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Marchi M, Alkema A, Xia C, Thio CHL, Chen LY, Schalkwijk W, Galeazzi GM, Ferrari S, Pingani L, Kweon H, Evans-Lacko S, David Hill W, Boks MP. Investigating the impact of poverty on mental illness in the UK Biobank using Mendelian randomization. Nat Hum Behav 2024; 8:1771-1783. [PMID: 38987359 PMCID: PMC11420075 DOI: 10.1038/s41562-024-01919-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 05/31/2024] [Indexed: 07/12/2024]
Abstract
It is unclear whether poverty and mental illness are causally related. Using UK Biobank and Psychiatric Genomic Consortium data, we examined evidence of causal links between poverty and nine mental illnesses (attention deficit and hyperactivity disorder (ADHD), anorexia nervosa, anxiety disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder and schizophrenia). We applied genomic structural equation modelling to derive a poverty common factor from household income, occupational income and social deprivation. Then, using Mendelian randomization, we found evidence that schizophrenia and ADHD causally contribute to poverty, while poverty contributes to major depressive disorder and schizophrenia but decreases the risk of anorexia nervosa. Poverty may also contribute to ADHD, albeit with uncertainty due to unbalanced pleiotropy. The effects of poverty were reduced by approximately 30% when we adjusted for cognitive ability. Further investigations of the bidirectional relationships between poverty and mental illness are warranted, as they may inform efforts to improve mental health for all.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Mental Health and Addiction Services, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Anne Alkema
- Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Charley Xia
- Lothian Birth Cohort Studies, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Chris H L Thio
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Population Health Sciences, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Li-Yu Chen
- Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Winni Schalkwijk
- Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Gian M Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Department of Mental Health and Addiction Services, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Mental Health and Addiction Services, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Mental Health and Addiction Services, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Hyeokmoon Kweon
- Department of Economics, School of Business and Economics, Vrije Universiteit Amsterdam, HV Amsterdam, the Netherlands
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - W David Hill
- Lothian Birth Cohort Studies, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Marco P Boks
- Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands.
- Dimence Institute for Specialized Mental Health Care, Dimence Group, Deventer, The Netherlands.
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.
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Grewal A, Hepburn KJ, Lear SA, Adshade M, Card KG. The impact of housing prices on residents' health: a systematic review. BMC Public Health 2024; 24:931. [PMID: 38561729 PMCID: PMC10983630 DOI: 10.1186/s12889-024-18360-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Rising housing prices are becoming a top public health priority and are an emerging concern for policy makers and community leaders. This report reviews and synthesizes evidence examining the association between changes in housing price and health outcomes. METHODS We conducted a systematic literature review by searching the SCOPUS and PubMed databases for keywords related to housing price and health. Articles were screened by two reviewers for eligibility, which restricted inclusion to original research articles measuring changes in housing prices and health outcomes, published prior to June 31st, 2022. RESULTS Among 23 eligible studies, we found that changes in housing prices were heterogeneously associated with physical and mental health outcomes, with multiple mechanisms contributing to both positive and negative health outcomes. Income-level and home-ownership status were identified as key moderators, with lower-income individuals and renters experience negative health consequences from rising housing prices. This may have resulted from increased stress and financial strain among these groups. Meanwhile, the economic benefits of rising housing prices were seen to support health for higher-income individuals and homeowners - potentially due to increased wealth or perception of wealth. CONCLUSIONS Based on the associations identified in this review, it appears that potential gains to health associated with rising housing prices are inequitably distributed. Housing policies should consider the health inequities born by renters and low-income individuals. Further research should explore mechanisms and interventions to reduce uneven economic impacts on health.
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Affiliation(s)
- Ashmita Grewal
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada.
| | - Kirk J Hepburn
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
| | - Marina Adshade
- Vancouver School of Economics, University of British Columbia, Vancouver, BC, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
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Essel-Gaisey F, Okyere MA, Forson R, Chiang TF. The road to recovery: Financial resilience and mental health in post-apartheid South Africa. SSM Popul Health 2023; 23:101455. [PMID: 37456618 PMCID: PMC10338347 DOI: 10.1016/j.ssmph.2023.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Following the post-apartheid era in South Africa, global economic hardships and financial shocks have forced most households to endure various mental and psychological stresses.. This has hindered the achievement of Sustainable Development Goal 3 (SDG-3)-good health and wellbeing-prompting policymakers and academics to search for remedies to mitigate such stresses. Highlighting resilience as a means of improving wellbeing, this paper focuses on financial resilience and constructs an index using a multidimensional framework to investigate its association with mental health disorders. Using the South Africa National Income Dynamic Study alongside several robust estimation techniques, we uncover a negative association between financial resilience and mental health disorders among South Africans. More specifically, financial resilience is associated with an approximately 37% decrease in the occurrence of mental health disorders. The results also reveal disparities in the correlation between financial resilience and mental health disorders across different subgroups. Non-Whites (especially Blacks), urban dwellers, and male household heads are shown to most strongly experience the depression-reducing effect of financial resilience. This paper also shows that life satisfaction and household expenditure mediate the relationship between financial resilience and mental wellbeing. Toward the end of this paper, we discuss the implications of our results and offer some policy recommendations.
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Affiliation(s)
| | - Michael Adu Okyere
- School of Management, China Institute for Studies in Energy Policy, Xiamen University, Fujian, 361005, China
- School of Economics, China Center for Energy Economics Research, Xiamen University, Xiamen 361005, China
| | - Richmond Forson
- Wang Yanan Institute for Studies in Economics, Xiamen University, Fujian, 361005, China
| | - Tsun-Feng Chiang
- Department of Applied Economics, National Chiayi University, Taiwan
- School of Economics, Henan University, Kaifeng, 475004, Henan, China
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Jafree SR, Mustafa M. The triple burden of disease, destitution, and debt: Small business-women's voices about health challenges after becoming debt-ridden. Health Care Women Int 2023; 44:4-27. [PMID: 31999221 DOI: 10.1080/07399332.2020.1716236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
More than 115 million women across the world are borrowers of microfinance loans. However, there is concern that women from poor backgrounds who take loans may suffer from multiple challenges of physical and mental health burdens. In this qualitative study we aimed to identify the types of health challenges faced by active women borrowers of microfinance loans. Open ended questions were asked from 442 women across seven cities and four provinces of Pakistan. Categories were developed through the content analysis approach using NVIVO. We have been able to identify thirteen different health challenges faced by poor women borrowers under two broad headings of "environmental factors" and "healthcare delivery system." We recommend the introduction and expansion of different health and social development services by microfinance provider's to support the health needs of poor women clients. Women also need support from the Government of Pakistan in improving access to education, health coverage, and formal sector work opportunities. Our study implies increased health policy support for disadvantaged women borrowers of microfinance across the world.
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Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Mudasir Mustafa
- Department of Sociology, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
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School-based Mental Health Interventions Targeting Depression or Anxiety: A Meta-analysis of Rigorous Randomized Controlled Trials for School-aged Children and Adolescents. J Youth Adolesc 2023; 52:195-217. [PMID: 36229755 PMCID: PMC9560730 DOI: 10.1007/s10964-022-01684-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/28/2022] [Indexed: 01/07/2023]
Abstract
Past meta-analyses in mental health interventions failed to use stringent inclusion criteria and diverse moderators, therefore, there is a need to employ more rigorous methods to provide evidence-based and updated results on this topic. This study presents an updated meta-analysis of interventions targeting anxiety or depression using more stringent inclusion criteria (e.g., baseline equivalence, no significant differential attrition) and additional moderators (e.g., sample size and program duration) than previous reviews. This meta-analysis includes 29 studies of 32 programs and 22,420 students (52% female, 79% White). Among these studies, 22 include anxiety outcomes and 24 include depression outcomes. Overall, school-based mental health interventions in grades K-12 are effective at reducing depression and anxiety (ES = 0.24, p = 0.002). Moderator analysis shows that improved outcomes for studies with anxiety outcomes, cognitive behavioral therapy, interventions delivered by clinicians, and secondary school populations. Selection modeling reveals significant publication and outcome selection bias. This meta-analysis suggests school-based mental health programs should strive to adopt cognitive behavioral therapy and deliver through clinicians at the secondary school level where possible.
