Mental Health and Bolsa Familia: A Mechanistically Focused Clinical Trial of a Cash Transfer Intervention on Child Brain, Behavior, and Mental Health
New York State Psychiatric Institute
Summary
This study examines the impact of Auxilio Brasil (AB), a cash transfer program to mothers of school-age children, on resource-deprived populations in Brazil and its protective effects on child neurodevelopment and mental health. The investigators will conduct a randomized clinical trial (RCT) among those already receiving AB in which 300 families will be randomized in a 1:1 ratio to receive either a high ($40/month) or low ($2/month) supplemental transfer for 2 years. Three hundred children (index child participants; 7-10 years old) will be enrolled across both study arms. Additionally, up to 150 siblings ("sibling participants;" 7-10 years old) will be enrolled. Eligible families who decide to participate will sign a study-specific informed consent (mother) and assent (child) form. The UNIFESP team will conduct the respective assessments at baseline, approximately 8- and 16- months, 24-months and approximately 6-months post-RCT. Aim 1: Determine the impact of high vs low cash transfers on children's exposure to adversities (ACEs) and neurodevelopment. Aim 2: Determine the impact of cash transfers on children's inflammatory markers and HPA activity/cortisol. Exploratory Aim: The investigators will explore (i) whether sex/gender of the children moderates the pathways in the above mediation model; and (ii) whether cash transfer-related effects persist 6 months post-RCT.
Description
Numerous studies link childhood poverty with altered neurodevelopment with the most robust effects often in brain substrates related to executive functions (EF). Poverty is associated with reduced grey matter thickness and surface area of the prefrontal cortex (PFC), a key structure underlying EF (4,5) Poverty is also associated with altered structure and function of the hippocampus - a region essential for memory and cognitive control (5,6). Effects of poverty on brain development are thought to give rise to the well described associations between poverty, impairments in EF, and risk for ment…
Eligibility
- Age range
- 23–45 years
- Sex
- All
- Healthy volunteers
- No
Mother: Inclusion Criteria: 1. Age 23-45 years old 2. Receiving AB cash transfers 3. Has at least two or more children ages 7- 10 years old at time of recruitment (up to 4 children per family) 4. Able to consent Exclusion Criteria: 1\. Mother and child do not reside in same household Child: Inclusion Criterion 1. Age 7-10 years old 2. Intellectual Disability Exclusion Criterion 1. Does not reside in same household as the mother 2. Major Axis I disorder (e.g., Autism, Schizophrenia, Bipolar) 3. Severe Disability 4. MRI contradictions (index child only)
Interventions
- OtherSupplemental cash transfer
Supplemental cash transfer ($40/month)
Locations (2)
- New York State Psychiatric InstituteNew York, New York
- UNIFESPSão Paulo, São Paulo