Background
Mental health, poverty and life chances
Interventions
Aims and objectives
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To understand the impact of CTPs, and their specific components (e.g., conditionality, age at first receipt and length of receipt) on young people’s mental health and on outcomes in early adulthood that predict life chances (objective 1);
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To understand the mechanisms and pathways from mental health and poverty to improved life chances; this includes understanding the relationship between poverty and mental health, and the extent to which improvements in mental health mediate or moderate the relationship between CTPs and life chances (objective 2);
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To investigate the economic impact of CTPs (with and without a mental health component) (objective 3);
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To understand the perspectives of professional groups involved in funding or running programmes, as well as the views and experiences of young people and their families who participate in CTPs; this includes understanding barriers in current provisions and opportunities for improving programmes (objective 4).
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To engage with stakeholders and young people to ensure that the knowledge is relevant to them and can inform national policies and the design and implementation of local programmes (Objective 5).
About the countries and their CTPs
Dataset | Sample and youth age range for analysis | Mental health measures | Life chances measures | Cash transfer program data linkage |
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Itaboraí youth study—Brazil (Wave 1 + 2, 2014–2016) | N = 1409 youth (aged 6 to 16) Representative of Itaboraí city, Rio de Janeiro | Child behaviour checklist Strengths and difficulties questionnaire Symptoms for post-traumatic stress disorder Self-harm, suicidality | Dwelling characteristics School drop-out Extracurricular activities Exposure to violence, bullying and stressful life events Resilience Substance abuse Expectations about future | Bolsa Familia program accessed by 30% of sample |
Encuesta Longitudinal de la Universidad de Los Andes—Colombia (ELCA) 2010-ongoing | N = 11,914 households; Youth (aged 10 to 16): n = 4164 nationally representative sample | EQ-5D father’s and mother’s self- reported depression or anxiety | Income, consumption Employment Educational achievement Access to financial services Substance use | Familias en Acción accessed by sample, linkage to administrative register (includes information for youth supplement) |
Malawi Schooling, Income, and Health Risk Impact Evaluation Household Survey (2007–2012), 4 waves | N = 3810 households female youth (aged 13–22) Rural town | General Health Questionnaire-12 Mental health inventory 5 | Dwelling characteristics Household assets and durables, shocks and consumption Employment Educational attainment Physical health HIV/AIDS Marriage | Randomised controlled trial with groups receiving (i) unconditional cash transfer programme, (ii) conditional cash transfer programme, (iii) nothing |
South African National Income Dynamics Study (2008-ongoing), 5 waves | N = 28,000 households youth (aged 15–24) nationally representative | Centre for Epidemiological Studies Depression Scale (CES-D) | Employment Educational attainment Income, expenditure, assets consumption, debt, savings | Child Support Grant (aged 0–17) accessed by sample |
Randomised controlled trial, Liberia (2010–2011), 2 waves | N = 999 men (aged 18–35); monrovia | Anti-social behaviour including aggression, impulsiveness NEO-five factor personality inventory | Income, assets, expenditure Criminal behaviour | Randomly assigned: 25% cash transfer only, 28% Cognitive Behavioural Therapy only, 25% both, 22% nothing |