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Leight J, Pedehombga A, Ganaba R, Gelli A. Women's empowerment, maternal depression, and stress: Evidence from rural Burkina Faso. SSM - MENTAL HEALTH 2022; 2:100160. [PMID: 36688233 PMCID: PMC9792374 DOI: 10.1016/j.ssmmh.2022.100160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 09/10/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Though there is a wide array of evidence that women's empowerment is associated with more positive health and nutritional outcomes for women and children, evidence around the relationship with mental health or subjective well-being remains relatively limited. The objective of this paper is to explore this relationship in longitudinal data from rural Burkina Faso. Methods We analyze the association between empowerment measured using the project-level Women's Empowerment in Agriculture Index (pro-WEAI), and two additional outcomes of interest: stress (measured using the SRQ-20) and maternal depression (measured using the Edinburgh scale for post-partum depression). The analysis employs both cross-sectional specifications and panel specifications conditional on individual fixed effects. Results We find evidence of substantial negative correlations between the empowerment score and maternal stress and depression measured using both continuous and binary variables. This relationship seems to be particularly driven by self-efficacy and respect among household members, where higher scores have negative associations with depression and stress that are both large in magnitude and precisely estimated. Conclusion Enhanced mental health may be another channel for a positive effect of empowerment on women's welfare.
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Affiliation(s)
- Jessica Leight
- International Food Policy Research Institute (IFPRI), USA
| | | | | | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), USA
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Racial disparities in psychological distress in post-apartheid South Africa: results from the SANHANES-1 survey. Soc Psychiatry Psychiatr Epidemiol 2022; 57:843-857. [PMID: 34617128 PMCID: PMC8494453 DOI: 10.1007/s00127-021-02175-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/30/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE South Africa has long endured a high prevalence of mental disorders at the national level, and its unique social and historical context could be a contributor to an increased risk of mental health problems. Our current understanding is limited regarding the relative importance of various social determinants to mental health challenges in South Africa, and how existing racial inequities may be explained by these determinants. METHODS This study attempted to elucidate potential social determinants of mental health in South Africa using data from the nationally representative South African National Health and Nutrition Examination Survey (SANHANES-1). The main outcome of interest was psychological distress, measured with the Kessler-10 scale. Hierarchical linear regression models included covariates for demographic and socioeconomic factors, count of traumatic events, and a series of stress-related constructs. Analyses were conducted on two populations: the entire sample (n = 15,981), and the African subpopulation (n = 10,723). RESULTS Regression models on the entire sample indicated racial disparities in psychological distress, with Africans experiencing higher distress than White and Coloured individuals. Results within the African sub-population indicated geo-spatial disparities, with Africans in formal urban settings experiencing higher psychological distress than those living in formal and informal rural locales. Across both samples, results indicated a cumulative association between count of stressors and traumatic events and distress. CONCLUSION We found racial disparities across several mental health-related domains. Africans had greater exposure to traumatic events, social stressors, and psychological distress. This research is a necessary foundation for public health interventions and policy change to effectively reduce inequities in psychological distress.
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Li Y, Sunder N. What doesn't kill her, will make her depressed. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101064. [PMID: 34601324 DOI: 10.1016/j.ehb.2021.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/04/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
In this paper we study the long run effects of the 1959-61 Chinese Famine on mental health outcomes. We focus on cohorts that were born during the famine and examine their mental health as adults, when they are roughly 55 years of age. We find that early-life exposure to this famine leads to a large statistically significant negative impact on women's mental health, while there is limited effect on men. This gender differential effect is observed because male fetuses experience a stronger natural selection as compared to female fetuses, which implies that in the longer run, surviving females may exhibit larger detrimental effects of early-life famine exposure. Thus, the observed effects are a composite of two well-established factors, the survival of the fittest and the Fetal Origins hypothesis.
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Affiliation(s)
- Yanan Li
- Business School, Beijing Normal University, 1720 Houzhu Building, No. 19 XinJieKouWai Street, Haidian District, Beijing 100875, China.
| | - Naveen Sunder
- Department of Economics, Bentley University, AAC Room 187, 175 Forest St., Waltham, MA, 02452, United States.
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9
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Abstract
Depression is a common and debilitating condition that adversely affects functioning and the capacity to work and establish economic stability. Women are disproportionately burdened by depression, and low-income pregnant and parenting women have particularly high rates of depression and often lack access to treatment. As depression can be treated, it is a modifiable risk factor for poor economic outcomes for women, and thus for children and families. Recent national and state health care policy changes offer the opportunity for community-based psychological and economic interventions that can reduce the number of pregnant and parenting women with clinically significant depressive symptoms. Moreover, there is strong evidence that in addition to benefiting women's well-being, such reforms bolster children's emotional and social development and learning and help families rise out of poverty. This review summarizes the mental health and economic literature regarding how maternal depression perpetuates intergenerational poverty and discusses recommendations regarding policies to treat maternal depression in large-scale social services systems.
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Affiliation(s)
- Megan V Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA; .,The Child Study Center, Yale University School of Medicine, New Haven, Connecticut 06519, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut 06510, USA.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA; .,Women's Health Research at Yale, Yale University School of Medicine, New Haven, Connecticut 06510, USA.,Department of Psychology, Yale University, New Haven, Connecticut 06511, USA
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Zimmerman A, Garman E, Avendano-Pabon M, Araya R, Evans-Lacko S, McDaid D, Park AL, Hessel P, Diaz Y, Matijasevich A, Ziebold C, Bauer A, Paula CS, Lund C. The impact of cash transfers on mental health in children and young people in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:e004661. [PMID: 33906845 PMCID: PMC8088245 DOI: 10.1136/bmjgh-2020-004661] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Although cash transfer programmes are not explicitly designed to improve mental health, by reducing poverty and improving the life chances of children and young people, they may also improve their mental health. This systematic review and meta-analysis assessed the evidence on the effectiveness of cash transfers to improve the mental health of children and young people in low-income and middle-income countries. METHODS We searched Pubmed, EBSCOhost, Scientific Electronic Library Online, ISI Web of Science and Social Sciences Citation Index and grey literature (from January 2000 to July 2020) for studies which quantitatively assessed the impact of cash transfers on mental health in young people (aged 0-24 years), using a design that incorporated a control group. We extracted Cohen's d effects size and used a random-effects model for the meta-analysis on studies that measured depressive symptoms, I2 statistic and assessment of study quality. RESULTS We identified 12 116 articles for screening, of which 12 were included in the systematic review (covering 13 interventions) and seven in the meta-analysis assessing impact on depressive symptoms specifically. There was high heterogeneity (I2=95.2) and a high risk of bias (0.38, 95% CIs: -5.08 to 5.85; p=0.86) across studies. Eleven interventions (85%) showed a significant positive impact of cash transfers on at least one mental health outcome in children and young people. However, no study found a positive effect on all mental health outcomes examined, and the meta-analysis showed no impact of cash transfers on depressive symptoms (0.02, 95% CIs: -0.19 to 0.23; p=0.85). CONCLUSION Cash transfers may have positive effects on some mental health outcomes for young people, with no negative effects identified. However, there is high heterogeneity across studies, with some interventions showing no effects. Our review highlights how the effect of cash transfers may vary by social and economic context, culture, design, conditionality and mental health outcome.
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Affiliation(s)
- Annie Zimmerman
- Health Service & Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Global Health and Social Medicine, King's College London, London, UK
| | - Emily Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mauricio Avendano-Pabon
- Global Health and Social Medicine, King's College London, London, UK
- Department of Social and Behavioural Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Ricardo Araya
- Health Service & Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Philipp Hessel
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogota, Colombia
| | - Yadira Diaz
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogota, Colombia
| | - Alicia Matijasevich
- Faculdade de Medicina FMUSP, Departamento de Medicina Preventiva, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carola Ziebold
- Faculdade de Medicina FMUSP, Departamento de Medicina Preventiva, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Annette Bauer
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Cristiane Silvestre Paula
- Programa de Pós-graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil
| | - Crick Lund
- Health Service & Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Ibrahim F, McHugh N, Biosca O, Baker R, Laxton T, Donaldson C. Microcredit as a public health initiative? Exploring mechanisms and pathways to health and wellbeing. Soc Sci Med 2021; 270:113633. [PMID: 33395609 DOI: 10.1016/j.socscimed.2020.113633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
The widening health gap between the best and worst-off in the UK requires innovative solutions that act upon the social, economic and environmental causes of ill-health. Initiatives such as microcredit have been conceptualised as having the potential to act on the social determinants of health. However, pathways that lead to this impact have yet to be empirically explored. People living on low incomes, who are financially-excluded, require access to credit to cope with everyday financial needs. While research shows the connections between debt and health, this link is often focused on over-indebtedness and negative health outcomes. In this paper, we investigate the impact of responsibly-delivered credit on the health and wellbeing of borrowers. In 2016-17, in-depth, semi-structured interviews were undertaken with fourteen borrowers from two microcredit providers offering personal and business microloans, operating in Glasgow, United Kingdom. Findings are presented, using social determinants of health as an analytic lens, and illustrated in a conceptual model explaining the loan mechanisms and pathways connecting microcredit to health and wellbeing. Microcredit, and the mechanisms through which it is delivered, were perceived by participants as positively impacting on their health and wellbeing. Access to flexible, responsibly-delivered, microloans enabled participants to plan and feel secure when faced with (un)expected financial events, reducing the associated stress, sustaining social relationships and empowering borrowers to take greater control over their lives. For some, receiving microcredit was stressful, as it is still a debt that needs to be repaid. Such stress can also be exacerbated by particular aspects of the lending model; for example, group lending. Our results contribute to growing evidence on the impact of financial inclusion approaches on health and wellbeing, highlighting the potential role of microcredit as a public health initiative and the need to support 'alternative' economic spaces in the UK to serve the financially-excluded.
