Non-Healthcare Societal Burden of Schizophrenia Among Veterans

Introduction: Schizophrenia (SCZ) is a severe mental disorder imposing substantial healthcare burden to society. Data quantifying the non-healthcare societal burden of SCZ is limited, especially among veterans where the prevalence of mental illness is high.

Objective: To estimate the non-healthcare societal burden and associated costs among veterans with SCZ.

Methods: A retrospective cohort study was conducted using the Veterans Health Administration data between 01/2013–09/2019. Veterans diagnosed with SCZ between 01/2014-09/2019 (index date: first observable diagnosis) and those without SCZ (index date: randomly assigned replicating index year distribution of SCZ cohort) were included. Veterans with SCZ were matched 1:1 to SCZ-free controls on age, sex, race, urban vs. rural residence, geographic region of residence, index year, and Charlson Comorbidity Index through propensity scores. Sociodemographic and clinical characteristics were assessed during the 12-month pre-index period. Non-healthcare societal outcomes and associated costs were compared between cohorts, and excess costs due to SCZ were estimated.

Results: In each cohort, a total of 102,207 veterans remained after matching (median age 59, 91.1% male, 61.4% white). Veterans with SCZ had higher frequency of divorce (35.0% vs. 27.7%), unemployment (69.2% vs. 41.1%), homelessness (28.2% vs. 7.2%), incarceration (0.4% vs. 0.1%), and pre-mature death (14.2% vs. 11.9%), compared to SCZ-free controls. Estimated excess cost due to SCZ was $158,893,683 for divorce (one-time event), $1,535,163,000 lost annual wages from unemployment, $400,223,252 and $32,011,985 annually from homelessness and incarceration, respectively (all p  < 0.0001).

Conclusion: Veterans with SCZ had greater non-healthcare societal burden and associated costs compared to SCZ-free controls.