Humanistic and economic impact of providing care for a person with
schizophrenia: Results from the 2012 National Health and Wellness Survey
Csoboth C, Villa KF, Witt EA, Pomerantz D, O’Gorman, C
1
Discussion: The results of this study suggest that caregivers of people with SCZ are also
impacted by the disorder such that SCZ caregivers have lower health status, reduced work
productivity, and more healthcare resource utilization than non-caregivers. SCZ caregivers
consistently had worse estimated outcomes than caregiver controls, but these differences
were modest and not statistically significant. This pattern suggests that the effect of caring for
an individual with SCZ may be higher than the effect of providing care for patients with other
conditions, but this effect may be small, and future work is needed.
40
30
20
3.83%
Mean (%)
0
*p=0.147 vs schizophrenia; †p=0.014 vs schizophrenia
Overall work productivity loss
*
31.26%
†
26.09%
$1618h
*p=0.049 vs schizophrenia; †p<0.001 vs schizophrenia
30
20
*
24.93%
†
32.21%
47.54
0
*p=0.069 vs schizophrenia; p=0.001 vs schizophrenia
†
Mean
43.70
†
10
p=0.001 vs
schizophrenia
Non−schizophrenia (n=294)
Mean
45.71
*p=0.218 vs
schizophrenia
p=0.003 vs
schizophrenia
Mean
†
Absenteeism
Presenteeism
ER visits
Hospitalizations
Physician visits
LIMITATIONS
*
0.37
0.39
• S
CZ caregivers had consistently worse estimated health outcomes than non-SCZ
caregivers and non-caregivers; when there were significant differences between groups,
post hoc analyses reported the same results
4
†
*
0.24
0.43
*p=0.428 vs schizophrenia; †p=0.555 vs schizophrenia
0.65
6.59
6
*p=0.244 vs
schizophrenia
0.2
†
p=0.001 vs
schizophrenia
†
4
*
4.90
Schizophrenia (n=147)
Labor force participation and work productivity loss
ACKNOWLEDGEMENTS
Disclaimer: The authors were responsible for drafting the poster and received layout, and
production support from inVentiv Medical Communications, which was funded by F. HoffmannLa Roche, Ltd. Kathleen F. Villa (kathleenvilla68@gmail.com) was an employee of Genentech,
Inc. at the time the study was performed.
0
*p=0.023 vs schizophrenia; †p=0.001 vs schizophrenia
Non−caregiver (n=294)
Non−schizophrenia (n=294)
Schizophrenia (n=147)
REFERENCES
1. Fisher GA et al. Res Community Ment Health 1990;6:203–36.
• There were no significant differences between groups with regard to labor force participation
• However, SCZ caregivers reported greater work productivity loss than non-SCZ caregivers
and non-caregivers
• N
onetheless, the pattern of results suggests that SCZ caregivers experience a greater
burden than non-SCZ caregivers and non-caregivers
Funding: This research was funded by F. Hoffmann-La Roche, Ltd.
3.84
2
0.0
• T
he pattern of means was consistent such that SCZ caregivers had worse estimates on
outcome variables than non-SCZ caregivers; however, these differences were not always
statistically significant, potentially due to small sample sizes
• T
his research provides insight into an understudied population as well as support for the
humanistic and economic burden of SCZ caregiving
Physician visits
8
0.4
• L
astly, the non-SCZ caregiver group was heterogeneous (especially with regard to the other
types of conditions cared-for). This may have influenced results, but sample size restricted
us from splitting this heterogeneous group out into separate groups for each condition
DISCUSSION
0
Health utilities
Non−schizophrenia (n=294)
Type
negative symptoms with health outcomes
Hospital visits
0.29
Non−caregiver (n=294)
Non−caregiver
(n=156)
• T
he studied outcomes likely relate to other (unmeasured) economic, medical, QoL and
psychosocial outcomes; thus, in addition to the small sample, this study may be
underestimating the true extent of SCZ caregiver burden
2
0
0.71
Non−schizophrenia
(n=152)
4
8
10
0.6
$5562
ER=emergency room.
a
p=0.882 vs non-caregivers; bp=0.503 vs non-caregivers; cp=0.737 vs non-caregivers; dp=0.540 vs non-caregivers;
e
p=<0.001 vs non-caregivers; fp=0.177 vs non-caregivers; gp=0.028 vs non-caregivers; hp=0.825 vs non-caregivers;
i
p=0.997 vs non-caregivers; jp=<0.001 vs non-caregivers.