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Affiliation(s)
- Fatma Ibrahim
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK.
| | - Neil McHugh
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK
| | - Olga Biosca
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK
| | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK
| | - Tim Laxton
- School of Health and Life Sciences at Glasgow Caledonian University, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK
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Women's participation in microfinance: Effects on Women's agency, exposure to partner violence, and mental health. Soc Sci Med 2021; 270:113686. [PMID: 33453629 PMCID: PMC7962741 DOI: 10.1016/j.socscimed.2021.113686] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The health and social effects of women's microfinance participation remain debated. METHODS Using propensity-score methods, we assessed effects of microfinance participation on novel measures of agency; intimate partner violence (IPV) exposure; and depressive symptoms in 930 wives in Matlab, Bangladesh interviewed 11/2018-01/2019. RESULTS Participants, versus non-participants, were married younger (16.7 vs. 17.4 years), more often Muslim (90.7% vs. 86.2%), less schooled (5.4 vs. 6.8 grades), and more often had husbands (27.0% vs. 19.6%) and mothers (63.2% vs. 50.5%) without schooling. Participants and non-participants had similar unadjusted mean scores for prior-week depressive symptoms, prior-year IPV, and intrinsic attitudinal agency (gender-equitable attitudes; non-justification of wife beating). Participants had higher unadjusted mean scores for intrinsic voice/mobility; instrumental agency (using financial services, voice with husband, voice/mobility outside home); and collective agency. Average adjusted treatment effects were non-significant for depressive symptoms, IPV, and attitudinal intrinsic agency, and significantly favorable for other agency outcomes. CONCLUSIONS Microfinance participation had no adverse health effects and favorable empowerment effects in Bangladeshi wives. POLICY IMPLICATIONS Microfinance can empower women without adverse health effects. Social-norms programming with men and women may be needed to change gendered expectations about the distribution of unpaid labor and the rights of women.
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Collin DF, Shields-Zeeman LS, Batra A, Vable AM, Rehkopf DH, Machen L, Hamad R. Short-term effects of the earned income tax credit on mental health and health behaviors. Prev Med 2020; 139:106223. [PMID: 32735990 PMCID: PMC7494578 DOI: 10.1016/j.ypmed.2020.106223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/16/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
Poverty has consistently been linked to poor mental health and risky health behaviors, yet few studies evaluate the effectiveness of programs and policies to address these outcomes by targeting poverty itself. We test the hypothesis that the earned income tax credit (EITC)-the largest U.S. poverty alleviation program-improves short-term mental health and health behaviors in the months immediately after income receipt. We conducted parallel analyses in two large longitudinal national data sets: the National Health Interview Survey (NHIS, 1997-2016, N = 379,603) and the Panel Study of Income Dynamics (PSID, 1985-2015, N = 29,808). Outcomes included self-rated health, psychological distress, tobacco use, and alcohol consumption. We employed difference-in-differences analysis, a quasi-experimental technique. We exploited seasonal variation in disbursement of the EITC, which is distributed as a tax refund every spring: we compared outcomes among EITC-eligible individuals interviewed immediately after refund receipt (Feb-Apr) with those interviewed in other months more distant from refund receipt (May-Jan), "differencing out" seasonal trends among non-eligible individuals. For most outcomes, we were unable to rule out the null hypothesis that there was no short-term effect of the EITC. Findings were cross-validated in both data sets. The exception was an increase in smoking in PSID, although this finding was not robust to sensitivity analyses. While we found no short-term "check effect" of the EITC on mental health and health behaviors, others have found long-term effects on these outcomes. This may be because recipients anticipate EITC receipt and smooth their income accordingly.
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Affiliation(s)
- Daniel F Collin
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Laura S Shields-Zeeman
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Akansha Batra
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Anusha M Vable
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - David H Rehkopf
- Department of Medicine, Stanford University, Stanford, CA, United States of America
| | - Leah Machen
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Rita Hamad
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, United States of America; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America.
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14
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Palermo T, Hall BJ, Cirillo C. Enhanced life distress inventory: Development and validation in two African countries. Br J Health Psychol 2020; 25:728-753. [PMID: 32634299 DOI: 10.1111/bjhp.12448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Poverty is linked to poor mental health, and stress is a key pathway. Most existing stress scales were developed in high-income settings. We use primary data collected from three large population-based studies in Ghana and Tanzania to examine the performance and psychometric properties of a new measure of self-perceived stress, the Enhanced Life Distress Inventory (ELDI). METHODS Development of the ELDI was informed by an exploratory qualitative study implemented among youth and adolescents in Ghana, Malawi, and Tanzania and structured following the Life Distress Inventory (LDI). We implemented the ELDI in three ongoing longitudinal impact evaluations involving quantitative household surveys in two studies in Tanzania and in one in Ghana to evaluate its performance and psychometric properties. FINDINGS Sample sizes ranged from N = 608 to N = 2,458, with variation in gender, age, and geographic location. Exploratory factor analysis uncovered three underlying factors of the ELDI, which justified the use of three sub-scales: economic and health-related well-being, risk/security, and social relations. Further analysis demonstrated that the ELDI has adequate psychometric properties, including internal consistency, and construct validity. CONCLUSION A major contribution of the ELDI is its development in and for LMIC settings and its ability to assess different areas (life domains) of distress. This multi-sectoral lens gives the scale the potential to examine not only programmes targeting stress, but also those targeting sources of stress, and to examine whether they improve stress and mental health via those pathways. More testing of the ELDI's performance and psychometric properties is needed in additional settings.
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Affiliation(s)
- Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo (State University of New York), New York, USA
| | - Brian J Hall
- Global and Community Mental Health Research Group, Faculty of Social Sciences (E21-3040), University of Macau, Avenida da Universidade, Taipa, Macao (SAR), People's Republic of China.,Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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- UNICEF Office of Research-Innocenti, Florence, Italy
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Mhando F, Dovel K, Jennings Mayo-Wilson L, Rwehumbiza D, Thompson N, Nwaozuru U, Rehani A, Iwelunmor J, Nelson LE, Conserve DF. Microfinance and Peer Health Leadership Intervention Implementation for Men in Dar es Salaam, Tanzania: A Qualitative Assessment of Perceived Economic and Health Outcomes. Am J Mens Health 2020; 14:1557988320936892. [PMID: 32627650 PMCID: PMC7492860 DOI: 10.1177/1557988320936892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022] Open
Abstract
Men in sub-Saharan Africa continue to experience health disparities that are exacerbated by low employment. This study qualitatively assessed men's perceptions of the economic and health-care-seeking effects of participation in an integrated microfinance and peer health leadership intervention on violence and HIV risk reduction in Tanzania. Three focus group discussions with 27 men, aged 20 to 44 years, examined the perceived effects on income generation, employability, mental health, and uptake of HIV and related health services. All discussions were recorded, transcribed, and analyzed using deductive and inductive coding methods. Men reported that the benefits of the intervention included increased employability and income-earning activities due to greater access to entrepreneurial training, low-interest microfinancing, and male-oriented group supports to start or strengthen their businesses. Increased wages through business or other forms of employment were also attributed to men's lower anxiety and distress as financial providers for their families. However, men indicated that apart from the uptake of free HIV testing services, there was limited change in overall health-care-seeking behavior given the high clinic fees and lost time to earn income when attending routine health visits. Men recommended that future microfinance and health promotion interventions provide larger loan amounts, less frequent repayment intervals, and access to health and social insurance. Microfinance and peer health leadership interventions may help to address economic and health disparities in poor, urban men. Efforts are needed to assist lower income men in accessing financial tools as well as fee-based preventive and health-care services.
