse – Alcohol (30%), and/or Drugs (25%)
• Makes symptoms worse and treatment plans become
ineffective
• Lifetime diagnosis of alcohol and drug abuse is higher
than the general population
• Smoking is a common form of substance abuse with a
risk of associated health issues, one study suggests
80% of people with schizophrenia smoke
31

32. SUICIDE ISSUES
• The World Health Organisation (WHO) calculates
lifetime risk of suicide for people with schizophrenia as
10-13%, 12 times population risk
• Higher in men 20%, women 17%
32

33. SCHIZOPHRENIA – MORBIDITY
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34. SCHIZOPHRENIA – MORBIDITY
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35. SCHIZOPHRENIA – MORBIDITY
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36. SCHIZOPHRENIA – MORBIDITY
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37. SCHIZOPHRENIA – MORBIDITY
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38. SCHIZOPHRENIA – MORBIDITY
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39. SCHIZOPHRENIA – MORBIDITY
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40. SCHIZOPHRENIA – MORBIDITY
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