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

• Published in: PloS one Vol. 17; no. 10; p. e0272481
• Main Authors: Machado, Daiane Borges, Azevedo Paiva de Araujo, Jacyra, Alves, Flávia Jôse Oliveira, Fernando Silva Castro-de-Araujo, Luis, da Silva Rodrigues, Elisângela, Fialho Morais Xavier, Erika, Lins Rodrigues, Rodrigo, Rasella, Davide, Naslund, John, Patel, Vikram, L Barreto, Mauricio
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06-10-2022; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aggression; Brazil - epidemiology; Children & youth; Demographic aspects; Economic aspects; Effectiveness; Evaluation; Financial Statements; Health aspects; Health care; Health problems; Health risks; Health services; Hospitalization; Humans; Illnesses; Impulsivity; Influence; Information systems; Intervention; Low income groups; Medicine and Health Sciences; Mental Disorders; Mental Health; Pathways; People and places; Population; Post traumatic stress disorder; Poverty; Psychological aspects; Retrospective Studies; Risk factors; Social factors; Social Sciences; Socioeconomic factors; Socioeconomics; Study Protocol; Suicidal behavior; Suicide; Suicides & suicide attempts; Sustainable development; Teenagers; Trends; Violence; Welfare; Youth; Brazil
• DOI: 10.1371/journal.pone.0272481
• EISSN: 1932-6203

Physical, emotional, and social changes, including exposure to poverty, abuse, or violence, increases youth vulnerability to mental illness. These factors interfere with development, limit opportunities, and hamper achievement of a fulfilling life as adults. Addressing these issues can lead to improved outcomes at the population level and better cost-effectiveness for health services. Cash transfer programs have been a promising way to address social drivers for poor mental health. However, it is still unclear which pathways and mechanisms explain the association between socioeconomic support and lower mental illness among youth. Therefore, we will evaluate the effect of social drivers on youth mental health-related hospitalizations and suicide, test mechanisms and pathways of a countrywide socioeconomic intervention, and examine the timing of the intervention during the life course.
We will combine individual-level data from youth national hospitalization, mental health disorders and attempted suicide, suicide registries and notifications of violence, with large-scale databases, including "The 100 Million Brazilian Cohort", over an 18-year period (2001-2018). Several approaches will be used for the retrospective quasi-experimental impact evaluations, such as Regression Discontinuity Designs, Propensity Score Matching and difference-in-differences, combined with multivariable regressions for cohort analyses. We will run multivariate regressions based on hierarchical analysis approach to evaluate the association between important social drivers (mental health care, demographic and economic aspects) on mental health-related hospitalizations and suicide among youth. Furthermore, we will perform microsimulations to generate projections regarding how mental health-related hospitalizations and suicide trends will be in the future based on the current state, and how BFP implementation scenarios will affect these trends.
The results of this project will be of vital importance to guide policies and programs to improve mental health and reduce mental health-related hospitalizations and suicide in youth. It will provide information to improve the effectiveness of these programs worldwide. If cash transfers can decrease mental health problems among youth and reduce suicide.