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Affiliation(s)
- Frank Mhando
- Department of Geography,
University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Kathryn Dovel
- Division of Infectious Diseases,
David Geffen School of Medicine, University of California Los Angeles
(UCLA), Los Angeles, USA
| | - Larissa Jennings Mayo-Wilson
- Department of Applied Health
Science, Indiana University School of Public Health, Bloomington, IN,
USA
- Department of International
Health, Johns Hopkins University School of Public Health, Baltimore, MD,
USA
| | | | - Noah Thompson
- Department of Health Promotion,
Education, and Behavior, University of South Carolina, Columbia, SC,
USA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science
and Health Education, Saint Louis University, Saint Louis, MO, USA
| | | | - Juliet Iwelunmor
- Department of Behavioral Science
and Health Education, Saint Louis University, Saint Louis, MO, USA
| | | | - Donaldson Fadael Conserve
- Department of Health Promotion,
Education, and Behavior, University of South Carolina, Columbia, SC,
USA
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16
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Hatcher A, Lemus Hofstedler L, Doria K, Dworkin S, Weke E, Conroy A, Bukusi E, Cohen C, Weiser S. Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings. Transcult Psychiatry 2020; 57:124-139. [PMID: 31242065 PMCID: PMC6930985 DOI: 10.1177/1363461519858446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
While food insecurity and poverty worsen mental health outcomes among people living with HIV/AIDS (PLHIV), few intervention studies have targeted poverty and food insecurity as a way to improve mental health. Among HIV-positive patients, addressing such upstream determinants may prove crucial to ensure better mental health and HIV clinical outcomes. We integrated longitudinal, qualitative research into a randomized trial of a livelihood intervention to understand processes and mechanisms for how the intervention may affect mental health among HIV-infected Kenyan adults. In-depth interviews were conducted with intervention participants (n = 45) and control participants (n = 9) at two time-points (after intervention start and upon intervention end). Interviews (n = 85) were translated, double-coded, and analyzed thematically using an inductive-deductive team approach. Participants reported numerous mental health improvements post-intervention including reduced stress, fewer symptoms of anxiety, improved mood, lower depressive symptoms, fewer repetitive and ruminating thoughts, and more hopefulness for the future. Improvements in mental health appear to occur via several mechanisms including: 1) better food security and income; 2) increased physical activity and ability to create fruitful routines around farm work; and, 3) improved sense of self as an active member of the community. Qualitative, longitudinal interviews may help identify intervention mechanisms for improved mental health, but additional research is required to confirm self-reports of mental health changes. These findings suggest that livelihood interventions may improve mental health in multi-faceted ways, and help PLHIV better integrate with their communities. Trial registered at ClinicalTrials.gov: NCT01548599.
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Affiliation(s)
- A.M Hatcher
- University of the Witwatersrand and an Honorary Researcher at the University of California, San Francisco
| | | | | | - S. Dworkin
- University of Washington Bothell School of Nursing and Health Studies
| | - E. Weke
- Kenya Medical Research Institute (KEMRI)
| | - A. Conroy
- Center for AIDS Prevention Studies at the University of California San Francisco
| | - E. Bukusi
- Kenya Medical Research Institute (KEMRI), University of Washington and University of California San Francisco
| | - C.R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences at the University of California San Francisco (UCSF) and University of California Global Health Institute (UCGHI)
| | - S.D. Weiser
- Division of HIV, Infectious Disease and Global Medicine at UCSF
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17
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Nadkarni S, Genberg B, Galárraga O. Microfinance Interventions and HIV Treatment Outcomes: A Synthesizing Conceptual Framework and Systematic Review. AIDS Behav 2019; 23:2238-2252. [PMID: 30805757 PMCID: PMC6708758 DOI: 10.1007/s10461-019-02443-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Microfinance interventions have the potential to improve HIV treatment outcomes, but the mechanisms through which they operate are not entirely clear. OBJECTIVES To construct a synthesizing conceptual framework for the impact of microfinance interventions on HIV treatment outcomes using evidence from our systematic review. METHODS We conducted a systematic review by searching electronic databases and journals from 1996 to 2018 to assess the effects of microfinance interventions on HIV treatment outcomes, including adherence, retention, viral suppression, and CD4 cell count. RESULTS All studies in the review showed improved adherence, retention, and viral suppression, but varied in CD4 cell count following participation in microfinance interventions-overall supporting microfinance's positive role in improving HIV treatment outcomes. Our synthesizing conceptual framework identifies potential mechanisms through which microfinance impacts HIV treatment outcomes through hypothesized intermediate outcomes. CONCLUSION Greater emphasis should be placed on assessing the effect mechanisms and intermediate behaviors to generate a sound theoretical basis for microfinance interventions.
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Affiliation(s)
| | - Becky Genberg
- Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI, 02912, USA
| | - Omar Galárraga
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI, 02912, USA.
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18
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Green EP, Cho H, Gallis J, Puffer ES. The impact of school support on depression among adolescent orphans: a cluster-randomized trial in Kenya. J Child Psychol Psychiatry 2019; 60:54-62. [PMID: 30055002 DOI: 10.1111/jcpp.12955] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of this study was to determine if a school support intervention for adolescent orphans in Kenya had effects on mental health, a secondary outcome. METHODS In this paper, we analyzed data from a 4-year cluster-randomized trial of a school support intervention (school uniforms, school fees, and nurse visits) conducted with orphaned adolescents in Siaya County, western Kenya, who were about to transition to secondary school. 26 primary schools were randomized (1:1) to intervention (410 students) or control (425 students) arms. The study was longitudinal with annual repeated measures collected over 4 years from 2011 to 2014. We administered five items from the 20-item Center for Epidemiologic Studies Depression Scale Revised, a self-reported depression screening instrument. RESULTS The intervention prevented depression severity scores from increasing over time among adolescents recruited from intervention schools. There was no evidence of treatment heterogeneity by gender or baseline depression status. The intervention effect on depression was partially mediated by higher levels of continuous school enrollment among the intervention group, but this mediated effect was small. CONCLUSIONS School support for orphans may help to buffer against the onset or worsening of depression symptoms over time, promoting resilience among an important at-risk population.
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Affiliation(s)
- Eric P Green
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Hyunsan Cho
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - John Gallis
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Eve S Puffer
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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19
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Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, Chisholm D, Collins PY, Cooper JL, Eaton J, Herrman H, Herzallah MM, Huang Y, Jordans MJD, Kleinman A, Medina-Mora ME, Morgan E, Niaz U, Omigbodun O, Prince M, Rahman A, Saraceno B, Sarkar BK, De Silva M, Singh I, Stein DJ, Sunkel C, UnÜtzer JÜ. The Lancet Commission on global mental health and sustainable development. Lancet 2018; 392:1553-1598. [PMID: 30314863 DOI: 10.1016/s0140-6736(18)31612-x] [Citation(s) in RCA: 1178] [Impact Index Per Article: 196.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/11/2018] [Accepted: 07/05/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Vikram Patel
- Harvard Medical School, Boston, MA, USA; Harvard TH Chan School of Public Health, Boston, MA, USA; Sangath, Goa, India; Public Health Foundation of India, New Delhi, India.
| | - Shekhar Saxena
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London UK
| | - Florence Baingana
- WHO Sierra Leone, Freetown, Sierra Leone; Makerere University School of Public Health, Kampala, Uganda
| | - Paul Bolton
- Department of International Health and Department of Mental Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dan Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - Pamela Y Collins
- University of Washington School of Medicine and School of Public Health, Seattle, WA, USA
| | - Janice L Cooper
- The Carter Center, Monrovia, Liberia; Emory University, Atlanta, GA, USA
| | - Julian Eaton
- CBM International, Bensheim, Germany; Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Herrman
- Orygen, National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; World Psychiatric Association, Melbourne, VIC Australia; WHO Collaborating Centre in Mental Health, Melbourne, VIC Australia
| | - Mohammad M Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Jerusalem, Palestine; Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, USA
| | - Yueqin Huang
- National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Mark J D Jordans
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Research and Development, War Child, Amsterdam, Netherlands; Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Arthur Kleinman
- Department of Anthropology, Harvard University, Cambridge, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Ellen Morgan
- Templeton World Charity Foundation, Nassau, The Bahamas
| | - Unaiza Niaz
- Psychiatric Clinic and Stress Research Centre, Karachi, Pakistan; University of Health Sciences, Lahore, Pakistan; Dow University of Health Sciences, Karachi, Pakistan
| | - Olayinka Omigbodun
- College of Medicine and Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria
| | - Martin Prince
- King's Global Health Institute, King's College London, London, UK
| | - Atif Rahman
- University of Liverpool, Liverpool, UK; Human Development Research Foundation, Islamabad, Pakistan
| | - Benedetto Saraceno
- School of Medical Sciences, University Nova of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Bidyut K Sarkar
- PRIDE Project, Sangath, India; Public Health Foundation of India, New Delhi, India
| | | | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Groote Schuur Hospital, Cape Town, South Africa; South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Charlene Sunkel
- South African Federation for Mental Health, Johannesburg, South Africa; Movement for Global Mental Health, Johannesburg, South Africa
| | - JÜrgen UnÜtzer
- Department of Psychiatry and Behavioral Sciences and the Advancing Integrated Mental Health Solutions Center, University of Washington, Seattle, WA, USA
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20
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Unconditional cash transfers for clinical and economic outcomes among HIV-affected Ugandan households. AIDS 2018; 32:2023-2031. [PMID: 29847330 DOI: 10.1097/qad.0000000000001899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV infection has profound clinical and economic costs at the household level. This is particularly important in low-income settings, where access to additional sources of income or loans may be limited. While several microfinance interventions have been proposed, unconditional cash grants, a strategy to allow participants to choose how to use finances that may improve household security and health, has not previously been evaluated. METHODS We examined the effect of an unconditional cash transfer to HIV-infected individuals using a 2 × 2 factorial randomized trial in two rural districts in Uganda. Our primary outcomes were changes in CD4 cell count, sexual behaviors, and adherence to ART. Secondary outcomes were changes in household food security and adult mental health. We applied a Bayesian approach for our primary analysis. RESULTS We randomized 2170 patients as participants, with 1081 receiving a cash grant. We found no important intervention effects on CD4 T-cell counts between groups [mean difference 35.48, 95% credible interval (CrI) -59.9 to 1131.6], food security [odds ratio (OR) 1.22, 95% CrI: 0.47 to 3.02], medication adherence (OR 3.15, 95% CrI: 0.58 to 18.15), or sexual behavior (OR 0.45 95% CrI: 0.12 to 1.55), or health expenditure in the previous 3 weeks (mean difference $2.65, 95% CrI: -9.30 to 15.69). In secondary analysis, we detected an effect of mental planning on CD4 cell count change between groups (104.2 cells, 9% CrI: 5.99 to 202.16). We did not have data on viral load outcomes. CONCLUSION Although all outcomes were associated with favorable point estimates, our trial did not demonstrate important effects of unconditional cash grants on health outcomes of HIV-positive patients receiving treatment.
