INVITED COMMENTARY

 

Improving the mental health and life chances of young people in Brazil in the context of the COVID-19 pandemic: an overview of the CHANCES-6 project

 

 

Annette Bauer^I; Cristiane S. Paula^II; Sara Evans-Lacko^III

^ICare Policy and Evaluation Centre, London School of Economics and Political Science. E-mail: a.bauer@lse.ac.uk
^IIMackenzie Presbyterian University, Graduate Program of Developmental Disorders, São Paulo, Brazil. E-mail: csilvestrep09@gmail.com
^IIICare Policy and Evaluation Centre, London School of Economics and Political Science. E-mail: s.evans-lacko@lse.ac.uk

 

 

Increasingly, evidence shows the strongly adverse effects of the COVID-19 pandemic on the mental health of young people (Pierce et al., 2020; Townsend, 2020). In Brazil, the prevalence of symptoms of anxiety, depression, and stress during the pandemic has been estimated at between 50% to 60% for the general population, with young people aged 15 to 24 years and those with diagnosed conditions being at a particularly high risk of experiencing mental distress as a result of the pandemic (Campos et al., 2020; Filgueiras & Stults-Kolehmainen, 2020). In addition to the immediate impacts of the pandemic on youth mental health, for example, due to the socially isolating effects linked to the lock-down (Cash & Patel, 2020), there are expected long-term effects on young people's mental health (Townsend, 2020). Evidence from past economic recessions also suggests that young people, which make up a fifth of the total population in Brazil (World Bank, 2019), are particularly vulnerable to long-term unemployment (Egan, Daly, & Delaney, 2015). The substantial disruptions they experience during the pandemic concerning education and employment (IBGE, 2020) are likely to influence their long-term job prospects and earnings (ILO, 2020), and increase national youth unemployment, which was as high as 24% even before the pandemic (versus 18.4% of the general population; Azzopardi et al., 2019). For example, modeling by the World Bank predicts substantial income shocks particularly among people in informal work, which is more common among young people than adults, with 80% expected to fall into poverty due to the pandemic (Cereda, Rubiao, & Sousa, 2020). Young people are more likely to be informal workers than adults. We hypothesize that to prevent the long-term effects of the pandemic on young people's mental health, poverty, and mental health needs to be addressed together since those are closely interconnected (Lund & Cois, 2018; Lund et al., 2011).

In this short paper, we describe an international research project called CHANCES-6 that seeks to generate knowledge about the role of cash transfer programs in improving the mental health and life chances of young people in Brazil and other countries. Cash transfer programs, which provide regular direct payments to individuals or households identified as poor, are in most low- or middle-income countries the main vehicle for alleviating poverty. Introduced in 2003, the Brazilian Bolsa Família Program (BFP) is the largest cash transfer program worldwide reaching 14 million families (Ministério da Cidadania). Whilst most cash transfer programs, including BFP, seek to address the social determinants of health and human capital development of children more broadly, their goals do not explicitly include mental health. However, evaluations suggest that they can reduce depressive symptoms and psychological distress among young people (Angeles et al., 2019; Baird, de Hoop, & Ozler, 2011; Kilburn, Thirumurthy, Halpern, Pettifor, & Handa, 2016). Evidence from the BFP suggests, that, in addition to addressing important poverty and child health indicators (Paes-Sousa, Santos, & Miazaki, 2011; Ramos, Heukelbach, & Oliveira, 2020; Rasella, Aquino, Santos, Paes-Sousa, & Barreto, 2013; Shei, Costa, Reis, & Ko, 2014), the program helped to improve school attendance and reduce school dropout rates (Santos, Delatorre, Ceccato, & Bonolo, 2019) as well as reduce suicide rates especially among women (Alves, Machado, & Barreto, 2019). However, so far, evaluations have not investigated the impact of BFP on the mental health of all range of ages, a gap that CHANCES-6 seeks to address, particularly among young people.

