PhD defence L.M. (Leah) Prencipe

Below is a brief summary about the dissertation:

Poor mental health places a huge burden on youth, impacting their physical, social, and financial wellbeing in the present and across the lifespan. Marginalized populations, including those living in remote and low-resource settings, are disproportionately at risk for developing mental health disorders and are less equipped to treat them. Although existing research on the social determinants of mental health provides a window into the bidirectional relationship between poverty and mental health, epidemiological evidence on the prevalence and determinants of depression among youth populations in the Global South is scarce.

From a policy perspective, social protection initiatives which target financial poverty have come to the forefront as a tool to address concurrent risks associated with living in poverty, including those related to poor psychosocial wellbeing. These initiatives range in complexity and breadth, from those providing cash directly to households or individuals in need (cash transfer programmes), to more complex integrated approaches that provide financial support in conjunction with access to services or other complementary programming (cash plus programmes). Prior evidence on the efficacy of social protection to improve mental health has been promising, but inconsistent, with differential results among subpopulations and according to programme type, implementation mechanisms, and context.

The United Republic of Tanzania, a highly populated country on the Eastern coast of Africa, has made great strides reducing poverty and boosting the local economy, efforts which propelled the country from low-income to lower-middle income status in 2020. However, extreme poverty is still a major concern, especially among rural households and young people, the latter of which make up most of Tanzania’s population. An ambitious poverty reduction platform spearheaded by the government, coupled with the many children and adolescents coming of age now and in the near future, provide a compelling environment for understanding drivers of poor youth mental health, as well as the potential role social protection can play in promoting psychosocial wellbeing, in this population.

This thesis exploited data from large scale cluster randomized controlled designed evaluations to address the gaps identified in the literature on adolescent and youth mental health in low-resource settings. First, we identified the determinants of depression outcomes, as measured by continuous and binary constructs of the 10-item Centre for Epidemiologic Studies Depression Scale (CES-D 10) among Tanzanian youth living below the poverty line (Chapters 2 & 3). Next, we estimated the impacts of the following two social protection programmes on depression severity and prevalence as well as exploring pathways of effect (Chapters 4-6): the Productive Social Safety Net (PSSN) (aka the Cash Intervention) and an adolescent-focused integrated intervention provided on top of the PSSN (aka the Cash Plus Intervention).