Progresa/oportunidades, Mexico (1997–2012) 4 waves | N = 6,786 housholds Youth (aged 15–17) nationally representative | Previously published depression index Subjective well-being18 | 36 parameters on micro-entrepreneurship, income, labour supply, expenditures, social status | Progresa/Oportunidades accessed by sample |
Colombiaa | Brazilb | South Africac | Liberiad | Malawie | Mexicof | |
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Name of cash transfer program | Familias en acción | Bolsa familia program | Child support grant | Cash transfer program provided to study participants for limited time | Zomba cash transfer programme | Progresa/oportunidades |
Population (families, young people) | Families | Families | Children | Young men | Girls and young women | Families |
Objectives | To overcome poverty and strengthen human capital | To promote social inclusion and strengthen human capital | To ensure basic needs of children < 18 years are met (as part of broader poverty reduction strategy) | To stimulate legal self-employment | To increase schooling and health of female adolescents and young adults | To improve child nutrition, health and education |
Households/individuals reached (estimate) | 2.7 million families | 11 million households, 46 million people | 12 million children | Experimental: N = 999 male offenders aged 18–35 | Experimental: N = 3796 female adolescents and young adults | 5.8 million households |
Coverage | 17.5% of total population | 20% of total population | 78% of eligible children | Not applicable | Not applicable | 20% of total population |
Budget of programme as proportion of GDP | 0.19% | 0.5% | 7.5% | Not applicable | Not applicable | 0.5% |
Benefits | USD 17 to USD 33 per month | USD 20 per month/person plus USD 10 per child and 15 per young person aged 16–17 (for conditional program); average USD 50 per family | USD 28 per month | USD 100 per month (two one off payments in 2 consecutive months) | USD 4 to 10 for parent; USD 1 to 5 for adolescent/ young adult; plus school fees | USD 10.5 to USD 66 per month |
Recipient | Caregiver of child or young person | Caregiver of child or young person | Caregiver of child | Young person (male) | Caregivers, young person (female) | Female head of household |
Eligibility | Families in poverty, displaced by internal conflict and/or from indigenous communities with members under 18 years old | Poor families: monthly per capita income < 40 USD (eligible for conditional part of programme) or < 20 USD (eligible for unconditional part of programme) | Child < 18 years; caregiver’s yearly income < USD 3,275 (single) or < USD 6,555 (combined with spouse) | High risk (defined by their involvement in drug use and dealing and other types of offences) | Age 13–22, never married, enrolled in primary/secondary school or recent dropout | Poor families with child < 18 years |
Identification methods | Geographical; identification system (SISBEN) | Geographical; means test income threshold | Proxy means test | Not applicable | Not applicable | Geographical; proxy means test (questionnaire ENCASEH) |
Conditional or unconditional | Conditional | Mix: unconditional for extremely poor; conditional for poor families | Unconditional | Unconditional | Mix: conditional and unconditional arms in study | Conditional |
Conditionalities | Child health checks; regular school attendance (80%) | Regular medical consultation, vaccinations, school attendance (75–85%) | Not applicable | Not applicable | Conditional arm Regular school attendance (80%) | Regular school attendance (85%); regular medical check ups |
Monitoring | Information systems | Nutritional surveillance; vaccination monitoring | Not applicable | Not applicable | Self-reported; school attendance records | Compliance checks (attendance cards) |
Brazil | Colombia | South Africa | Liberia | Malawi | Mexico | |
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Populationg | ||||||
