The Economic Burden of Dissociative Disorders: A Qualitative Systematic Review of Empirical Studies

Objective: Dissociative disorders (DDs) are associated with intensive, long-term treatment, suicidality, recurrent hospitalizations, and high rates of disability. However, little is known about the specifics of the economic burden associated with DDs. This worldwide, systematic review examines the results of studies in adults on direct and indirect costs associated with DDs. Method: We searched 6 databases and the reference lists of articles. We also approached researchers to identify unpublished studies. No language restrictions were imposed. Results: A total of 1,002 records met the search criteria, of which 29 papers were selected for full-text inspection. Ultimately, of these, we reviewed four empirical studies. We provide a narrative discussion of study findings. Our findings suggest that DDs are costly to society, and that there is a reduction in service utilization and associated costs over time with diagnosing of and specialized treatment for DDs. However, the overall quality of the economic evaluations was low; several types of DDs, comorbid conditions, and costs were not included; and men were underrepresented. Due to the heterogeneity among studies, we could not perform a meta-analysis. Conclusions: Due to the heterogeneity and low quality of the identified economic evaluations, no firm conclusions about the economic burden of DDs alone can be drawn. Higher quality research, including a detailed description of the study design, population, and primary outcome measures used, utilizing appropriate clinical alternatives and including major comorbidities, is urgently needed to more rigorously assess the economic impact of DDs. Clinical Impact Statement This review suggests that dissociative disorders (DDs) are associated with substantial costs to the society, although conclusions are tentative due to few studies and methodological limitations. There was agreement in the studies about DDs having substantial direct mental health care costs. Considering that these disorders might often be undetected or misdiagnosed, clinicians and health care authorities should be aware of potential economic gains from earlier recognition and treatment. Appropriate diagnostic and treatment practice may result in financial savings as well as improved life quality for patients and their families.