Costs of common perinatal mental health problems in South Africa

Annette Bauer; Emily Garman; Donela Besada; Sally Field; Martin Knapp; Simone Honikman

doi:10.1017/gmh.2022.48

Costs of common perinatal mental health problems in South Africa

Glob Ment Health (Camb). 2022 Aug 23:9:429-438. doi: 10.1017/gmh.2022.48. eCollection 2022.

Authors

Annette Bauer¹, Emily Garman², Donela Besada³, Sally Field⁴, Martin Knapp¹, Simone Honikman⁴

Affiliations

¹ London School of Economics and Political Science (LSE), Care Policy and Evaluation Centre, Houghton Street, London WC2A 2AE, UK.
² Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.
³ Health Systems Unit, South African Medical Research Council, Cape Town, South Africa.
⁴ Department of Psychiatry and Mental Health, Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.

Abstract

Background: Perinatal mental health problems, defined as mental health problems occurring from the start of pregnancy to one year after birth, substantially affect women's and children's quality of life in low- and middle-income countries. In South Africa, despite high prevalence and documented negative impacts, most women do not receive any care.

Methods: A modelling study examined the costs of perinatal mental health problems, namely depression and anxiety, for a hypothetical cohort of women and their children in South Africa over part of their life course (10 years for women, 40 years for children). In sensitivity analysis, additional impacts of post-traumatic stress disorder (PTSD) and completed suicide were included. Data sources were published findings from cohort studies, as well as epidemiological and economic data from South Africa. Data from international studies were considered where no data from South Africa were available.

Results: Lifetime costs of perinatal depression and anxiety in South Africa amount to USD 2.8 billion per annual cohort of births. If the impacts of PTSD and suicide are included, costs increase to USD 2.9 billion. This includes costs linked to losses in quality of life (USD 1.8 billion), losses in income (USD 1.1 billion) and public sector costs (USD 3.5 million).

Conclusions: Whilst important progress has been made in South Africa with regards to mental health policies and interventions that include assessment and management of perinatal mental health problems, substantial underinvestment prevents progress. Findings from this study strengthen the economic case for investing in perinatal mental health care.

Keywords: Child impact; South Africa; cost analysis; maternal mental health; perinatal mental health.