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21
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Mozumdar A, Khan ME, Mondal SK, Mohanan PS. Increasing knowledge of home based maternal and newborn care using self-help groups: Evidence from rural Uttar Pradesh, India. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 18:1-9. [PMID: 30420079 DOI: 10.1016/j.srhc.2018.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 08/08/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND In India, pregnant women and recently delivered mothers of marginalized communities in Uttar Pradesh (UP) remain un-reached by frontline-health-workers. In these communities, self-help groups (SHGs) have the potential to reach these women with knowledge of home-based maternal and newborn care (HBMNC). OBJECTIVE The study examines the feasibility of SHGs to improve knowledge of HBMNC. The study identifies the facilitating factors and barriers to knowledge change. METHODS A panel study with a quasi-experimental design was conducted in Jhansi, UP. Peer educators, called Swasthya Sakhi, of the SHGs of the experimental area were trained on how to conduct discussions on HBMNC topics. Both at baseline and endline 233 women from the experimental area and 237 women from the comparison area were interviewed to measure their knowledge change in HBMNC topics. The net-effect of the intervention was examined using difference-in-difference (DID) analysis with propensity-score-matching (PSM) controlling for the effect of background characteristics of the participants from two study areas. Generalized-estimating-equation (GEE) was used to identify the facilitating factors and barriers to the knowledge change. RESULTS The findings show significant net-increases in women's knowledge for most of the HBMNC topics including danger signs for a pregnant mother and a newborn child, even after controlling for the background characteristics of the participants. The most significant determinant of the increase of knowledge was the women's education. CONCLUSION Findings from the study showed SHGs can increase HBMNC knowledge among women. However, studies with longer duration are required to examine the scalability and sustainability of the intervention.
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Affiliation(s)
| | - M E Khan
- Center of Operations Research and Training, Vadodara, India
| | | | - P S Mohanan
- Rajiv Gandhi Mahila Vikas Pariyojana, Rana Nagar, Raebareli, Uttar Pradesh, India
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22
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Baum A, Elize W, Jean-Louis F. Microfinance Institutions' Successful Delivery Of Micronutrient Powders: A Randomized Trial In Rural Haiti. Health Aff (Millwood) 2018; 36:1938-1946. [PMID: 29137512 DOI: 10.1377/hlthaff.2017.0281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Globally, two-thirds of child deaths could be prevented by increased provision of health interventions such as vaccines, micronutrient supplements, and water purification tablets. We report the results from a randomized controlled trial in Haiti during 2012 that tested whether microfinance institutions-which reach 200 million households worldwide-can effectively deliver health products. These institutions provide loans to underserved entrepreneurs, primarily poor women in rural areas. In the intervention group, micronutrient powders to improve the nutrition of young children were distributed at regularly occurring microfinance meetings by a trained borrower. In both the control and the intervention groups, nurses led seminars on nutrition and extended breastfeeding during microfinance meetings. At three-month follow-up, the mean difference in hemoglobin concentration between children in the intervention group and those in the control group was 0.28 grams per deciliter (g/dL)-with a subsample of younger children (under two years of age) showing greater relative improvement (0.46 g/dL)-and the odds ratio for children in the intervention group meeting the diagnostic criteria for anemia was 0.64. The results are similar to those of previous studies that evaluated micronutrient powder distribution through dedicated health institutions. Our findings suggest that microfinance institutions are a promising platform for the large-scale delivery of health products in low-income countries.
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Affiliation(s)
- Aaron Baum
- Aaron Baum ( ) is an assistant professor of health system design and global health at the Icahn School of Medicine at Mount Sinai and an economist at the Arnhold Institute for Global Health, both in New York City
| | - Wesly Elize
- Wesly Elize is a physician and health project officer at Fonkoze, in Port-au-Prince, Haiti
| | - Florence Jean-Louis
- Florence Jean-Louis is a physician and human development director at Fonkoze
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Maselko J, Bates L, Bhalotra S, Gallis JA, O’Donnell K, Sikander S, Turner EL. Socioeconomic status indicators and common mental disorders: Evidence from a study of prenatal depression in Pakistan. SSM Popul Health 2017; 4:1-9. [PMID: 29349268 PMCID: PMC5769091 DOI: 10.1016/j.ssmph.2017.10.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 01/05/2023] Open
Abstract
There is growing interest in the relationship between socioeconomic status (SES), poverty, and mental health in low and middle-income countries (LMIC). However, it is not clear whether a gradient approach focused on a wider SES distribution or a binary poverty approach is more salient for mental health in LMIC. Yet this distinction has implications for interventions aimed at improving population health. We contribute to the literature by examining how multiple indicators of socioeconomic status, including gradient SES and binary poverty indicators, contribute to prenatal depression symptoms in a LMIC context. Prenatal depression is an important public health concern with negative sequela for the mother and her children. We use data on assets, education, food insecurity, debt, and depression symptoms from a sample of 1154 pregnant women residing in rural Pakistan. Women who screened positive for depression participated in a cluster randomized controlled trial of a perinatal depression intervention; all women were interviewed October 2015-February 2016, prior to the start of the intervention. Cluster-specific sampling weights were used to approximate a random sample of pregnant women in the area. Findings indicate that fewer assets, experiencing food insecurity, and having household debt are independently associated with worse depression symptoms. The association with assets is linear with no evidence of a threshold effect, supporting the idea of a gradient in the association between levels of SES and depression symptoms. A gradient was also initially observed with woman’s educational attainment, but this association was attenuated once other SES variables were included in the model. Together, the asset, food insecurity, and debt indicators explain 14% of the variance in depression symptoms, more than has been reported in high income country studies. These findings support the use of multiple SES indicators to better elucidate the complex relationship between socioeconomic status and mental health in LMIC. We compare the association between poverty, gradient measures of SES, and depression. Above the poverty level, SES predict depression in a low income country. Relying on simple, dichotomous, poverty measures in studies of mental health is not recommended.
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Affiliation(s)
- Joanna Maselko
- Dept. of Epidemiology, 2105e McGavran-Greenberg Hall, Campus Box 7435, Gillings School of Global Public Health, UNC, Chapel Hill, NC 27599-7435, USA
- Corresponding author.
| | - Lisa Bates
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA
| | - Sonia Bhalotra
- ISER and Department of Economics, University of Essex, Wivenhoe Park CO4 3SQ, UK
| | - John A. Gallis
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Durham, NC 27705-3819, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Karen O’Donnell
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Durham, NC 27705-3819, USA
- Center for Child and Family Health, 1121W Chapel Hill St #100, Durham, NC 27701, USA
| | - Siham Sikander
- Human Development Research Foundation, P.O Box No 516, F 7 Markaz, Islamabad, Pakistan
| | - Elizabeth L. Turner
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Durham, NC 27705-3819, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
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Wahlbeck K, Cresswell-Smith J, Haaramo P, Parkkonen J. Interventions to mitigate the effects of poverty and inequality on mental health. Soc Psychiatry Psychiatr Epidemiol 2017; 52:505-514. [PMID: 28280872 DOI: 10.1007/s00127-017-1370-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To review psychosocial and policy interventions which mitigate the effects of poverty and inequality on mental health. METHODS Systematic reviews, controlled trials and realist evaluations of the last 10 years are reviewed, without age or geographical restrictions. RESULTS Effective psychosocial interventions on individual and family level, such as parenting support programmes, exist. The evidence for mental health impact of broader community-based interventions, e.g. community outreach workers, or service-based interventions, e.g. social prescribing and debt advice is scarce. Likewise, the availability of evidence for the mental health impact of policy level interventions, such as poverty alleviation or youth guarantee, is quite restricted. CONCLUSIONS The social, economic, and physical environments in which people live shape mental health and many common mental disorders. There are effective early interventions to promote mental health in vulnerable groups, but it is necessary to both initiate and facilitate a cross-sectoral approach, and to form partnerships between different government departments, civic society organisations and other stakeholders. This approach is referred to as Mental Health in All Policies and it can be applied to all public policy levels from local policies to supranational.
