Distributed impact of Severe Mental Disorders in rural Ethiopia, a qualitative study.

Abstract Aim: To explore the distributed impact of Severe Mental Disorders (SMD) among people with lived experience of SMD, their family members, and community members.Methods: We conducted in-depth interviews with family key informants of people with SMD (n=32), people with SMD (schizophrenia, bipolar disorder, and major depression) (n=10), and community members (n=6) in rural Ethiopia. The study was nested within a long-standing population-based cohort of people with SMD. Interviews were conducted in Amharic and were audiotaped. We conducted thematic analysis. Results: All except one respondent described multidimensional impacts of the illness on the person with the illness, family members, and the community. We identified four themes: stress and physical tolls, lost expectations, social disruption, and economic threat.Family members reported stress and hopelessness even to the extent that they sometimes wished the individual with the illness would die; some had also tried to harm themselves. Family members reported that their relationships with each other and with the wider community were disrupted significantly. Spouses and children did not get the support they needed leading to disappointed expectations; left alone in caring for children, unable to go to school or dropping out early. The study participants with SMD also spoke about the effects of their illness on other family members and the community which appeared to be a source of shame and self-isolation. Both the family and the community respondents reported the economic effect of the illness which may result in selling assets, debt, unemployment, forced migration, and food insecurity. The community members reported the economic burden and danger related with aggressive behaviour of the person with SMD while the person with the illness and their family members blames the community for the stigma and discrimination against them. Conclusion: SMD has profound consequences on the person with the illness, their family members, and the community. Future interventions for SMD should consider household level interventions to address economic and care needs and mitigate intergenerational impact. The community should be considered as a resource as well as target for intervention.