Effects of Adolescent-Focused Integrated Social Protection on Depression: A Pragmatic Cluster-Randomized Controlled Trial of Tanzania’s Cash Plus Intervention

Abstract

We assessed the impacts of Tanzania’s Cash Plus adolescent-focused intervention on depression. In this pragmatic cluster-randomized controlled trial, 130 villages were randomly allocated to intervention or control (1:1). Youth aged 14-19 years living in households receiving governmental cash transfers were invited to participate. The intervention included an intensive period (12-session course) and aftercare period (9-months mentoring, productive grants, and strengthened health services). We examined intervention impacts on the 10-item Centre for Epidemiological Studies Depression Scale (0-30) and exhibiting depressive symptomatology (≥10 scale), which were collected at baseline (April-June 2017), midline (May-July 2018), and endline (June-August 2019). Using intention-to-treat methodology, logistic and generalized linear models estimated effects for binary and continuous outcomes, respectively. Quantile regressions (QR) estimated effects across the scale. From 2458 baseline participants, 941 intervention and 992 control adolescents were re-interviewed at both follow-ups. At endline, the intervention reduced the odds of depressive symptomatology (adjusted odds ratio 0.67 [95% CI 0.52 to 0.86]), with an undetectable mean scale difference (effect -0.36 [95%CI -0.84 to 0.11]). QR results demonstrated an intervention effect along the upper distribution of the scale. Integration of multi-sectoral initiatives within existing social protection shows potential to improve mental health among youth in low-resource settings.

Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed‐methods study

“…This may be due to a number of reasons. While this intervention has been previously demonstrated to be protective along several pathway indicators, including gender-equitable attitudes [49], increased knowledge related to contraception and HIV prevention [50], mental health [51] and economic activities [47], it was perhaps not sufficient to overcome all the interrelated social, relational and economic vulnerabilities which lead AGYW to engage in transactional sex. Alternatively, the lack of impacts may be reflective of alternative drivers of engagement in transactional sex, namely choice of partners, addressing low self-esteem or a need to boost one's own power and social status [6,52].…”

Impacts of cash transfer and “cash plus” programs on self- perceived stress in Africa: Evidence from Ghana, Malawi, and Tanzania

“…Alternatively, impacts on stress and broader mental health may also depend on pre-existing characteristics of the intervention population. For example, the Tanzania Cash Plus program provided was previously found to be protective against another mental health outcome, depressive symptoms, but only among the upper distribution (i.e., those with worse mental health) ( Prencipe et al, 2022 ). Similarly, the Oportunidades program impacts on children's cortisol levels in Mexico was moderated by mothers' depressive symptoms; the program reduced cortisol levels among children of mothers with high depressive symptoms but not those with mothers with low depressive symptoms ( Fernald & Gunnar, 2009 ).…”

Short Video-Based Mental Health Intervention for Depressive Symptoms in Junior High School Students: A Cluster Randomized Controlled Trial

“…The standard deviations of the DSRSC change scores were assumed to be equal in each group and were estimated to be 5 from previous research. 42 Based on a standard deviation of 5 points, an intracluster correlation coefficient of 0.03, 43,44 40 students per class, 80% power, 5% significance, and 1:1:2 allocation, we required a sample size of 320 in psychologist-led intervention, 320 in teacher-led intervention, and 600 in usual school provision (a total of 1240 assenting participants). A standardized treatment effect size of 0.3 is equivalent to an estimated difference on the DSRSC of 1.5 points based on an SD of 5.…”