Pharmacoeconomics. 2008;26(2):149-62.

The burden of schizophrenia on caregivers: a review.

Awad AG1, Voruganti LN.
Author information
1
Department of Psychiatry and the Institute of Medical Science, University of Toronto, Humber River Regional Hospital, Toronto,
Ontario, M6M 3Z4, Canada. gawad@hrrh.on.ca
Abstract

Schizophrenia is a disabling, chronic psychiatric disorder that poses numerous challenges in its management and consequences. It

extols a significant cost to the patient in terms of personal suffering, on the caregiver as a result of the shift of burden of care from

hospital to families, and on society at large in terms of significant direct and indirect costs that include frequent hospitalizations and the

need for long-term psychosocial and economic support, as well as life-time lost productivity. 'Burden of care' is a complex construct that

challenges simple definition, and is frequently criticized for being broad and generally negative. Frequently, burden of care is more

defined by its impacts and consequences on caregivers. In addition to the emotional, psychological, physical and economic impact, the

concept of 'burden of care' involves subtle but distressing notions such as shame, embarrassment, feelings of guilt and self-blame. The

early conceptualization of 'burden of care' into two distinct components (objective and subjective) has guided research efforts until the

present time. Objective burden of care is meant to indicate its effects on the household such as taking care of daily tasks, whereas

subjective burden indicates the extent to which the caregivers perceive the burden of care. Research contributions in later years (1980s

to the present) have added more depth to understanding of the construct of burden of care by exploring important determinants and

factors that likely contribute or mediate the caregiver's perception of burden of care. Several studies examined the role of gender, and

reported that relatives of male patients with schizophrenia frequently experience more social dysfunction and disabilities than those of

female patients. Similarly, a number of other studies documented the contribution of ethnicity and cultural issues to subjective burden of

care. Although there is no complete agreement on whether a specific cluster of psychotic symptoms has the most impact on a

caregiver's burden of care, there is agreement that the severity of symptoms increases it. An extensive literature concerning family

interventions in schizophrenia has demonstrated the positive impact of various family interventions in improving family environment,

reducing relapse and easing the burden of care. Although the evidence of such positive impact of family interventions in schizophrenia

is well documented, such interventions are neither widely used nor appropriately integrated in care plans, and are frequently

underfunded. Although the cost of caregiving is considered to be significant, there are no reliable estimates of the costs associated with

such care. The majority of available literature categorized the cost of burden of care among the indirect costs of schizophrenia in

general. In recent years, attempts to compare the costs of caregiving in several countries have been reported in the evolving literature

on this topic. 'Burden of care' as a complex construct certainly requires the development of appropriate methodology for its costing. In

achieving a balance between the patients' and caregivers' perspectives, caregivers have to be included in the care plan and adequate

information and support extended to the family and caregivers. Access to better treatment for patients, including medications,

psychosocial interventions and rehabilitation services, are important basic elements in easing the burden on caregivers. Other

measures such as availability of crisis management, provision of legally mandated community treatment to avert hospitalization, and

well informed and balanced advocacy are also important. Although research efforts have been expanded in the last 3 decades, an

urgent need exists for enhancing such efforts, particularly in the development and evaluation of effective family interventions strategies.

There is also a need for continued improvement in the delivery of psychiatric services to the severely psychiatrically ill and their families.

As there is a lack of reliable cost information about the family burden of care specific to schizophrenia, there is an urgent need to

develop reliable approaches that can generate data that can inform in policy making and organization of services.
PMID:

18198934

[Indexed for MEDLINE]

 BEBAN EKONOMI KELUARGA PENDERITA GANGGUAN JIWA
1
Sugeng Mashudi, 2Lusia C.Y.K Wardhany
1
Fakultas Ilmu Kesehatan Universitas Muhammadiyah Ponorogo
2
Pusat Kesehatan Masyarakat Sampung Kab. Ponorogo
email: sugengmashudi@umpo.ac.id

ABSTRAK
Gangguan jiwa merupakan salah satu penyakit kronis yang menyebabkan disabilitas bagi
penderita dan berdampak pada keluarga. Selain beban fisik dan beban psikis, keluarga
penderita ganguan jiwa juga mengalami beban ekonomi. Perhitungan beban ekonomi pada
keluarga penderita gangguan jiwa selama ini belum jelas. Nilai beban ekonomi akan
memberikan peluang bagi LAZ bahwa keluarga penderita gangguan jiwa dapat
dikategorikan sebagai calon Asnaf. Penyaluran zakat untuk keluarga penderita gangguan
jiwa bisa menjadi salah satu solusi dalam mengurangi beban ekonomi keluarga penderita
gangguan jiwa. Metode perhitungan beban keluarga penderita gangguan jiwa di Indonesia
masih sangat lemah. Perlu segera diteliti beban ekonomi keluarga penderita gangguan jiwa
di Indonesia.
Kata kunci: gangguan jiwa, zakat, keluarga penderita, disabilitas.

