Does poverty alleviation decrease depression symptoms in post-conflict settings? A cluster-randomized trial of microenterprise assistance in Northern Uganda

Abstract

Background.By 2009, two decades of war and widespread displacement left the majority of the population of Northern Uganda impoverished.Methods.This study used a cluster-randomized design to test the hypothesis that a poverty alleviation program would improve economic security and reduce symptoms of depression in a sample of mostly young women. Roughly 120 villages in Northern Uganda were invited to participate. Community committees were asked to identify the most vulnerable women (and some men) to participate. The implementing agency screened all proposed participants, and a total of 1800 were enrolled. Following a baseline survey, villages were randomized to a treatment or wait-list control group. Participants in treatment villages received training, start-up capital, and follow-up support. Participants, implementers, and data collectors were not blinded to treatment status.Results.Villages were randomized to the treatment group (60 villages with 896 participants) or the wait-list control group (60 villages with 904 participants) with an allocation ration of 1:1. All clusters participated in the intervention and were included in the analysis. The intent-to-treat analysis included 860 treatment participants and 866 control participants (4.1% attrition). Sixteen months after the program, monthly cash earnings doubled from UGX 22 523 to 51 124, non-household and non-farm businesses doubled, and cash savings roughly quadrupled. There was no measurable effect on a locally derived measure of symptoms of depression.Conclusions.Despite finding large increases in business, income, and savings among the treatment group, we do not find support for an indirect effect of poverty alleviation on symptoms of depression.

Reducing PTSD symptoms through a gender norms and economic empowerment intervention to reduce intimate partner violence: a randomized controlled pilot study in Côte D'Ivoire

“…This study shows that adding a discussion group focused on challenging inequitable gender norms to a savings group overall significantly reduced women's posttraumatic stress symptoms compared with a savings group alone. These findings add to mixed findings from other studies, including a recent economic intervention study in eastern DRC that yielded secondary mental health benefits (Glass et al 2017 ) as well as studies on two economic interventions in conflict-affected DRC and northern Uganda that did not improve mental health (Bass et al 2016 ; Green et al 2016 ).…”

“…Two recent studies have examined the impact of women's economic empowerment on IPV and mental health in conflict-affected settings and yielded mixed findings regarding mental health. A cash grant with business skills training for women in northern Uganda did not reduce IPV or symptoms of depression in the treatment group (Green et al 2016 ). However, a recently completed trial of a livestock asset transfer intervention in eastern DRC showed significant reductions in symptoms of anxiety and PTSD, although it did not significantly reduce IPV more than the control group (Glass et al 2017 ).…”

Socioeconomic status indicators and common mental disorders: Evidence from a study of prenatal depression in Pakistan

“…Recent evidence from experimental interventions may be able to contribute key data towards estimating the relative contribution of each link in the SES-mental health cycle: There are a growing number of (a) poverty reduction programs that assess mental health outcomes and (b) mental health interventions that assess economic outcomes ( Lund et al, 2011 ). For example, Mexico’s Opportunidades conditional cash transfer program has shown improved mental health outcomes, although not all programs have been successful ( Ozer et al, 2011 , Madhani et al, 2015 , Green et al, 2016 , Kilburn et al, 2016 ). Evaluations of the economic impact of mental health interventions (addressing the social drift hypothesis) are still relatively rare.…”

The Returns to Microenterprise Support among the Ultrapoor: A Field Experiment in Postwar Uganda

“…It is a standardized index of days ill, a subjective "overall" health question, and three activities of daily living (walking a distance, carrying a heavy load, and working on a farm). See Appendix D for component treatment effects.27 Also, as shown byGreen et al (2015b), there is also no change in mental health, as measured by an index of 35 symptoms of depression and distress.28 Means and treatment effects for individual components are available in Appendix D.…”