Social Psychiatry and Psychiatric Epidemiology

, Volume 53, Issue 8, pp 803–814 | Cite as

Functional impairment among people with severe and enduring mental disorder in rural Ethiopia: a cross-sectional study

  • Kassahun Habtamu
  • Atalay Alem
  • Girmay Medhin
  • Abebaw Fekadu
  • Charlotte Hanlon
Original Paper



Evidence regarding functional impairment in people with severe mental disorders (SMD) is sparse in low- and middle-income countries. The aim of this study was to identify factors associated with functional impairment in people with enduring SMD in a rural African setting.


A cross-sectional study was conducted at the baseline of a health service intervention trial. A total of 324 participants were recruited from an existing community-ascertained cohort of people with SMD (n = 218), and attendees at the Butajira General Hospital psychiatric clinic (n = 106). Inclusion criteria defined people with SMD who had ongoing need for care: those who were on psychotropic medication, currently symptomatic or had a relapse in the preceding 2 years. The World Health Organization Disability Assessment schedule (WHODAS-2.0) and the Butajira Functioning Scale (BFS) were used to assess functional impairment. Multivariable negative binomial regression models were fitted to investigate the association between demographic, socio-economic and clinical characteristics, and functional impairment.


Increasing age, being unmarried, rural residence, poorer socio-economic status, symptom severity, continuous course of illness, medication side effects, and internalized stigma were associated with functional impairment across self-reported and caregiver responses for both the WHODAS and the BFS. Diagnosis per se was not associated consistently with functional impairment.


To optimize functioning in people with chronic SMD in this setting, services need to target residual symptoms, poverty, medication side effects, and internalized stigma. Testing the impact of community interventions to promote recovery will be useful. Advocacy for more tolerable treatment options is warranted.


Severe mental disorder Disability Low- and middle-income countries Schizophrenia Bipolar disorder Major depressive disorder 



We are grateful to all the participants for giving their time and the data. We would also like to acknowledge the TaSCS (Task Sharing the Care of People with Severe Mental Disorders) project outreach workers for helping to recruit and inviting the participants.

Author contributions

KH, CH, AA, GM, and AF conceived and designed the study. KH trained the data collectors and CH followed up the data collection. KH did the data analysis. GM and CH supervised analysis of the data. KH wrote the first draft of the manuscript. All authors agree with the results and conclusions, contributed to the writing of the manuscript, and approved the final manuscript to be submitted for possible publication.


This research was conducted as part of the Africa Focus on Intervention Research for Mental Health (AFFIRM). Research reported in this publication was funded by the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH) under Award Number U19MH095699. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. KH is supported by a post-doctoral fellowship from the African Mental Health Research Initiative (AMARI). AMARI is part of the DELTAS Africa Initiative [DEL-15-01]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [DEL-15-01] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, WellcomeTrust or the UK government.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Availability of data and materials

The data are part of an ongoing cross-country clinical trial study, African Focus on Intervention Research for Mental Health (AFFIRM). Due to the cross-country and ongoing nature of the study, we are not able to make the data publicly available at present. However, the data set used for the current study will be made available and can be accessed from the corresponding author on reasonable request, once the study is completed within 2 years from now.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Psychology, College of Education and Behavioral StudiesAddis Ababa UniversityAddis AbabaEthiopia
  2. 2.Department of Psychiatry, School of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
  3. 3.Aklilu Lemma Institute of PathobiologyAddis Ababa UniversityAddis AbabaEthiopia
  4. 4.Department of Psychological Medicine, Centre for Affective DisordersKing’s College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK
  5. 5.Health Services and Population Research Department, Centre for Global Mental HealthKings College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK

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