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Original research
The impact of cash transfers on mental health in children and young people in low-income and middle-income countries: a systematic review and meta-analysis
  1. Annie Zimmerman1,2,
  2. Emily Garman3,
  3. Mauricio Avendano-Pabon2,4,
  4. Ricardo Araya1,
  5. Sara Evans-Lacko5,
  6. David McDaid5,
  7. A-La Park5,
  8. Philipp Hessel6,
  9. Yadira Diaz6,
  10. Alicia Matijasevich7,
  11. Carola Ziebold7,
  12. Annette Bauer5,
  13. Cristiane Silvestre Paula8,
  14. Crick Lund1,3
  1. 1Health Service & Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
  2. 2Global Health and Social Medicine, King's College London, London, UK
  3. 3Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
  4. 4Department of Social and Behavioural Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
  5. 5Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
  6. 6Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogota, Colombia
  7. 7Faculdade de Medicina FMUSP, Departamento de Medicina Preventiva, Universidade de Sao Paulo, Sao Paulo, Brazil
  8. 8Programa de Pós-graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil
  1. Correspondence to Dr Annie Zimmerman; annie.zimmerman{at}kcl.ac.uk

Abstract

Introduction Although cash transfer programmes are not explicitly designed to improve mental health, by reducing poverty and improving the life chances of children and young people, they may also improve their mental health. This systematic review and meta-analysis assessed the evidence on the effectiveness of cash transfers to improve the mental health of children and young people in low-income and middle-income countries.

Methods We searched Pubmed, EBSCOhost, Scientific Electronic Library Online, ISI Web of Science and Social Sciences Citation Index and grey literature (from January 2000 to July 2020) for studies which quantitatively assessed the impact of cash transfers on mental health in young people (aged 0–24 years), using a design that incorporated a control group. We extracted Cohen’s d effects size and used a random-effects model for the meta-analysis on studies that measured depressive symptoms, I2 statistic and assessment of study quality.

Results We identified 12 116 articles for screening, of which 12 were included in the systematic review (covering 13 interventions) and seven in the meta-analysis assessing impact on depressive symptoms specifically. There was high heterogeneity (I2=95.2) and a high risk of bias (0.38, 95% CIs: −5.08 to 5.85; p=0.86) across studies. Eleven interventions (85%) showed a significant positive impact of cash transfers on at least one mental health outcome in children and young people. However, no study found a positive effect on all mental health outcomes examined, and the meta-analysis showed no impact of cash transfers on depressive symptoms (0.02, 95% CIs: −0.19 to 0.23; p=0.85).

Conclusion Cash transfers may have positive effects on some mental health outcomes for young people, with no negative effects identified. However, there is high heterogeneity across studies, with some interventions showing no effects. Our review highlights how the effect of cash transfers may vary by social and economic context, culture, design, conditionality and mental health outcome.

  • health policy
  • systematic review
  • child health
  • mental health & psychiatry
  • health economics

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Data extracted from studies are available directly from published work. Data extraction tables generated for the purposes of this review are available upon request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjgh-2020-004661

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study. Data extracted from studies are available directly from published work. Data extraction tables generated for the purposes of this review are available upon request.

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors AZ designed the study, conducted the review and analysis and prepared the manuscript. EG conducted the review and analysis and helped design the study and advise on the manuscript. CL designed the study and supervised the review, analysis and write-up. DMD and A-LP conducted the grey literature review and advised on the manuscript. MA-P and RA supervised the review, analysis and write-up. SEL PH, YD, AM, AB, CSP and CZ helped design the study and all authours red and commented on the the manuscript.

    • Funding This study is an output of the CHANCES-6 study. This work was supported by the UKRI’s Global Challenges Research Fund (ES/S001050/1). The support of the Economic and Social Research Council (ESRC) is gratefully acknowledged. MA-P is additionally supported by the ESRC Centre for Society and Mental Health at King's College London (ESRC Reference: ES/S012567/1).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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    © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.