Total population | 205,962,108 | 48,228,697 | 55,291,225 | 4,499,621 | 18,143,315 | 125,890,949 |
Population 15–24 years | 33,689,000 | 8,711,000 | 9,820,000 | 983,000 | 3,886,000 | 22,139,000 |
Proportion 15–24 years, in % | 18 | 16 | 18 | 22 | 21 | 18 |
Proportion (all ages) living in rural areas, in % | 15 | 23 | 35 | 50 | 84 | 21 |
Poverty and income inequalityh | ||||||
GDP per capita (2018), in USD | 8,921 | 6,651 | 6,374 | 674 | 389 | 9,698 |
Poverty headcount ratio at USD 1.90 a day (2011 PPP), in % of population | 3.4 | 4.5 | 18.9 | 38.6 | 71.7 | 3.8 |
GINI Index (2017) | 53.3 | 49.7 | 63 | 35.3 | 44.7 | 48.3 |
Mental health (MH)i | ||||||
MH expenditure per person, in USD | 1.4 | Not reported | 6.7 (12.4j) | 0.02 | Not reported | Not reported |
Government’s expenditure on MH as proportion of total government health expenditure, in % | 1 | Not reported | 3 (5k) | 2.4 | Not reported | Not reported |
Burden of mental disorders (DALYs); per 100,000 | 3,593 | 3,526 | 3,191 | 2,298 | Not reported | 2,368 |
Plan or strategy for child and/or adolescent mental health | Yesl | Yes | Yes | Yes | Not reported | No |
Suicide mortality rate; per 100,000 | 6.5 | 7.2 | 11.6 | 6.8 | Not reported | 5.1 |
Psychiatrists per 100,000 | 3.16 | 1.84 | 1.52 (0.31 among uninsured populationm) | 0.04 | 0.01 | 0.21 |
Child psychiatrists per 100,000 | (38n) | Not reported | 0.08 (0.02 among uninsured populationo) | Not reported | Not reported | 0.03 |
Psychologists per 100,000 | 12.37 | Not reported | Not reported (0.97 among uninsured populationp) | Not reported | 0.02 | 3.46 |
Other paid MH workers per 100,000 | 243 | Not reported | Not reported | 4.56 | Not reported | 0.25 |
Total number of mental health professionals | 653,329 | 885 | Not reported | 560 | Not reported | 5,541 |
Total number of mental health workers per 100,000 | 318 | 1.84 | Not reported | 12.45 | Not reported | 4.4 |
Outpatient facilities for children and adolescents (total) | 223 | Not reported | Not reported | 6 | Not reported | 26 |
Life chancesq | ||||||
Not in education, employment or training (NEET), 15–14 years old, in % | 24 | 23 | 32 | Not reported | Not reported | 18 |
Youth unemployment, in % | 29 | 19 | 53 | 3 | 7 | 7 |
Labour force participation (ages 15–24) in % | 55 | 52 | 26 | 30 | 64 | 44 |
Employment to population ratio, ages 15–24 total, in % | 39.5 | 42.9 | 11.9 | 55.6 | 27.4 | 40.7 |
HIV prevalence (ages 15–24), in % | Female: 15–19 years 3.2, 20–24 years 10.3 Male: 15–19 years 7.0 20–24 years 36.2r | Female: 0.1 Male: 0.1 | Female: 11.3 Male: 3.7 | Female: 0.8 Male: 0.4 | Female: 4.3 Male: 2 | Female: 0.1 Male: 0.1 |
Prevalence binge alcohol use (ages 15–19), in % | Female: 32.3 Male: 32.7 | Female: 20 Male: 29 | Female: 11.2 Male: 15.8 | Female: 13.4 Male: 17.8 | Female: 5.0 Male: 16.3 | Female: 11.8 Male: 21.6 |
Adolescent life births per 1000, 15–19 years | 66.8 | 41.6 | 40.4 | 104.8 | 142.7 | 60.5 |
Females (ages 20–24) in marriage before age 18 years, in % | 26s | 23.4 | Not reported | 35.9 | 42.1 | 26.1 |
Methods
General approach
Investigating the impact of CTPs (Objective 1)
Brazila | Colombiab | South Africac | |||||||||||||||||
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Total (N = 1189) | Mental health problemsd (N = 155) | No mental health problems (N = 1034) | Total (N = 6430) | Mental health problemsd (N = 642) | No mental health problems (N = 5788) | Total (N = 2452) | Mental health problemsd (N = 394) | No mental health problems (N = 2058) | |||||||||||
N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | ||
Single mother | 421 | 35 | 57 | 37 | 364 | 35 | – | – | – | – | – | – | – | – | – | – | – | – | |
Socio-economic groupe | |||||||||||||||||||
Low | 662 | 58 | 93 | 60 | 569 | 55 | 1136 | 18 | 302 | 47 | 2877 | 50 | – | – | – | – | – | – | |
Middle | 458 | 39 | 54 | 35 | 404 | 39 | 1663 | 26 | 333 | 52 | 2818 | 49 | – | – | – | – | – | – | |
High | 69 | 6 | 8 | 5 | 61 | 6 | 3534 | 56 | 7 | 1 | 93 | 2 | – | – | – | – | – | – | |
