Mental health and Bolsa Familia: A mechanistically focused clinical trial of a cash transfer intervention on child brain, behavior, and mental health

心理健康和 Bolsa Familia：现金转移干预对儿童大脑、行为和心理健康的机械重点临床试验

• 批准号: 10573268
• 负责人: Cristiane S. Duarte
• 金额: $ 61.65万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10573268
• 关键词: 9 year old; Address; Adrenal Glands; Affect; Behavior; Behavioral; Behavioral Assay; Blood; Brain; Brazil; Child; Child Behavior Checklist; Child Mental Health; Clinical Trials; Collaborations; Collection; Corpus striatum structure; Development; Diffusion Magnetic Resonance Imaging; Domestic Violence; Dose; Eligibility Determination; Enrollment; Event; Executive Dysfunction; Exposure to; Family; Female; Functional Magnetic Resonance Imaging; Funding; Gender; Goals; Hair; Health Food; Hippocampus; Homicide; Household; Hydrocortisone; Hypothalamic structure; Income; Inequality; Inflammation; Inflammatory; Infrastructure; Intervention; Life; Lifting; Link; MRI Scans; Magnetic Resonance Imaging; Measures; Mediating; Mediation; Mental Health; Mental Health Services; Mental disorders; Modeling; Morphology; Mothers; Outcome; Parents; Pathway interactions; Performance; Peripheral; Pituitary Gland; Policies; Population; Positioning Attribute; Poverty; Pregnant Women; Prevention; Randomized; Research; Resource-limited setting; Rest; Risk; Schools; Site; Social support; Suicide; Symptoms; TNF gene; Testing; Translating; Universities; Violence; adverse childhood events; behavioral outcome; biological systems; brain magnetic resonance imaging; child poverty; childhood adversity; cohesion; design; executive function; food insecurity; health care availability; improved; indexing; inflammatory marker; insight; low and middle-income countries; male; mesolimbic system; neglect; neurodevelopment; neurodevelopmental effect; offspring; post intervention; programs; protective effect; randomized, clinical trials; reducing suicide; response; sex; social; social interventions

PROJECT SUMMARY Over 40% of children in Brazil live in poverty that is often severe and carries with it a significant risk for mental illness. Existing interventions can help alleviate mental health problems in children, yet the capacity to implement these interventions is limited across the globe, and particularly in low-resourced settings. Because they are highly scalable, social interventions such as cash transfer programs offer a promising approach that may limit a critical social driver of mental illness, adverse childhood experiences (ACEs), thereby reducing an important social burden arising from poverty – child mental illness. We propose a 24-month randomized clinical trial involving 300 households to examine causal effects of cash transfers on child neurodevelopment and mental health. Our study builds off of the largest cash transfer program in the world, Bolsa Familia, that has been in place in Brazil for over 2 decades. Consistent with the goals of RFA-MH-21-160, our study includes a mechanistic framework, testing whether cash transfers reduce new onset ACEs, protecting child brain and behavioral development by limiting inflammation and hypothalamic- pituitary-adrenal (HPA) activity (cortisol). With pre- and post-intervention assessments that include brain MRI scans, behavioral assays, and symptom measures, we will index the neurodevelopmental effects of cash transfers across multiple units of analysis. Although cash transfer programs are becoming increasingly common, their effects on child mental health remain poorly characterized particularly in low/middle income countries where poverty is widespread. Because our proposed study builds off of Bolsa Familia, a well-established program with a successful, national infrastructure for transferring cash, our findings could rapidly move toward implementation. Moreover, by providing mechanistic insights, our study will take a key step needed for refining Bolsa Familia and other cash transfer programs, facilitating studies aimed at targeting the specific populations that are most likely to benefit, optimizing the dose/amount of the transfers, and determining the ideal timing/duration for intervention.

项目总结 在巴西，超过40%的儿童生活在贫困中，贫困往往很严重，而且伴随着严重的 有患精神疾病的风险。现有的干预措施可以帮助缓解儿童的心理健康问题， 然而，在全球范围内，实施这些干预措施的能力有限，尤其是在 资源匮乏的环境。因为它们是高度可扩展的社会干预措施，如现金 转移项目提供了一种很有希望的方法，可能会限制精神疾病的关键社会驱动因素， 不良童年经历(ACE)，从而减轻因以下原因而产生的重要社会负担 贫困--儿童精神疾病。我们提出了一项为期24个月的随机临床试验，涉及300人 家庭检查现金转移对儿童神经发育和智力的因果影响 健康。我们的研究建立在世界上最大的现金转移计划Bolsa Familia的基础上，即 在巴西已经存在了20多年。与RFA-MH-21-160的目标一致，我们的 研究包括一个机械框架，测试现金转移是否会减少新的A， 通过限制炎症和下丘脑保护儿童的大脑和行为发育- 垂体-肾上腺(HPA)活动(皮质醇)。干预前和干预后的评估 包括脑MRI扫描、行为分析和症状测量，我们将索引 跨多个分析单元的现金转移的神经发育影响。虽然现金 转移项目变得越来越普遍，但它们对儿童心理健康的影响依然存在 特别是在贫穷普遍存在的低收入/中等收入国家。 因为我们提议的研究建立在Bolsa Familia的基础上，Bolsa Familia是一个久负盛名的项目， 成功的国家现金转移基础设施，我们的发现可能会迅速向 实施。此外，通过提供机械性的见解，我们的研究将迈出关键的一步 精炼Bolsa Familia和其他现金转移计划所需的资金，促进旨在 针对最有可能受益的特定人群，优化 并确定理想的干预时间/持续时间。