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

精神健康问题是全世界青年残疾的主要原因。这些问题在生活贫困的青年中更为常见。心理健康问题可能会对身心健康、教育、就业和人际关系产生短期和长期影响。贫困大学生心理健康问题发生率高，支持有限。这些学生面临着表现和成功以及养家糊口的巨大压力。这些压力也出现在从事危险行为的可能性更大、学业压力更大的人生阶段，这可能会进一步增加心理健康问题的风险。对弱势学生提供有效的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怀或支持。在巴西，大约80%的有心理健康问题的年轻人没有得到护理，接受循证治疗的人更少。虽然有大量证据表明心理疗法(如认知行为疗法[CBT])对预防和治疗青少年心理健康问题有效，但缺乏服务和训练有素的提供者大大限制了机会。此外，交通、成本和耻辱等障碍进一步限制了准入。对于贫穷的年轻人来说，这些障碍比非贫穷的年轻人更大。使用数字干预可以改善获得护理的机会。它们的成本更低，可以减轻卫生系统的压力，接触到更多的用户。考虑到他们更私密，他们还可以解决污名问题。然而，许多数字干预未能吸引用户并保持参与。这限制了他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)相结合是否能够增加低收入大学生的参与度和参与度。研究表明，有条件现金援助可以通过让学生购买书籍和食物来提高健康行为和参与度，从而避免粮食不安全，减少经济压力，使其能够专注于干预，并减少羞耻感。其他研究表明，同伴支持可以减少耻辱，增加参与，特别是在弱势群体中。首先，我们将适应和试点数字心理健康干预(e-CBT)，与CCT和/或与低收入大学生合作的同伴支持相结合，在大学生中被证明是有效的。在细化之后，我们将看到e-CBT与：(1)有条件现金转移；(2)同行支持或(3)有条件现金转移+同行支持相结合是否能提高参与度和参与度。我们将使用创新的方法，结合有条件现金转移和同伴支持，探索干预的较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.