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Affiliation(s)
- Kristian Wahlbeck
- The Finnish Association for Mental Health, Maistraatinportti 4 A, 7th floor, 00240, Helsinki, Finland.
| | - Johanna Cresswell-Smith
- Mental Health Unit, National Institute for Health and Welfare (THL), PO Box 30, 00271, Helsinki, Finland
| | - Peija Haaramo
- Mental Health Unit, National Institute for Health and Welfare (THL), PO Box 30, 00271, Helsinki, Finland
| | - Johannes Parkkonen
- The Finnish Association for Mental Health, Maistraatinportti 4 A, 7th floor, 00240, Helsinki, Finland
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Kaminer D, Owen M, Schwartz B. Systematic review of the evidence base for treatment of common mental disorders in South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317704126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The scarcity of mental health resources in low- and middle-income countries requires the identification of effective interventions that can be taken to scale in a cost-efficient manner. Yet the evidence base for treatment of common mental disorders in low- and middle-income countries remains limited. As one of the better resourced countries on the African continent, South Africa could potentially play a leading role in developing an African evidence base for mental health care. This study sought to describe and evaluate the South African evidence base for treating common mental disorders. A systematic review of randomised controlled trials for depression, substance use, and anxiety in the adult South African population from 2000 to mid-2015 was conducted. Eligible studies were assessed for their consistency with recommendations for mental health interventions in low- and middle-income countries and for methodological and reporting rigour. A total of 16 RCTs satisfied the inclusion criteria, of which 8 targeted depression, 6 targeted substance use, and 2 targeted anxiety symptoms. There has been a strong trend towards alignment with prevailing recommendations for delivery of mental health interventions in resource-scarce regions. While there are some promising findings with regard to effectiveness of specific interventions, replication, costing, and dissemination studies are still required and there is still an urgent need for treatment studies for anxiety disorders, which are the most common class of common mental disorder in South Africa. The review also indicates that research design and reporting practices in South African mental health intervention research could be enhanced and recommendations towards this are suggested.
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Affiliation(s)
- Debra Kaminer
- Department of Psychology, University of Cape Town, South Africa
| | - Michael Owen
- Department of Psychology, University of Cape Town, South Africa
| | - Byron Schwartz
- Department of Psychology, University of Cape Town, South Africa
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Maselko J. Social Epidemiology and Global Mental Health: Expanding the Evidence from High-Income to Low- and Middle-Income Countries. CURR EPIDEMIOL REP 2017; 4:166-173. [PMID: 28680795 PMCID: PMC5488107 DOI: 10.1007/s40471-017-0107-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF THE REVIEW The vast majority of research on the social determinants of mental health has been generated from high-income country (HIC) populations, even as the greatest health disparities, and greatest disease burden, is observed in lower- and middle-income countries (LMICs). The goal of this review is to examine the evidence base on how key social epidemiology constructs relate to mental health in LMIC contexts. A special focus is on points of departure from the HIC knowledge base, gaps in overall understanding, and opportunities for social epidemiology to make a significant contribution. RECENT FINDINGS A growing body of literature suggests that there is significant heterogeneity, both in the direction and magnitude, of association between factors such as socioeconomic status, income inequality, gender, and social networks/supports and mental health in LMIC. For example, higher levels of education and being married can be risk factors for worse mental health among women in certain contexts. However, many studies have methodological limitations that make causal inference difficult. Poverty alleviation interventions offer a unique opportunity to examine the impact of improving economic resources and mental health. SUMMARY Much remains unknown about the impact of key social factors on mental health in LMIC. Findings from HICs may not apply to LMIC populations, since the meaning and distribution of a given social variable may differ significantly from what is commonly observed in HICs. These points of departure point to opportunities for social epidemiology to make a contribution to the field of global mental health.
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Affiliation(s)
- Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2105e McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC 27599-7435 USA
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Moore THM, Kapur N, Hawton K, Richards A, Metcalfe C, Gunnell D. Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review. Psychol Med 2017; 47:1062-1084. [PMID: 27974062 PMCID: PMC5426338 DOI: 10.1017/s0033291716002944] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Job loss, debt and financial difficulties are associated with increased risk of mental illness and suicide in the general population. Interventions targeting people in debt or unemployed might help reduce these effects. METHOD We searched MEDLINE, Embase, The Cochrane Library, Web of Science, and PsycINFO (January 2016) for randomized controlled trials (RCTs) of interventions to reduce the effects of unemployment and debt on mental health in general population samples. We assessed papers for inclusion, extracted data and assessed risk of bias. RESULTS Eleven RCTs (n = 5303 participants) met the inclusion criteria. All recruited participants were unemployed. Five RCTs assessed 'job-club' interventions, two cognitive behaviour therapy (CBT) and a single RCT assessed each of emotional competency training, expressive writing, guided imagery and debt advice. All studies were at high risk of bias. 'Job club' interventions led to improvements in levels of depression up to 2 years post-intervention; effects were strongest among those at increased risk of depression (improvements of up to 0.2-0.3 s.d. in depression scores). There was mixed evidence for effectiveness of group CBT on symptoms of depression. An RCT of debt advice found no effect but had poor uptake. Single trials of three other interventions showed no evidence of benefit. CONCLUSIONS 'Job-club' interventions may be effective in reducing depressive symptoms in unemployed people, particularly those at high risk of depression. Evidence for CBT-type interventions is mixed; further trials are needed. However the studies are old and at high risk of bias. Future intervention studies should follow CONSORT guidelines and address issues of poor uptake.
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Affiliation(s)
- T. H. M. Moore
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Whitefriars, Lewins Mead, Bristol,UK
| | - N. Kapur
- Centre for Suicide Prevention, Division of Psychology and Mental Health, The University of Manchester, Manchester,UK
| | - K. Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford,UK
| | - A. Richards
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Whitefriars, Lewins Mead, Bristol,UK
| | - C. Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D. Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Whitefriars, Lewins Mead, Bristol,UK
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Hjelm L, Handa S, de Hoop J, Palermo T. Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia. Soc Sci Med 2017; 177:110-117. [PMID: 28167339 PMCID: PMC6662605 DOI: 10.1016/j.socscimed.2017.01.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Poverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia. METHOD Secondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline. RESULTS Cash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels. CONCLUSION In this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population.
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Affiliation(s)
- Lisa Hjelm
- UNICEF Office of Research - Innocenti, Piazza SS, Annunziata, 12, 50122 Florence, Italy.
| | - Sudhanshu Handa
- UNICEF Office of Research - Innocenti, Piazza SS, Annunziata, 12, 50122 Florence, Italy; Carolina Population Center, University of North Carolina at Chapel Hill, 206 West Franklin St., Rm. 208, Chapel Hill, NC 27516, USA.
| | - Jacobus de Hoop
- UNICEF Office of Research - Innocenti, Piazza SS, Annunziata, 12, 50122 Florence, Italy.
| | - Tia Palermo
- UNICEF Office of Research - Innocenti, Piazza SS, Annunziata, 12, 50122 Florence, Italy.
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Kajula L, Balvanz P, Kilonzo MN, Mwikoko G, Yamanis T, Mulawa M, Kajuna D, Hill L, Conserve D, Reyes HLM, Leatherman S, Singh B, Maman S. Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam. BMC Public Health 2016; 16:113. [PMID: 26842360 PMCID: PMC4738785 DOI: 10.1186/s12889-016-2774-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/22/2016] [Indexed: 12/01/2022] Open
Abstract
Background Intimate partner violence (IPV) and sexually transmitted infections (STIs), including HIV, remain important public health problems with devastating health effects for men and women in sub-Saharan Africa. There have been calls to engage men in prevention efforts, however, we lack effective approaches to reach and engage them. Social network approaches have demonstrated effective and sustained outcomes on changing risk behaviors in the U.S. Our team has identified and engaged naturally occurring social networks comprised mostly of young men in Dar es Salaam in an intervention designed to jointly reduce STI incidence and the perpetration of IPV. These stable networks are locally referred to as “camps.” In a pilot study we demonstrated the feasibility and acceptability of a combined microfinance and peer health leadership intervention within these camp-based peer networks. Methods design We are implementing a cluster-randomized trial to evaluate the efficacy of an intervention combining microfinance with health leadership training in 60 camps in Dar es Salaam, Tanzania. Half of the camps have been randomized to the intervention arm, and half to a control arm. The camps in the intervention arm will receive a combined microfinance and health leadership intervention for a period of two years. The camps in the control arm will receive a delayed intervention. We have enrolled 1,258 men across the 60 study camps. Behavioral surveys will be conducted at baseline, 12-months post intervention launch and 30-month post intervention launch and biological samples will be drawn to test for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) at baseline and 30-months. The primary endpoints for assessing intervention impact are IPV perpetration and STI incidence. Discussion This is the first cluster-randomized trial targeting social networks of men in sub-Saharan Africa that jointly addresses HIV and IPV perpetration and has both biological and behavioral endpoints. Effective approaches to engage men in HIV and IPV prevention are needed in low resource, high prevalence settings like Tanzania. If we determine that this approach is effective, we will examine how to adapt and scale up this approach to other urban, sub-Saharan African settings. Trial registration Clinical Trials.gov: NCT01865383. Registration date: May 24, 2013.