PENDAHULUAN
Gangguan psikiatris kronis pada penderita gangguan jiwa menimbulkan berbagai
konsekuensi pada keluarga dan memberikan tantangan pada tenaga kesehatan dalam
manajemen perawatan penderita skizofrenia (Awad AG & Information, 2008). Berdasarkan
survay Riskesdas (2013) jumlah penderita gangguan jiwa Indonesia sebesar 1,7 %. Jawa
timut menempati urutan ke-4 dengan nilai 2,2%, termasuk Kabupaten Ponorogo dengan
jumlah penderita gangguan jiwa sebesar 2,2%. Terdapat 67 penderita gangguan jiwa di
Paringan Ponorogo (Mashudi, Widiyahseno, & Priyoto, 2016). Sebanyak 25% beban keluarga
penderita gangguan jiwa di Paringan Ponorogo dalam tingkat sedang (Mashudi, 2017). Beban
ekonomi sebagai salah satu komponen beban keluarga gangguan jiwa merupakan biaya
langsung dan biaya tidak langsung yang dikeluarkan keluarga untuk perawatan penderita
gangguan jiwa setiap bulan selama fase disabilitas. Beban ekonomi tidak langsung
merupakan lamanya merawat penderita oleh caregiver perjam perhari, sedangkan beban
ekonomi langsung merupakan biaya medis dan biaya non medis yang dikeluarkan oleh
keluarga (Addo R, Nonvignon J, 2013). Lembaga Amal Zakat (LAZ) sebagai lembaga
penyalur zakat di Indonesia belum memasukkan secara khusus keluarga penderita gangguan
jiwa sebagai salah satu Asnaf. Penghitungan beban ekonomi keluarga penderita gangguan
jiwa sampai saat ini belum jelas. Tujuan artikel ini menjelaskan perhitungan beban ekonomi
keluarga penderita gangguan jiwa.

BEBAN EKONOMI
Ghana sebagai negara berkembang di kawasan Afrika, seperti Indonesia di kawasan
Asia, terdapat data beban ekonomi keluarga yang mengalami Skizofrenia. Biaya perawatan
skizofrenia yang dikeluarkan rata-rata USD180.72, biaya kebutuhan sehari-hari keluarga
rata-rata USD 60,24 sedangkan rata-rata pendapatan keluarga USD184.48 (Addo R,
Nonvignon J, 2013). Sehingga, rata-rata setiap keluarga dalam sebuan harus menanggung
hutang USD 56,48 untuk mencukupi kebutuhan hidup keluarganya.
Dinas Trasmigrasi dan Tenaga kerja Jatim menetapkan UMR Ponorogo tahun 2018
sebesar Rp. 1.509.816,12 (Surya, 2017). Berdasarkan nilai UMR tersebut upah pekerja
harian ditetapkan sebesar Rp. 60.392,6 atau Rp. 7.549 per jam (lama kerja 8 Jam). Penderita
gangguan jiwa selama fase kambuh (relaps) akan merawat penderita lebih dari 8 Jam sehari.
Jika di nilai dengan uang maka pengasuh akan kehilangan pendapatan lebih dari Rp.
60.000,-/hari. Perawatn gangguan jiwa dilakukan secara terus menerus selama enam bulan,
sehingga potensi keluarga kehilangan pendapatan sebesar Rp. 60.000 cx 30 hari x 6 Bulan =
Rp. 10.800.000,-. Nilai tersebut termasuk beban ekonomi tidak langsung keluarga penderita
skizofrenia.

Gambar 1. Beban ekonomi harian pengasuh penderita gangguan jiwa.Biaya perawatan penderita
gangguan jiwa sebesar Rp. 37.167 sebagai konstanta fungsi beban ekonomi dan nilai pengasuhan
satu jam dihitung sebesar Rp. 7.500. Asumsi biaya hidup Kab. Ponorogo 2018 sebesar 1.500.000

Biaya untuk membeli obat-obatan sebagai penyumbang tertinggi biaya langsung

penyakit skizofrenia (Addo R, Nonvignon J, 2013). Biaya pengobatan gangguan jiwa di
Indonesia sekitar Rp. 1. 115.000,-/ bulan. Sehingga, biaya perawatan selama 6 bulan sebesar
Rp. 1. 115.000 x 6 Bulan = Rp. 6.690.000,-. Fungsi beban keluarga penderita gangguan jiwa
bisa dirumuskan Y= 37.167 + 7500x (Gambar 1).

KONSEP PENERIMA ZAKAT

Salah satu penentuan penerima zakat berdasarkan pertimbangan tiga variabel yaitu
variabel ekonomi, variabel aset, dan variabel kesehatan (Ramadhani & Sulaksono, 2016).
Variabel ekonomi didefinisikan sebagai biaya hidup minimal berdasarkan MDG’s
(Milennium Development Goals) sebesar $1,25. Variabel aset didefinisikan sebagai jumlah
barang berharga yang dimiliki keluarga. Sedangkan variabel kesehatan tingkat kesehatan
penerima zakat. Variabel kesehatan pada penelitian Ramadhani dan Sulaksono (2016) masih
berdasarkan standart kriteria rumah sehat, belum mencantumkan status kesehatan penerima
zakat.

SIMPULAN
Perhitungan beban ekonomi pada keluarga penderita gangguan jiwa memberikan
pengetahuan baru pengembangan Asnaf di Indonesia. LAZ bisa menjadikan keluarga
penderita gangguan jiwa sebagai bagian dari Amil.

REFERENSI
Addo R, Nonvignon J, A. M. (2013). Household costs of mental health care in Ghana. J Ment
Health Policy Econ, 16(4), 151–159. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/24526584
Awad AG, V. L., & Information. (2008). The burden of schizophrenia on caregivers: a review.
Pharmacoeconomics, 26(2), 149–162. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/18198934
Mashudi, S. (2017). Caregiver Burden with Patients Skizophrenia. In Internatinal Conference
Public Health (p. 30). kuala lumpur: icoph.
Mashudi, S., Widiyahseno, Ba., & Priyoto. (2016). Model Kampung Gila Ponorogo (1st ed.).
Ponorogo.
Ramadhani, R. A., & Sulaksono, J. (2016). Penentuan penerima zakat dengan metode fuzzy.
In Seminar Nasional Teknologi Informasi dan Multimedia (pp. 6–7). Retrieved from
https://ojs.amikom.ac.id/index.php/semnasteknomedia/article/viewFile/1345/1264
Surya. (2017, November 22). Daftar Lengkap UMK Jatim 2018. Surya.