The impact of social drivers, conditional cash transfers and their mechanisms on mental health of the young: an integrated retrospective and forecasting approach using the 100 million Brazilian Cohort

Fundacao Oswaldo Cruz, Rio De Janeiro

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Abstract

PROJECT SUMMARY Physical, emotional, and social changes, including exposure to poverty, abuse, or violence, increases youth vulnerability to mental illness. These factors interfere with development, limit opportunities, and hamper achievement of a fulfilling life as adults. Addressing these issues can lead to improved outcomes at the population level and better cost-effectiveness for health services. This should be especially important to low- and middle-income countries, due to the substantial number of financially and socially vulnerable individuals in these settings. Cash transfer programs have been a promising way to address some of the social drivers for poor mental health among youth. It has been shown that such programs can alleviate income restriction, increase schooling and access to health facilities, and decrease alcohol consumption and violence in families. However, it is still unclear which pathways and mechanisms explain the association between socioeconomic support and lower mental illness among youth. In this project, we will evaluate the effect of social drivers on youth mental health-related hospitalizations and suicide, test mechanisms and pathways of a countrywide socioeconomic intervention, and examine the timing of the intervention during the life course. For example, determining whether cash transfers delivered earlier in life can contribute to better outcomes over time. This project will also investigate the cash transfer effect on vulnerable groups (African descendants, women, and youth with lower income). We will evaluate social drivers’ determination and the association between being beneficiaries of the Conditional Cash Transfer program, called the Bolsa Família Program (BFP), and mental illness and its long-term effects using robust methodologies for big datasets, such as Regression Discontinuity Designs, Propensity Score Matching and difference-in-differences. We will test mechanisms and pathways, between BFP and mental health-related hospitalizations and suicide among youth using Structural Equation Modeling. Furthermore, we will perform microsimulations to generate projections regarding how mental health-related hospitalizations and suicide trends will be in the future based on the current state, and how BFP implementation scenarios will affect these trends. The results of this project will be of vital importance to guide policies and programs to improve mental health and reduce mental health-related hospitalizations and suicide in youth. It will provide information to improve the effectiveness of these programs worldwide. Finally, it can potentially advance the global debate on the economic response to the pandemic and times of economic crises. If cash transfers can decrease mental health problems among youth and reduce suicide, it will have a dramatic impact on saving lives.