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Do Conditional Cash Transfers Reduce Mortality in People Hospitalised for Psychiatric Disorders? A Quasi-Experimental Analysis of the Brazilian Bolsa Família Programme

25 Pages Posted: 11 Mar 2024

See all articles by Camila Barreto Bonfim

Camila Barreto Bonfim

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Flávia Jôse O. Alves

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Erika Xavier

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

John Naslund

Harvard University - Department of Global Health and Social Medicine

Mauricio Lima Barreto

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Vikram Patel

Public Health Foundation of India - Centre for Chronic Conditions and Injuries; Harvard University - Harvard Medical School; Global Nature Care Sangathan Group of Institutions; Harvard University - Department of Global Health and Social Medicine

Daiane Machado

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS); Harvard University - Department of Global Health and Social Medicine

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Abstract

Background: Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Familia Programme (BFP) recipient and the risk of mortality among people previously hospitalised for any psychiatric disorders.

Methods: This quasi-experimental study utilized Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation for a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to ICD-10. Poisson models estimated the incidence rate ratio (IRR) for mortality outcomes associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. 

Findings: We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60·5%), and 26,556 (37·99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (IRR 0·73, 95% CI 0·68 – 0·79, p <0·001) and mortality due to natural causes (IRR 0·72, 95% CI 0·66 – 0·79, p <0·001). Reductions in unnatural causes (IRR 0·91, 95% CI 0·77 – 1·08, p=0·281) and suicide (IRR 0·73, 95% CI 0·51 – 1·04, p=0·085) were observed, although they were not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals, while its impact on unnatural causes of death was greatest among the elderly.

Interpretation: BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.

Funding: Research reported in this manuscript was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH128911.

Declaration of Interest: The authors declare no competing interests.

Ethical Approval: Ethical approval for the study was obtained from the Federal University of Bahia (UFBA - registration number: 1023107).

Keywords: mental disorder, cash transfer, mortality, hospitalization, cohort

Suggested Citation

Bonfim, Camila Barreto and Alves, Flávia Jôse O. and Xavier, Erika and Naslund, John and Barreto, Mauricio Lima and Patel, Vikram and Machado, Daiane, Do Conditional Cash Transfers Reduce Mortality in People Hospitalised for Psychiatric Disorders? A Quasi-Experimental Analysis of the Brazilian Bolsa Família Programme. Available at SSRN: https://ssrn.com/abstract=4752611 or http://dx.doi.org/10.2139/ssrn.4752611

Camila Barreto Bonfim (Contact Author)

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Flávia Jôse O. Alves

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Bahia
Brazil

Erika Xavier

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

John Naslund

Harvard University - Department of Global Health and Social Medicine ( email )

Mauricio Lima Barreto

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Bahia
Brazil

Vikram Patel

Public Health Foundation of India - Centre for Chronic Conditions and Injuries ( email )

India

Harvard University - Harvard Medical School ( email )

25 Shattuck St
Boston, MA 02115
United States

Global Nature Care Sangathan Group of Institutions ( email )

India

Harvard University - Department of Global Health and Social Medicine ( email )

Daiane Machado

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Bahia
Brazil

Harvard University - Department of Global Health and Social Medicine ( email )