TOPOWA Study: Social Drivers of Mental Illness among AGYW in Slums.

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Project Summary Abstract Despite extensive research linking poverty to mental illness, there is a dearth of studies examining mechanisms of resilience against complex proximal stressors in low-resource settings. Our previous work, conducted during Dr. Swahn’s Fulbright Award and via long-standing collaborations with Makerere University, demonstrates that urban youth in Kampala, Uganda, particularly Adolescent Girls and Young Women (AGYW) experience many adverse social drivers which contribute to their poor mental health. Our proposed TOPOWA project (meaning empowerment) will used a mixed-methods approach to examine the mechanisms for which Socioeconomic Strengthening Targeted Training (SeSTT) moderates the pathway between the adverse effects of poverty (proximal social and environmental stressors) and mental illness among AGYW in Kampala. Previous, but limited, research demonstrates the positive impact of SeSTT on employment and improved mental health among AGYW. Building on the Social Determinants of Mental Health (SDoMH) and the Research Domain Criteria (RDoC) frameworks, we will target AGYW ages 18-24 years, the age period when most mental health symptoms are manifested and expressed. Embedded within the SDoMH conceptual model we will focus on stress, operationalized through the RDoC framework as Negative Valence -Acute, Sustained Threat and Arousal and Regulatory Systems. Using a multicomponent 27-month, parallel prospective cohort design of AGYW, we will recruit 300 participants to determine the pathways and mechanisms of mental health outcomes using 10 quarterly, tablet administered survey assessments (Time 1-10). Participants will be those enrolled in a community-based intervention program (n=150and an age- and location- matched non-intervention community sample (n=150). The objective is to determine the mechanistic changes of SeSTT on the proximal social stressors and mental health outcomes (i.e., anxiety, depression, suicidality and substance use symptoms and disorders) among AGYW.