*p=0.898 vs schizophrenia; †p=1.00 vs schizophrenia
20
*
0.67
$7647e
Schizophrenia
(n=75)
6
†
$15282j
Schizophrenia (n=147)
0
Physical component summary
30
0.8
$6813d
• A
s with other self-report measures, there is the potential for response bias and/or
retrospective recall bias in the measures assessed here
0.39
†
METHODS
$17573
6
2
0
48.91
$1180c
*p=0.086 vs schizophrenia; p<0.001 vs schizophrenia
ER visits
8
*p=0.172 vs
schizophrenia
*
47.03
$5755b
†
Figure 3. Healthcare resource use
20
50
20000
$2329
$1331
a
0
30
†
$17644i
• SCZ caregivers were more likely to visit their physician than both non-SCZ caregivers and
non-caregivers
Mental component summary
*
45.30
$3997
10000
Non−caregiver (n=294)
Figure 1. Health-related quality of life component summary
†
$1189
15.44%
10
• There were no significant differences between reported frequency of ER or hospital visits
between groups
50
30000
Overall activity impairment
40
37.07%
10
13.42%
10
Cost in $
0
40000
$6529g
• T
hese differences were only statistically significant for comparisons between SCZ caregivers
and non-caregivers
and caregivers across psychosocial, SCZ treatment and medical outcomes
Measures
Grouping variable
• Caregiving status: Participants were categorized by caregiving type (caregiver SCZ,
caregiver – other disorder, non-caregiver)
Covariates
• Demographics: Age, gender, race/ethnicity, marital status, education and income
• Health characteristics: Body mass index (BMI), smoking status, pregnancy status,
whether or not they currently drink alcohol, exercise status and comorbidities (Charlson
Comorbidity Index; CCI)
†
10.53%
†
Healthcare resource use
symptoms, specifically, on treatment/service use and medical outcomes in these groups
Sample
• Respondents who self-reported that they cared for an individual with SCZ (n=147) served
as the analysis group of interest. Caregivers who reported caring for someone with another
condition (not SCZ) and non-caregivers were matched to SCZ caregivers via two separate
propensity score matches using a 2:1 control to target matching algorithm. This resulted in
two comparison groups (n=294 each) of non-SCZ caregivers and non-caregivers for
comparison for subsequent analyses
*
6.58%
*
22.15%
20
$2471f
29.72%
• S
CZ caregivers had lower Mental Component Summary (MCS), Physical Component
Summary (PCS) and Health Utilities scores than non-SCZ caregivers and non-caregivers
40
Data source
• Data from the 2012 US National Health and Wellness Survey (NHWS; N=71,141) were used
in the analyses. The NHWS is a national, internet-based health survey conducted each year
• Respondents of the NHWS are recruited from an internet panel using a random stratified
sampling framework to ensure the demographic composition (with respect to age and sex)
is identical to that of the adult population based on governmental statistics
10
Health-related quality of life
• H
owever, little work has been done on SCZ caregiving; the present study sought to
examine the burdens associated with caregiving for patients with SCZ in the US
• T
o provide a deeper understanding about the humanistic and economic impact of SCZ
on the caregiver
30
20
RESULTS
• C
aregiving for those with a mental illness has been associated with increased stress,3
heightened emotional distress (e.g., depressive symptoms, anxiety),4 decreased life
satisfaction,5 and poorer QoL6
OBJECTIVE
Presenteeism
30
0
schizophrenia caregivers.
• G
iven the severity of schizophrenia (SCZ), patients with SCZ regularly require an informal
caregiver and between 1/3 and 2/3 of persons with a long-term psychiatric disorders, like
SCZ, currently reside with family members,1 specifically, the parents2
Absenteeism
negative symptoms with health outcomes
40
INTRODUCTION
Figure 4. Average annual costs of healthcare resource utilization by group and type among
employed patients
Mean (%)
Results: SCZ caregivers had lower mental component summary scores (assessed by the
SF-36; M = 43.70) than both the CGC (M = 45.30; ns) and NCGC (M = 47.54; p=0.001) groups.
The pattern also held for physical component summary scores (MSCZ = 45.71; MCGC = 47.03, ns;
MNCGC = 48.91, p=0.003) and Health Utilities (MSCZ = .65; MCGC = .67, ns; MNCGC = .71, p<0.001).
