Can cash transfers protect mental health? Evidence from an observational cohort of children and adolescents living in adverse contexts in Brazil

BACKGROUND: Youth exposed to poverty and adversities like violence are at higher risk of mental health problems (MHP), but whether antipoverty interventions can reduce this risk remains unclear. We examined the association between participation in the Brazilian Cash Transfer Program (BFP) and mental health of children/adolescents exposed to different levels of adversity. METHODS: Observational study using nearest-neighbor propensity score matching to compare BFP participants and non-participants from the Itaboraí study, a community-based cohort of 1,189 children/adolescents (6-15 years) assessed at two waves (meaninterval: 12.9 months).Measures included the Child Behaviour Checklist (CBCL) externalizing, internalizing, and total problems scales; an adversity score derived from a confirmatory factor analysis on violence victimization at home (WorldSAFE), school (threat/maltreatment/being chased by peers) and community (Survey of Exposure to Community Violence), and stressful life events (UCLA Posttraumatic Stress Disorder Reaction Index); and BFP exposure for at least 12 months (yes/no). Latent change score models tested whether BFP participation predicted changes in CBCL T-scores, moderated by adversity levels. RESULTS: A total of 330 BFP participants were matched with 330 non-participants with similar sociodemographic characteristics. Decreases in total (b=-0.124, SE=0.034, p<0.001), externalizing (b=-0.122, SE=0.036, p=0.001), and internalizing problems (b=-0.141, SE=0.033, p<0.001) between baseline and follow-up were observed among BFP participants exposed to higher levels of adversity compared with non-participants. CONCLUSIONS: BFP participation was associated with reduced MHP only among children/adolescents facing high adversity, suggesting the program may help break the cycle between poverty and mental health problems-but benefits are concentrated among the most vulnerable.