Poverty and mental illness may mutually reinforce one another. In collaboration with World Vision, IFPRI evaluated a program to test whether the benefits of poverty alleviation interventions may be enhanced with the addition of psychosocial support. Based on promising evidence from this pilot study showing improvements to mental health in the short term, the intervention was expanded to the Tigray region and a second study was designed to test service delivery models in a post-conflict setting.
Mental health disorders, particularly anxiety and depression, are leading contributors to the global health burden. It is estimated that 8% of the world’s population suffers from anxiety and depression and the burden is much higher in LMICs where 80% of people with mental illness go untreated. In conflict affected areas, estimates of prevalence of mental health disorders are much higher at 22%.
Poverty and mental illness can mutually reinforce one another. While studies in LMICs show that psychotherapy interventions are effective at improving mental health disorders (Singla et al., 2017) and, separately, that cash interventions also have a positive effect on mental health (Ridley et all., 2020), there is scarce literature on the combined effects of cash and psychotherapy interventions. Further, most studies are short term (measuring impacts <6 months after programs end) and focus mainly on mental health outcomes. Thus, we aim to test whether the benefits of poverty alleviation interventions may be enhanced with the addition of group therapy.
When you look at it from an economic point of view, if someone is stressed or depressed they will not be able to go out and work and do the things that are expected from them. They will not have peace with their neighbors. — Tsahay Aweke, Field office staff, SPIR II
In collaboration with World Vision International, IFPRI conducted an evaluation of the effects of a psychological intervention called group Problem Management Plus (gPM+) among Ethiopia Productive Safety Net Program (PSNP) clients experiencing mild to moderate depression from 2022-2023. Developed by WHO to address common mental health problems such as depression, stress, and anxiety, gPM+ introduces behavioral strategies in a group setting to address psychological issues (e.g., stress, fear, feelings of helplessness) and practical problems (e.g., livelihood problems, conflict in the family). The gPM+ program consists of five 90-minute sessions delivered over 5 weeks by a trained group leader. The innovation of the program evaluated by IFPRI was to combine the delivery of the gPM+ intervention with an unconditional cash transfer provided in a one-time lump sum of 15,000 Birr (about $278 USD) to support income-generating activities that improve livelihoods along with 2.5 days of livelihood training. We investigate the impact of the cash transfers alone, gPM+ alone, and the combination of both measuring short- and medium-term impacts on a range of outcomes.
The study uses a two-stage cluster randomized control trial design across 70 kebeles (13 woredas) in the regions of Amhara and Oromia. We find that in the short term, gPM+ improves mental health, childcare, and psychosocial outcomes. In the medium term, gPM+ combined with the cash transfer leads to large improvements in economic (0.23 SD) and psychosocial outcomes (0.06 SD). We also find that armed conflict (measured using ACLED data) attenuates any positive impacts of the combined arm in the medium term; for households that were not exposed to any armed conflict, we observe significant improvements to mental health (0.18 SD), childcare (0.07), psychosocial outcomes (0.06 SD), and economic outcomes (0.29 SD). For every additional conflict event experienced by the household, impacts are reduced by 0.02 SD for mental health and 0.01 for childcare and economic outcomes.
Short term evidence from this pilot study in the regions of Amhara and Oromia was presented to the project implementers. This evidence supported the decision to expand the gPM+ program to Tigray region, a post-conflict setting. The study in Tigray is designed to test which delivery mechanism of gPM+ has the most potential to scale up, comparing NGO and government health worker led delivery. The ongoing collaboration between World Vision and IFPRI, has led to mutual learning on how to best scale up psychological interventions in a resource-poor, conflict affected setting.