CHANCES-6¹ is an international research project led by the Care Policy and Evaluation Centre at the London School of Economics and Political Science, which aims to generate knowledge that can inform antipoverty programs and policies so they maximize opportunities for improving the mental health and life chances of young people. Brazil - together with Colombia and South Africa - is one of the three main countries in which the research is conducted (data are analyzed for altogether six countries, which in addition to the previously mentioned ones include Liberia, Malawi, and Mexico). Using various data collection methods (Bauer et al; under review), the project seeks to establish not only the impacts of cash transfer programs, such as BFP, on young peoples' mental health but also the mechanisms leading to such impacts. The latter is at the moment not well understood although there is consistent evidence that program features, such as the conditionalities many programs employ, have an important impact on various outcomes of participants (Baird, Ferreira, Özler, & Woolcock, 2014; Cooper, Benmarhnia, Koski, & King, 2020; Lagarde, Haines, & Palmer, 2009; Pega et al., 2017), including their mental health (Cooper et al., 2020).

CHANCES-6 employs various methods to generate knowledge, including qualitative and quantitative methods as well as economic analysis. For the quantitative analyses, data from studies that follow participants of cash transfer programs over time will be analyzed. Data sets utilized for Brazil include those from the Itaboraí Youth study (Bordin et al., 2018), a large cohort study (N = 1,409), that is representative of Itaboraí city in Rio de Janeiro metropolitan area and measures various poverty, life chances, and mental health indicators. Using a difference-in-differences design, incorporating propensity score matching when appropriate, and other epidemiological approaches, we will estimate associations and causal effects between BFP usage and youth mental health and life chances, as well as relationships between mental health and poverty. Important life-chances indicators include those of education and employment, whilst important mental health outcomes include those measured with the Child Behaviour Checklist, Strengths and Difficulties Questionnaire as well as those established by asking questions about self-harm, suicidality, and symptoms for post-traumatic stress disorder.

For the qualitative analysis, interviews and focus groups are being conducted with young people, parents, and practitioners involved in running BFP and other programs, to explore their views and experiences concerning youth poverty, mental health, and life chances. So far, we interviewed 12 youth living in two deprived neighborhoods in São Paulo city, Sapopemba and Vila Medeiros. We asked them how living in poverty influences their mental health and future life chances (and vice versa), in particular in the context of the current COVID-19 pandemic. Next, we will conduct four focus groups (two in each neighborhood) comprising approximately 16 parents and 16 practitioners. We will gather their views about the strengths and challenges of BFP, its impact on young people's mental health and life chances, and how the program can be improved to support young people.

Data, both quantitative and qualitative, will be analyzed for Brazil alone, as well as in comparison with the other CHANCES-6 countries. Whilst the analysis for Brazil will provide rich and comprehensive insights about program mechanisms and impacts, the cross-country analysis, utilizing a harmonized data sets, seeks to identify findings that are generalizable across countries. Finally, an economic analysis will estimate the costs and benefits of delivering BFP programs in Brazil. Also, information gathered from literature reviews will inform the analysis and interpretation of data.

An important part of the project is the involvement of young people and of individuals responsible for funding or delivering cash transfer programs as well as mental health professionals and representatives of other agencies concerned with young people's wellbeing. Through this kind of engagement work, we seek to ensure that our findings are relevant to young people and can inform national policies and development programs, especially as those are currently expanded and restructured in response to the COVID-19 pandemic (Gentilini, Almenfi, Demarco, & Santos, 2020). In Brazil, the local CHANCES-6 leadership organized a workshop where we provided an overview of the project and gathered feedback from lead representatives of government and non-government organizations in the (mental) health, education, social justice, and welfare sectors in the city of São Paulo. Since then, we have developed a network of stakeholders who we keep updated with project developments. Towards the end of the project in autumn 2021, we will organize another workshop, at which we will present the findings and discuss how stakeholders can inform the development of BFP and other programs that seek to support young people's mental health.

As we outlined at the beginning of this paper, the current pandemic poses major risks to young people's life chances. Inter-sectoral and integrated responses play an important role in preventing some of the likely long-term consequences on youth mental health and poverty. Considering the very limited resources that governments might be able (or want) to spend on mental health, it is important to build on existing infrastructures and programs, including those not previously considered as possible vehicles for improving mental health. Projects like CHANCES-6 offer an opportunity to address the long-term mental health of young people through cash transfer programs. In a second invited commentary, published in a subsequent issue of this journal, we will present some suggestions for how this might be achieved in the Brazilian context.

 

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1 Retrieved from https://www.lse.ac.uk/cpec/chances-6