University of California, Los Angeles (UCLA), Luskin School of Public Affairs, Social Welfare Department, United States.
Washington University in St. Louis, George Warren Brown School of Social Work, United States.
Soc Sci Med. 2019 May;228:17-24. doi: 10.1016/j.socscimed.2019.03.003. Epub 2019 Mar 7.
Some evidence points to the positive effects of asset accumulation programs on mental health of children living in low-resource contexts. However, no evidence exists as to why and how such impact occurs. Our study aims to understand whether child poverty, child work, and household wealth serve as pathways through which the economic strengthening intervention affects the mental health of AIDS-orphaned children. The study employed a cluster-randomized experimental design with a family-based economic strengthening intervention conducted among 1410 school-going AIDS-orphaned children ages 10 and 16 years old in 48 primary schools in South Western Uganda. To test the hypothesized relationships between the intervention, mediators (household wealth, child poverty, and child's work) and mental health, we ran structural equation models that adjust for clustering of individuals within schools and account for potential correlation among the mediators. We found significant unmediated effect of the intervention on children's mental health at 24 months (B = -0.59; 95% CI: 0.93, -0.25; p < 0.001; β = -0.33). Furthermore, the results suggest that participation in the intervention reduced child poverty at 12 months, which in turn improved latent mental health outcome at 24 months (B = -0.14; 95% CI: -0.29, -0.01; p < 0.06; β = -0.08). In addition, though not statistically significant at the 0.05 level, at 36 and 48 months, mental health of children in the treatment group improved by 0.13 and 0.16 standard deviation points correspondingly with no evidence of mediation. Our findings suggest that anti-poverty programs that aim solely to improve household income may be less advantageous to children's mental health as compared to those that are specifically targeted towards reducing the impact of poverty on children. Further studies using more comprehensive measures of child work and age-appropriate child mental health may shed more light on understanding the link between asset accumulation interventions, child labor and children's mental health.
一些证据表明，资产积累计划对生活在资源匮乏环境中的儿童的心理健康有积极影响。然而，目前尚不清楚这种影响产生的原因和方式。我们的研究旨在了解儿童贫困、儿童劳动和家庭财富是否是经济强化干预影响艾滋病孤儿儿童心理健康的途径。该研究采用了基于家庭的经济强化干预的集群随机实验设计，在乌干达西南部的 48 所小学中，对 1410 名 10 至 16 岁的在校艾滋病孤儿儿童进行了干预。为了检验干预、中介变量（家庭财富、儿童贫困和儿童劳动）与心理健康之间假设的关系，我们运行了结构方程模型，这些模型考虑了学校内个体的聚类，并考虑了中介变量之间的潜在相关性。我们发现，干预对儿童心理健康有显著的、未经中介的影响，在 24 个月时（B= -0.59；95%CI：0.93，-0.25；p<0.001；β= -0.33）。此外，结果表明，参与干预可以减少儿童在 12 个月时的贫困程度，从而在 24 个月时改善潜在的心理健康结果（B= -0.14；95%CI：-0.29，-0.01；p<0.06；β= -0.08）。此外，尽管在 0.05 水平上没有统计学意义，但在 36 个月和 48 个月时，治疗组儿童的心理健康分别提高了 0.13 和 0.16 个标准差，而没有中介的证据。我们的研究结果表明，与专门针对减轻贫困对儿童影响的项目相比，旨在提高家庭收入的扶贫项目对儿童心理健康的益处可能较小。使用更全面的儿童劳动衡量标准和适合年龄的儿童心理健康衡量标准的进一步研究可能会更深入地了解资产积累干预、儿童劳动和儿童心理健康之间的联系。