Furthermore, SCZ caregivers reported higher levels of work productivity loss than both
comparison groups (for absenteeism, presenteeism, productivity loss, and activity impairment).
Post-hoc tests revealed that these differences were significant between the SCZ caregiver
group and NCGC group. Finally, SCZ caregivers had more visits to their primary care physician
in the past 6 months (M = 6.59) than the CGC (M = 4.90; p=0.023) and NCGC (M = 3.84;
p<0.001) groups.
Statistical analysis
• Descriptive statistics were conducted on all matched variables (e.g., demographics and
health characteristics). Post-match revealed a largely successful propensity score match.
The lone remaining difference was for race/ethnicity with the non-schizophrenia caregiver
group still containing a higher percentage of non-Hispanic white patients Therefore, race/
ethnicity was controlled for all in all subsequent analyses
• General linear models were then conducted to determine the association of caregiving
status with health outcomes controlling for race/ethnicity
Figure 2. Work productivity and activity impairment
Mean (%)
Methods: Data for this study were drawn from the 2012 National Health and Wellness Survey
(NHWS; N=71,149). The NHWS is an annual, representative cross sectional patient report
survey of U.S. adults. This study focused on NHWS participants who provide care for an
individual with SCZ (n=147). Two separate comparison groups were drawn from those who
act as caregivers for someone with a medical condition other than SCZ (n=3,066) and the
remainder of participants who were not caregivers (n=67,936). Because this study was not
experimental and the focal group of SCZ caregivers was small, a 2:1 propensity score match
was used to create caregiver control group (CGC; n=294; drawn from all non-schizophrenia
caregivers) and a non-caregiver control group (NCGC; n=294; drawn from the remaining
non-caregiver participants). This analysis matched participants on the following variables:
age, gender, race/ethnicity, marital status, education, income, BMI, smoking, alcohol,
pregnancy, exercise, and comorbidities.
Outcomes
• Health-related quality of life: HRQoL was measured via the SF-36 v2. Specifically,
the Mental and Physical Component Summary scores and the Health Utilities measure
• Labor force participation and work productivity loss: Labor force participation
(employed full-time, employed part-time, or self-employed) was measured via one item.
Work productivity loss and activity impairment were measured via the Work Productivity
and Activity Impairment scale (WPAI-GH)
• Healthcare resource use: Frequency of three different forms of healthcare resources
over the past 6 months (emergency room [ER] visits, hospitalizations and physician visits)
• Estimated healthcare resource use costs: Estimated healthcare resource use costs were
calculated by extrapolating data from the Medical Expenditure Panel Survey (MEPS) and the
Bureau of Labor Statistics (BLS) to apply as unit costs to Healthcare Resource Use variables
from the NHWS. Direct (ER visits, hospitalizations, health care professionsl [HCP] visits) and
indirect costs (absenteeism and presenteeism) were calculated separately and also totaled
Mean (%)
Purpose: To examine the impact that SCZ has on individuals who provide care for people
with this condition. Specifically, how does caring for a person with SCZ affect a person’s
health status, work productivity, and healthcare resource utilization?
1
Genentech, Inc., South San Francisco, CA, USA; 2Kantar Health, Princeton, NJ, USA
Mean (%)
Background: When considering the impact of illness for schizophrenia (SCZ), it is important
to evaluate the impact on family caregivers and the potential effect on health and productivity.
1
Mean (%)
ABSTRACT
2
Mean (%)
1
1
Annual direct, indirect and total costs for schizophrenia caregivers
• SCZ caregivers reported significantly higher presenteeism relative to non-SCZ caregivers
• SCZ caregivers had consistently higher direct, indirect and total costs than non-SCZ
caregivers and non-caregivers
• SCZ caregivers reported significantly higher absenteeism, presenteeism, work productivity
loss and activity impairment than non-caregivers
• However, these differences were not significant due to extreme variability in estimates
due to the small sample size (employed participants only)
2. Dyck DG et al. Psychosom Med 1999;61(4):411–9.
3. van Wijngaarden B et al. J Affect Disord 2004;81(3):211–22.
4. Perlick DA et al. Bipolar Disord 2007;9(3):262–73.
5. Brodaty H et al. Int J Geriatr Psychiatry 2005;20(6):537–46.
6. Zauszniewski JA et al. J Am Psychiatr Nurses Assoc 2008;14(2):125–35.
Presented at the American Psychiatric Association (APA) Annual Meeting, May 3–7, 2014, New York, NY, USA