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Affiliation(s)
- Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania.
| | - Peter Balvanz
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Mrema Noel Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Gema Mwikoko
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Thespina Yamanis
- American University, School of International Service, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
| | - Marta Mulawa
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Deus Kajuna
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Lauren Hill
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Donaldson Conserve
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Heathe Luz McNaughton Reyes
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Sheila Leatherman
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7411, Chapel Hill, NC, 27599, USA
| | - Basant Singh
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Suzanne Maman
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
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Does poverty alleviation decrease depression symptoms in post-conflict settings? A cluster-randomized trial of microenterprise assistance in Northern Uganda. Glob Ment Health (Camb) 2016; 3:e7. [PMID: 28596876 PMCID: PMC5314750 DOI: 10.1017/gmh.2015.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 12/04/2015] [Accepted: 12/12/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND By 2009, two decades of war and widespread displacement left the majority of the population of Northern Uganda impoverished. METHODS This study used a cluster-randomized design to test the hypothesis that a poverty alleviation program would improve economic security and reduce symptoms of depression in a sample of mostly young women. Roughly 120 villages in Northern Uganda were invited to participate. Community committees were asked to identify the most vulnerable women (and some men) to participate. The implementing agency screened all proposed participants, and a total of 1800 were enrolled. Following a baseline survey, villages were randomized to a treatment or wait-list control group. Participants in treatment villages received training, start-up capital, and follow-up support. Participants, implementers, and data collectors were not blinded to treatment status. RESULTS Villages were randomized to the treatment group (60 villages with 896 participants) or the wait-list control group (60 villages with 904 participants) with an allocation ration of 1:1. All clusters participated in the intervention and were included in the analysis. The intent-to-treat analysis included 860 treatment participants and 866 control participants (4.1% attrition). Sixteen months after the program, monthly cash earnings doubled from UGX 22 523 to 51 124, non-household and non-farm businesses doubled, and cash savings roughly quadrupled. There was no measurable effect on a locally derived measure of symptoms of depression. CONCLUSIONS Despite finding large increases in business, income, and savings among the treatment group, we do not find support for an indirect effect of poverty alleviation on symptoms of depression.
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Economic, social and mental health impacts of an economic intervention for female sexual violence survivors in Eastern Democratic Republic of Congo. Glob Ment Health (Camb) 2016; 3:e19. [PMID: 28596887 PMCID: PMC5314746 DOI: 10.1017/gmh.2016.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/05/2016] [Accepted: 04/13/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Conflict-affected communities face poverty and mental health problems, with sexual violence survivors at high risk for both given their trauma history and potential for exclusion from economic opportunity. To address these problems, we conducted a randomized controlled trial of a group-based economic intervention, Village Savings and Loans Associations (VSLA), for female sexual violence survivors in the Democratic Republic of Congo. METHODS In March 2011, 66 VSLA groups, with 301 study participants, were randomized to the VSLA program or a wait-control condition. Data were collected prior to randomization, at 2-months post-program in June 2012, and 8-months later for VSLA participants only. Outcome data included measures of economic and social functioning and mental health severity. VSLA program effect was derived by comparing intervention and control participants' mean changes from baseline to 2-month follow-up. RESULTS At follow-up, VSLA study women reported significantly greater per capita food consumption and significantly greater reductions in stigma experiences compared with controls. No other study outcomes were statistically different. At 8-month follow-up, VSLA participants reported a continued increase in per capita food consumption, an increase in economic hours worked in the prior 7 days, and an increase in access to social resources. CONCLUSIONS While female sexual violence survivors with elevated mental symptoms were successfully integrated into a community-based economic program, the immediate program impact was only seen for food consumption and experience of stigma. Impacts on mental health severity were not realized, suggesting that targeted mental health interventions may be needed to improve psychological well-being.
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Asher L, Fekadu A, Hanlon C, Mideksa G, Eaton J, Patel V, De Silva MJ. Development of a Community-Based Rehabilitation Intervention for People with Schizophrenia in Ethiopia. PLoS One 2015; 10:e0143572. [PMID: 26618915 PMCID: PMC4664267 DOI: 10.1371/journal.pone.0143572] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 11/08/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and quality of life of people with disabilities. The RISE (Rehabilitation Intervention for people with Schizophrenia in Ethiopia) trial will evaluate the effectiveness of CBR for people with schizophrenia in Ethiopia. Nevertheless, the components of CBR that are both feasible and likely to prove effective in low and middle-income countries such as Ethiopia are unclear. METHODS In this study intervention development work was undertaken to design a CBR intervention that is acceptable and feasible in the local context. The development work consisted of five phases. 1: Identify potential components of CBR for schizophrenia, 2: Situational analysis, 3: Determine feasibility of CBR (Theory of Change workshops with experts and local stakeholders), 4: Determine acceptability of CBR (16 in-depth interviews and five focus group discussions with people with schizophrenia, caregivers, health workers and community leaders) and 5: Synthesise results to finalise intervention. A Theory of Change map was constructed showing the causal pathway for how we expect CBR to achieve its impact. RESULTS People with schizophrenia in rural Ethiopia experience family conflict, difficulty participating in work and community life, and stigma. Stakeholders perceived CBR to be acceptable and useful to address these problems. The focus of CBR will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists. Novel components of CBR for schizophrenia included family intervention and dealing with distressing symptoms. Microfinance was excluded due to concerns about stress and exploitation. Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR. CONCLUSION Extensive formative research using a variety of methods has enabled the design of a culturally appropriate CBR intervention for people with schizophrenia that is acceptable and feasible.
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Affiliation(s)
- Laura Asher
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Center for Global Mental Health, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Gemechu Mideksa
- RAPID (Rehabilitation And Prevention Initiative against Disabilities) CBR Project, Adama, Ethiopia
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- CBM West Africa Regional Office, Lome, Togo
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sangath, Goa, India
| | - Mary J. De Silva
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Maman S, Kajula L, Balvanz P, Kilonzo M, Mulawa M, Yamanis T. Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention. Glob Public Health 2015; 11:1202-1215. [PMID: 26588115 DOI: 10.1080/17441692.2015.1094105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analysed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection, and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomised trial of the microfinance and peer health leadership intervention.
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Affiliation(s)
- Suzanne Maman
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Lusajo Kajula
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Peter Balvanz
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Mrema Kilonzo
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Marta Mulawa
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Thespina Yamanis
- c School of International Service , American University , Washington , DC , USA
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Hamad R, Fernald LCH. Microcredit participation and women's health: results from a cross-sectional study in Peru. Int J Equity Health 2015; 14:62. [PMID: 26242582 PMCID: PMC4523998 DOI: 10.1186/s12939-015-0194-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/21/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Social and economic conditions are powerful determinants of women's health status. Microcredit, which involves the provision of small loans to low-income women in the hopes of improving their living conditions, is an increasingly popular intervention to improve women's socioeconomic status. Studies examining the health effects of microcredit programs have had mixed results. METHODS We conduct a cross-sectional study among female clients of a non-profit microcredit program in Peru (N = 1,593). The predictor variable is length of microcredit participation. We conduct bivariate and multivariate linear regressions to examine the associations between length of microcredit participation and a variety of measures of women's health. We control for participants' sociodemographic characteristics. RESULTS We find that longer participation is associated with decreased depressive symptoms, increased social support, and increased perceived control, but these differences are attenuated with the inclusion of covariates. We find no association between length of participation and contraception use, cancer screening, or self-reported days sick. CONCLUSIONS These results demonstrate a positive association between length of microcredit participation and measures of women's psychological health, but not physical health. These findings contribute to the discussion on the potential of microcredit programs to address the socioeconomic determinants of health, and suggest that addressing socioeconomic status may be a key way to improve women's health worldwide.
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Affiliation(s)
- Rita Hamad
- Division of General Medical Disciplines, Stanford University, 1070 Arastradero Road, Palo Alto, CA, 94304, USA.
| | - Lia C H Fernald
- School of Public Health, University of California Berkeley, 50 University Hall, Berkeley, CA, 94720, USA.
