Improving adoption of mental health interventions among low-income university students in Brazil

精神健康状况是全世界青年致残的主要原因。这些问题在贫困青年中更为普遍。心理健康问题可对身心健康、教育、就业和人际关系产生短期和长期影响。生活贫困的大学生有很高的心理健康问题，而且得到的支持有限。这些学生面临着表现和成功以及支持家庭的巨大压力。这些压力也会出现在一个更有可能从事危险行为的人生阶段，学业成就的压力也会增加——这可能进一步增加心理健康问题的风险。对弱势学生的有效支持可以改善他们的心理健康和未来的生活机会。然而，大多数年轻人得不到关心和支持。在巴西，约80%患有精神疾病的青年得不到护理，接受循证治疗的人数更少。尽管有大量证据表明心理疗法（如认知行为疗法[CBT]）在预防和治疗青少年心理健康问题方面是有效的，但缺乏服务和训练有素的提供者，极大地限制了人们获得心理治疗的机会。此外，交通、成本和耻辱等障碍进一步限制了获取。与非贫困青年相比，贫困青年面临的这些障碍更大。使用数字干预措施可以改善获得护理的机会。它们成本更低，可以减轻卫生系统的压力，并覆盖更多的用户。他们也可以消除耻辱，因为他们更注重隐私。然而，许多数字干预措施未能吸引用户并使其持续参与。这限制了它们改善用户心理健康的潜力。本研究将测试将数字心理健康干预与同伴支持和/或有条件现金转移（CCT）（即以干预参与为条件的货币激励）相结合是否可以增加低收入大学生的参与和参与。研究表明，有条件现金援助可以通过使学生能够购买书籍和食物，从而避免粮食不安全，减轻经济压力，使人们能够集中精力进行干预，并减少羞耻感，从而增加健康行为，促进参与。其他研究表明，同伴支持可以减少耻辱感，增加参与，特别是在弱势群体中。首先，我们将调整和试点一项数字心理健康干预（e-CBT），该干预已被证明在大学生中有效，与CCT和/或与低收入大学生合作的同伴支持相结合。细化后，我们将看到是否将e-CBT与：(1)CCT结合；(2)同伴支持或(3)有条件现金交换+同伴支持提高参与性和参与度。我们将使用创新的方法来探索结合有条件现金援助和同伴支持的干预措施的长期社会和经济影响。

Mental health conditions are the leading cause of disability among youth worldwide. These problems are more common among youth living in poverty. Mental health problems can have short- and long-term impacts on physical and mental health, education, employment and relationships. University students living in poverty have high rates of mental health problems and limited support. These students face strong pressures to perform and succeed and to support their families. These pressures also emerge during a life stage where there is greater potential to engage in risky behaviour, and increased pressure for academic achievement - which can further increase risk of mental health problems.Effective support for vulnerable students could improve their mental health and future life chances. Most youth, however, receive no care or support. In Brazil, around 80% of youth with mental health conditions receive no care and fewer receive evidence-based treatment. Although there is a great deal of evidence for effectiveness of psychotherapy (such as cognitive behavioural therapy [CBT]) for preventing and treating youth mental health problems, lack of services and trained providers significantly limits access. Moreover, barriers such as transportation, cost and stigma further limit access. These barriers are greater for poor vs. non-poor youth. Use of digital interventions could improve access to care. They are lower cost and could reduce stress on health systems and reach more users. They could also address stigma given they are more private. However, many digital interventions fail to engage users and sustain involvement. This limits their potential to improve the user's mental health.This research would test whether combining a digital mental health intervention with peer support and/or a conditional cash transfer (CCT) (i.e., monetary incentive conditional on intervention participation) could increase participation and engagement among low-income university students. Research suggests CCTs can increase healthy behaviours and promote engagement by enabling students to purchase books and food, thereby avoiding food insecurity, reducing financial stress to enable focus on intervention, and reduce shame. Other research shows peer support can reduce stigma and increase participation particularly among vulnerable populations.First, we would adapt and pilot a digital mental health intervention (e-CBT), shown to be effective among university students, in combination with CCT and/or peer support in collaboration with low-income university students. Following refinement, we would see whether combining the e-CBT with: (1) CCT; (2) peer support or (3) CCT+peer support improves participation and engagement. We would use innovative methods to explore longer-term social and economic impacts of the intervention in combination with CCT and peer support.