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: 10375234
• 负责人: Cristiane S. Duarte
• 金额: $ 65.45万
• 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 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10375234
• 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; Enrollment; Event; Executive Dysfunction; Exposure to; Family; Female; Functional Magnetic Resonance Imaging; Funding; Gender; Goals; Hair; Health Food; Hippocampus (Brain); Homicide; Household; Hydrocortisone; Hypothalamic structure; Incentives; 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; Randomized Clinical Trials; Research; Resource-limited setting; Rest; Risk; Schools; Site; Social support; Suicide; Symptoms; TNF gene; Testing; Translating; Universities; Violence; abuse neglect; adverse childhood events; behavioral outcome; biological systems; brain behavior; 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; neurodevelopment; neurodevelopmental effect; offspring; post intervention; programs; protective effect; 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.

项目摘要 超过40％的巴西儿童生活在贫困中，这通常很严重，并且带有重要的贫困 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，特别是在 低资源设置。因为它们是可扩展的，所以社会干预（例如现金） 转会计划提供了一种承诺方法，可能会限制精神疾病的关键社会驱动力， 不利的童年经历（ACE），从而减少了重要的社会燃烧 贫困 - 儿童精神疾病。我们提出了一项24个月的随机临床试验，涉及300 家庭检查现金转移对儿童神经发育和精神的因果影响的家庭 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 在巴西已经有20多年了。与RFA-MH-21-160的目标一致 研究包括一个机械框架，测试现金转移是否减少了新的发病ace， 通过限制注射和下丘脑来保护儿童大脑和行为发展 垂体 - 肾上腺（HPA）活性（皮质醇）。进行干预前和干预后评估 包括大脑MRI扫描，行为测定和症状测量，我们将索引 现金转移的神经发育影响跨多个分析单位。虽然现金 转移计划变得越来越普遍，他们对儿童心理健康的影响仍然存在 在贫困普遍存在的低/中等收入国家中的特征尤其不佳。 因为我们提出的研究是建立在Bolsa Familia的基础上的，这是一个完善的计划 成功的国家基础设施用于转移现金，我们的发现可能会迅速发展 执行。此外，通过提供机械见解，我们的研究将采取关键步骤 精炼Bolsa Familia和其他现金转移计划所需 针对最有可能受益的特定人群，优化剂量/量 转移，并确定理想的时间/持续时间进行干预。