Mental health: Improving youth transition to adulthood with cash transfers

Kelly Kilburn, University of North Carolina at Chapel Hill, November 2015

Mental health disorders are becoming an increasing concern in developing countries, particularly among young people, as evidence on the links between mental health problems and poverty grows. Mental health problems that develop during this developmental stage are not only an immediate health concern, but they often persist into adulthood and contribute to long-term physical health problems. They are also linked to negative social, cognitive, and economic developmental outcomes. These adverse health and developmental effects can in turn be detrimental, having long-term impacts on socioeconomic outcomes and leading to a vicious cycle of poverty and poor mental health.

In sub-Saharan Africa there is a critical need for mental health services for young people. While in some contexts targeted sector programs have been implemented and helpful, the combination of low resource availability and small-scale nature of these programs often means that the poorest, most vulnerable populations tend to have the least access. However, the rise of large-scale poverty alleviation programs such as social cash transfers may mitigate the severity of the problem among these populations. Social cash transfers that provide unconditional cash to households have the potential to address the severity of this problem because, as evidence shows, the cash can mitigate economic shocks to the household, which in turn can buffer against depression. Greater economic security can improve young people’s ability achieve their goals, enhancing hopefulness and future outlooks.

In multiple country evaluations, the Transfer Project has started to collect evidence on how cash transfers are impacting adolescents as they transition into adulthood, including mental health. To date, evidence has been ambiguous on whether poverty alleviation programs can improve mental health problems. Therefore, the Transfer Project is collecting important evidence that can help researchers, practitioners, and policymakers understand how economic interventions might help to ease the burden of mental illness among poor adolescents.

In Malawi, Kenya, Zambia and Zimbabwe, the Transfer Project collected data on aspects of adolescent mental health such as depression, hope and aspirations. In each of these countries, the severity of depressive symptomology in this population was measured with the Center for Epidemiological Studies Depression short scale (CES-D 10). To date, significant evidence was found in Kenya. In a recent paper from the Journal of Adolescent Health shows that youth living in households receiving the cash have a 24 percent reduced odds of depression. Additional assessments are planned using the CES-D scale and other psychosocial outcomes with longitudinal data from Malawi, Zimbabwe, and Zambia. Combining this data with comprehensive household surveys, researchers will also be able to yield valuable insights into household characteristics that are protective of mental health. Furthermore, experimental study designs can help establish whether a causal link exists between unconditional cash transfers and the reduction of mental health problems. These findings will have important policy implications and will also contribute to broader literature linking mental health and poverty.

For more, see:

Kilburn K, Thirumurthy H, Halpern CT, Pettifor A, Handa S. “Effects of a large-scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya”. Journal of Adolescent Health: [published online November 11, 2015]

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