Household income under poverty line | – | – | – | – | – | – | – | – | – | – | – | – | 1169 | 42 | 211 | 51 | 958 | 41 | |
Mother’s education | |||||||||||||||||||
No/basic | 464 | 39 | 65 | 42 | 399 | 39 | – | – | – | – | – | – | – | – | – | – | – | – | |
Middle | 354 | 30 | 42 | 27 | 312 | 30 | – | – | – | – | – | – | – | – | – | – | – | – | |
High | 371 | 31 | 48 | 31 | 323 | 31 | – | – | – | – | – | – | – | – | – | – | – | – | |
Father’s or head of household education | |||||||||||||||||||
No/basic | 511 | 43 | 73 | 47 | 438 | 43 | – | – | – | – | – | – | – | – | – | – | – | – | |
Middle | 372 | 31 | 38 | 25 | 334 | 32 | – | – | – | – | – | – | – | – | – | – | – | – | |
High | 303 | 26 | 44 | 28 | 259 | 25 | – | – | – | – | – | – | – | – | – | – | – | – | |
Mother unemployment (paid work in the past 30 days) | 484 | 41 | 70 | 45 | 414 | 40 | 229 | 4 | 24 | 4 | 205 | 4 | – | – | – | – | – | – | |
Father unemployment (paid work in the past 30 days) | 98 | 13 | 19 | 19 | 79 | 12 | 460 | 7 | 57 | 9 | 403 | 7 | – | – | – | – | – | – | |
Ethnic group | |||||||||||||||||||
Black African | – | – | – | – | – | – | – | – | – | – | – | – | 2091 | 84 | 348 | 91 | 1743 | 83 | |
‘Coloured’f | – | – | – | – | – | – | – | – | – | – | – | – | 310 | 8 | 41 | 6 | 269 | 9 | |
Indian | – | – | – | – | – | – | – | – | – | – | – | – | 19 | 2 | 0 | 0 | 19 | 2 | |
White | – | – | – | – | – | – | – | – | – | – | – | – | 32 | 5 | 5 | 3 | 27 | 6 | |
Resides in rural area | – | – | – | – | – | – | – | – | – | – | – | – | 1446 | 46 | 246 | 53 | 1200 | 48 | |
No health insurance | – | – | – | – | – | – | – | – | – | – | – | – | 2278 | 88 | 378 | 93 | 1900 | 87 | |
Overcrowding | |||||||||||||||||||
Average number of persons in one room | 1.1 | 57 | 1.3 | 77 | 1.0 | 52 | – | – | – | – | – | – | 1.7 | – | 2.1 | – | 1.7 | – | |
Number of people in one room > 2 | – | – | – | – | – | – | 1466 | 23 | 153 | 24 | 1293 | 22 | – | – | – | – | – | – | |
Quality of housing and access to house | |||||||||||||||||||
Street to house not paved or asphalted | 801 | 67 | 115 | 74 | 40 | 66 | – | – | – | – | – | – | – | – | – | – | – | – | |
Inadequate external wallsg | – | – | – | – | – | – | – | – | – | – | – | – | 565 | 19 | 90 | 22 | 475 | 19 | |
Access to water and sanitary facilities, public utilities | |||||||||||||||||||
No piped/running water access | 820 | 69 | 106 | 68 | 714 | 69 | 1336 | 21 | 113 | 18 | 1223 | 21 | – | – | – | – | – | – | |
Without access to sanitary service | – | – | – | – | – | – | 842 | 13 | 113 | 18 | 827 | 14 | 386 | 12 | 76 | 15 | 310 | 11 | |
Unimproved water systemg | – | – | – | – | – | – | – | – | – | – | – | – | 870 | 30 | 139 | 34 | 731 | 30 | |
Unimproved sewage systemg | – | – | – | – | – | – | – | – | – | – | – | – | |||||||
Child education | |||||||||||||||||||
School attendance | 1174 | 99 | 151 | 97 | 1034 | 99 | – | – | – | – | – | – | – | – | – | – | – | – | |
School drop–out | 10 | 1 | 3 | 2 | 7 | 1 | – | – | – | – | – | – | – | – | - | – | – | – | |
School repetition | 151 | 13 | 28 | 19 | 123 | 12 | – | – | – | – | – | – | – | – | – | – | – | – | |
Education (in years) | – | – | – | – | – | – | – | – | – | – | – | – | 9 | – | 8.9 | – | 9 | – | |
≥ 2 years behind expected grade | – | – | – | – | – | – | – | – | – | – | – | – | 1315 | 49 | 210 | 53 | 1105 | 54 | |
Not in education, training or employment | – | – | – | – | – | – | – | – | – | – | – | – | 356 | 13 | 68 | 18 | 288 | 12 |
Delineating pathways and identifying mechanisms (Objective 2)
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Contextual factors: e.g., unemployment, social cohesion, family functioning;
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Conditionalities: e.g., school attendance and child health visits; and
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Other programme features: e.g., amount of money; length of time receiving the cash transfer; ways of monitoring compliance