Pettifor A, Wang J, Selin A, Hughes J, Gómez-Olivé X, Wagner R, MacPhail C, Kahn K, HPTN 068 Study Team. The impact of a cash transfer on young South African women's on mental health: HPTN 068.
Background: Cash Transfers have been found to improve the mental health of recipients. Possible mechanisms for the improvement in mental health include a reduction in financial stress and a hope for a better future due to an improved financial situation. Methods: HPTN 068 was a 3-year randomized controlled trial to assess the impact of a cash transfer, conditioned on school attendance, on HIV incidence among young rural South African women. 2328 young women were HIV negative at baseline and had at least one follow up visit. Young women completed a survey using Audio Computer Assisted Self-Interview at baseline and at 12, 24, and 36 months. We assessed depression and anxiety using: the Short Form Children''s Depression Index (CDI), The Center for Epidemiologic Studies Depression Score (CES-D), and the Revised Children''s Manifest Anxiety Scale. Hope was measured with the Abler Hope Scale. CDI (>=7) and CES-D (>=16) were analyzed using log-binomial regression and robust variance to account for repeated measures. CMAS (summed score) and Hope (summed score) were analyzed using generalized estimating equations (GEE) with identity link, normal distribution and robust variance to account for repeated measures. Results: Overall we saw no association between receipt of the conditional cash transfer and reduced depression or anxiety among young women (Table 1). In addition, there was no association between receipt of the cash transfer and increased hope for the future (Table 1). Outcomes Range, cronbach''s alpha CCT n=1,214 Control n=1,114 RR 95%CI p-value CDI Index (>=7)**, alpha=0.70 25.8% 25.9% 0.99 0.85-1.16 0.93 CES-D (>=16)**, alpha=0.84 28.4% 29.9% 0.96 0.86-1.06 0.39 CMAS Anxiety (0-14), alpha=0.89 2.51 2.72 -0.21* -0.53-0.11 0.19 Abler Hope (0-39), alpha=0.97 31.9 32.0 -0.14* -0.75-0.48 0.66 *: Risk Difference ** >=7 for CDI and >=16 for CES-D indicates depressive symptoms [Association between cash transfer program and mental health outcomes in young South African women, HPTN 068] Conclusions: In this randomized control trial of a cash transfer, conditional on school attendance, we saw no impact of receiving the cash on depression, anxiety or hope for the future. High levels of school attendance and social protection coverage were observed in the cohort and thus it is possible that the addition of the cash transfer did not meaningfully reduce anxiety about poverty or improve future outlook above the baseline levels.