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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
More...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: Suggested Citation