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Patel CJ, Ioannidis JPA, Cullen MR, Rehkopf DH. Systematic assessment of the correlations of household income with infectious, biochemical, physiological, and environmental factors in the United States, 1999-2006. Am J Epidemiol 2015; 181:171-9. [PMID: 25589242 DOI: 10.1093/aje/kwu277] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A fuller understanding of the social epidemiology of disease requires an extended description of the relationships between social factors and health indicators in a systematic manner. In the present study, we investigated the correlations between income and 330 indicators of physiological, biochemical, and environmental health in participants in the US National Health and Nutrition Examination Survey (NHANES) (1999-2006). We combined data from 3 survey waves (n = 249-23,649 for various indicators) to search for linear and nonlinear (quadratic) correlates of income, and we validated significant (P < 0.00015) correlations in an independent testing data set (n = 255-7,855). We validated 66 out of 330 factors, including infectious (e.g., hepatitis A), biochemical (e.g., carotenoids, high-density lipoprotein cholesterol), physiological (e.g., upper leg length), and environmental (e.g., lead, cotinine) measures. We found only a modest amount of association modification by age, race/ethnicity, and gender, and there was no association modification for blacks. The present study is descriptive, not causal. We have shown in our systematic investigation the crucial place income has in relation to health risk factors. Future research can use these correlations to better inform theory and studies of pathways to disease, as well as utilize these findings to understand when confounding by income is most likely to introduce bias.
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Gordon-Strachan G, Cunningham-Myrie C, Fox K, Kirton C, Fraser R, McLeod G, Forrester T. Richer but fatter: the unintended consequences of microcredit financing on household health and expenditure in Jamaica. Trop Med Int Health 2014; 20:67-76. [PMID: 25329229 DOI: 10.1111/tmi.12403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Kristin Fox
- Sir Arthur Lewis Institute of Social and Economic Studies; University of the West Indies; Mona Jamaica
| | - Claremont Kirton
- Department of Economics; University of the West Indies; Mona Jamaica
| | - Raphael Fraser
- Department of Statistics; Florida State University; Tallahassee FL USA
| | - Georgia McLeod
- Department of Economics; University of the West Indies; Mona Jamaica
| | - Terrence Forrester
- UWI Solutions for Developing Countries; University of the West Indies; Mona Jamaica
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Abstract
A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvantaged suffer disproportionately, but those in the middle of the social gradient are also affected. It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age. Action throughout these life stages would provide opportunities for both improving population mental health, and for reducing risk of those mental disorders that are associated with social inequalities. As mental disorders are fundamentally linked to a number of other physical health conditions, these actions would also reduce inequalities in physical health and improve health overall. Action needs to be universal: across the whole of society and proportionate to need. Policy-making at all levels of governance and across sectors can make a positive difference.
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Affiliation(s)
- Jessica Allen
- UCL Institute of Health Equity, University College London , UK
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Abstract
Poverty remains one of the most pressing problems facing the world; the mechanisms through which poverty arises and perpetuates itself, however, are not well understood. Here, we examine the evidence for the hypothesis that poverty may have particular psychological consequences that can lead to economic behaviors that make it difficult to escape poverty. The evidence indicates that poverty causes stress and negative affective states which in turn may lead to short-sighted and risk-averse decision-making, possibly by limiting attention and favoring habitual behaviors at the expense of goal-directed ones. Together, these relationships may constitute a feedback loop that contributes to the perpetuation of poverty. We conclude by pointing toward specific gaps in our knowledge and outlining poverty alleviation programs that this mechanism suggests.
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Affiliation(s)
- Johannes Haushofer
- Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, 30 Wadsworth Street, Cambridge, MA 02142, USA. Program in Economics, History, and Politics, Harvard University, Cambridge, MA 02138, USA. Department of Economics, University of Zürich, Blümlisalpstrasse 10, Zürich 8006, Switzerland. Department of Psychology and Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ 08544, USA.
| | - Ernst Fehr
- Department of Economics, University of Zürich, Blümlisalpstrasse 10, Zürich 8006, Switzerland.
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Plagerson S. Integrating mental health and social development in theory and practice. Health Policy Plan 2014; 30:163-70. [DOI: 10.1093/heapol/czt107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Alexander Tsai and colleagues highlight the complex relationship between poverty and HIV stigma in sub-Saharan Africa, and discuss possible ways to break the cycle. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Alexander C. Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - David R. Bangsberg
- Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sheri D. Weiser
- Division of HIV/AIDS, San Francisco General Hospital, University of California at San Francisco, San Francisco, California, United States of America
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Familiar I, Sharma S, Ndayisaba H, Munyentwari N, Sibomana S, Bass JK. Community perceptions of mental distress in a post-conflict setting: a qualitative study in Burundi. Glob Public Health 2013; 8:943-57. [PMID: 23941217 DOI: 10.1080/17441692.2013.819587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There is scant documentation of the mental health characteristics of low-income communities recovering from armed conflict. To prepare for quantitative health surveys and health service planning in Burundi, we implemented a qualitative study to explore concepts related to mental distress and coping among adults. Mental distress was defined as problems related to feelings, thinking, behaviour and physical stress. Using free listing and key informant interviews with a range of community members, we triangulated data to identify salient issues. Thirty-eight free list respondents and 23 key informants were interviewed in 5 rural communities in Burundi using 2 interview guides from the WHO Toolkit for Mental Health Assessment in Humanitarian Settings. Based on these interviews, we identified four locally defined idioms/terms relating to mental distress: ihahamuka (anxiety spectrum illnesses), ukutiyemera (a mix of depression and anxiety-like syndrome), akabonge (depression/grief-like syndrome) and kwamana ubwoba burengeje (anxiety-like syndrome). Mental distress terms were perceived as important problems impacting community development. Affected individuals sought help from several sources within the community, including community leaders and traditional healers. We discuss how local expressions of distress can be used to tailor health research and service integration from the bottom up.
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Affiliation(s)
- Itziar Familiar
- a Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
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Field E, Pande R, Papp J, Park YJ. Repayment flexibility can reduce financial stress: a randomized control trial with microfinance clients in India. PLoS One 2012; 7:e45679. [PMID: 23049836 PMCID: PMC3458929 DOI: 10.1371/journal.pone.0045679] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/23/2012] [Indexed: 11/19/2022] Open
Abstract
Financial stress is widely believed to cause health problems. However, policies seeking to relieve financial stress by limiting debt levels of poor households may directly worsen their economic well-being. We evaluate an alternative policy - increasing the repayment flexibility of debt contracts. A field experiment randomly assigned microfinance clients to a monthly or a traditional weekly installment schedule (N=200). We used cell phones to gather survey data on income, expenditure, and financial stress every 48 hours over seven weeks. Clients repaying monthly were 51 percent less likely to report feeling "worried, tense, or anxious" about repaying, were 54 percent more likely to report feeling confident about repaying, and reported spending less time thinking about their loan compared to weekly clients. Monthly clients also reported higher business investment and income, suggesting that the flexibility encouraged them to invest their loans more profitably, which ultimately reduced financial stress.
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Affiliation(s)
- Erica Field
- Department of Economics, Duke University, Durham, North Carolina, USA
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Lund C, De Silva M, Plagerson S, Cooper S, Chisholm D, Das J, Knapp M, Patel V. Poverty and mental disorders: breaking the cycle in low-income and middle-income countries. Lancet 2011; 378:1502-14. [PMID: 22008425 DOI: 10.1016/s0140-6736(11)60754-x] [Citation(s) in RCA: 424] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Growing international evidence shows that mental ill health and poverty interact in a negative cycle in low-income and middle-income countries. However, little is known about the interventions that are needed to break this cycle. We undertook two systematic reviews to assess the effect of financial poverty alleviation interventions on mental, neurological, and substance misuse disorders and the effect of mental health interventions on individual and family or carer economic status in countries with low and middle incomes. We found that the mental health effect of poverty alleviation interventions was inconclusive, although some conditional cash transfer and asset promotion programmes had mental health benefits. By contrast, mental health interventions were associated with improved economic outcomes in all studies, although the difference was not statistically significant in every study. We recommend several areas for future research, including undertaking of high-quality intervention studies in low-income and middle-income countries, assessment of the macroeconomic consequences of scaling up of mental health care, and assessment of the effect of redistribution and market failures in mental health. This study supports the call to scale up mental health care, not only as a public health and human rights priority, but also as a development priority.
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Affiliation(s)
- Crick Lund
- Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
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Plagerson S, Patel V, Harpham T, Kielmann K, Mathee A. Does money matter for mental health? Evidence from the Child Support Grants in Johannesburg, South Africa. Glob Public Health 2011; 6:760-76. [DOI: 10.1080/17441692.2010.516267] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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