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

项目摘要 巴西40%以上的儿童生活在贫困之中，贫困往往很严重， 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，在地球仪上实施这些干预措施的能力有限，特别是在 资源匮乏的环境。因为它们具有高度的可扩展性， 转移计划提供了一种有希望的方法，可以限制精神疾病的关键社会驱动因素， 不良童年经历（ACE），从而减轻了 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名 研究现金转移对儿童神经发育和心理健康的因果影响 健康我们的研究建立在世界上最大的现金转移计划，Bolsa Familia， 已在巴西实施了20多年。与RFA-MH-21-160的目标一致， 研究包括一个机制框架，测试现金转移是否减少新发ACE， 通过限制炎症和下丘脑来保护儿童的大脑和行为发育， 垂体-肾上腺（HPA）活性（皮质醇）。通过干预前和干预后评估， 包括大脑MRI扫描，行为分析和症状测量，我们将索引 跨多个分析单位的现金转移对神经发育的影响。虽然现金 转学计划越来越普遍，但它们对儿童心理健康的影响仍然存在。 特别是在贫穷普遍存在的低/中等收入国家，特征不明显。 因为我们提出的研究建立了Bolsa Familia，一个完善的计划， 成功的、用于转移现金的国家基础设施，我们的发现可能会迅速走向 实施.此外，通过提供机制性见解，我们的研究将迈出关键一步 需要完善Bolsa Familia和其他现金转移计划，促进旨在 针对最有可能受益的特定人群， 转移，并确定干预的理想时机/持续时间。

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.