Exceptional Research Award PhD commendation prize

The Impact of Monetary Poverty Alleviation Programs on Children’s and Adolescents’ Mental Health: A Systematic Review and Meta-Analysis Across Low-, Middle-, and High-Income Countries

Mirela Zaneva

This research examines the evidence concerning whether monetary poverty alleviation programs, such as cash transfers, improve mental health outcomes for children and adolescents. It finds evidence for a positive effect, in particular the meta-analysis indicates reductions in internalizing symptoms after receiving a cash transfer.

A reviewer described the research as a ‘systematic review and meta-analysis of high quality and rigor…that contributes to the evidence base in Global Health and Wellbeing.’ It provides further support for the importance of considering multi-dimensional benefits of cash transfers, and for improving the targeting and types of securities provided.

This research relates to our research direction on applied mental health research.

Researcher profile

Mirela Zaneva

Mirela's doctoral degree is in Experimental Psychology at the University of Oxford, with a research focus in global mental health. She's currently in her final year and wrapping up final projects, and will be on the job market soon.

Researcher profile

What was your thesis topic?

My dissertation examines the impacts of poverty and socioeconomic inequalities on mental health, particularly for children and adolescents. A key focus has been understanding what the ingredients of an effective intervention are, as well as what the most important risk factors are.

In what ways do you think your topic improves the world?

One of the questions the field of global mental health asks is what interventions should be offered to improve mental health. That can be therapy and/or antidepressants for instance. By looking carefully at social determinants and working alongside potential recipients to understand their lived experiences, we may find that in some cases interventions outside the biomedical sphere may be more appropriate, more needed, and perhaps even more cost-effective. Cash transfers have traditionally been considered as poverty alleviation interventions, but new work including my own shows they can function as mental health interventions as well. 

As a second layer, my research also advocates for the more common use of subjective measures. This would include measures like mental health and wellbeing, as well as measures that track how people perceive their socioeconomic circumstances. These are measures that tell us how people feel about themselves and their lives. Historically, a lot of interventions have prioritized so-called objective measures, that tend to be relatively straightforward to observe and quantify consistently: what your income is, or if you have books for schools, or if you have heating at home. But objective measures can’t tell you what it feels like to be hungry, or miss school, or sleep in a cold room — or what you really want to have and be able to do. Including relevant subjective measures and carrying out participatory work is a fantastic way to improve intervention acceptability and ensure that key needs are met. Importantly, there is a lot of high-quality evidence emerging about how strongly subjective measures can predict health outcomes, in some cases even more so than “objective” measures.

In what ways have you changed your mind since you finished writing it?

My thinking has changed a lot in technical terms, especially regarding what robust analytical practices should be, how to make appropriate modelling or measurement decisions, what RCTs can and cannot do, how small decisions in data collection may have big implications for the evidence base. I think my interests in statistics and open science have been critical here. Then there are a range of theoretical and applied topics where my thinking is growing as well. For instance, there is a fantastic literature around why different forms of aid can be paternalistic, but recently I’ve seen how sometimes even how our measurement and categorizations practices can be paternalistic and inappropriate. I’m interested in better understanding issues around the potential of harm, such as regarding the sustainability and usefulness of short-term interventions, or how applying conditions to transfers may expose vulnerable people to further risk. Reading broadly and critically helps me a lot here, and I am especially grateful to experts from different fields with whom we have shared productive disagreements.

What recommendations would you make to others interested in taking a similar direction with their research?

If you’re at an early stage, where you’re still exploring your interests, I would say reading a lot and reading widely is valuable. You can start with blogs or podcasts from people in the field before jumping into the research literature. As an example, try this TedTalk by Vikram Patel on ‘Mental Health for All.’ To get more practical experience in global health, look out for future rounds of the brilliant Cause Innovation Bootcamp led by Leonie Falk and Akhil Bansal.

My experiences working with actual data and towards providing policy evidence have been particularly useful, so I will recommend a few organizations more broadly in global health. I’m really thankful to colleagues from Evidence Aid, UNICEF , The Case for Her, The Pleasure Project, The World Health Organization and I suggest checking all of their pages for internships or placements as well as getting on their newsletters. If you’re interested in child protection, UNICEF Innocenti is another fantastic organization. For more resources particularly for research, be sure to check out The Poverty Action Lab (J-PAL), Innovations for Poverty Action (IPA), and Population Council as well as the affiliated GIRL Center. If you’re at a stage where you’re thinking about academia vs non-academic careers, check out this blog over at IAPHS. Feel free to reach out to me via email at mirela.zaneva@psy.ox.ac.uk if I can help further.

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