Cash Transfers and Psychiatric Hospitalization for At-Risk Populations in Brazil

Importance: Psychiatric disorders are a major global public health concern, highlighting the urgent need for policies to mitigate their impact, especially for at-risk populations. Objective: To investigate the association of the Brazilian conditional cash transfer program (Bolsa Familia Program [BFP]) with psychiatric disorder hospitalizations and availability of community mental health service. Design, Setting, and Participants: This cohort study was conducted during an 8-year period using linked social and health data from the 100 Million Brazilian Cohort. The participants were all individuals who were registered at CadÚnico between January 1, 2008, and December 31, 2015. Statistical analyses were conducted between August 12, 2025, and January 31, 2026. Exposure: Participation in the BFP. Main Outcomes and Measures: All psychiatric disorder hospitalizations registered on the Hospital Information System according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) as psychiatric disorders, except for substance use disorders. Results: A total of 38 572 143 individuals (mean [SD] age, 21.66 [22.06] years; 20 661 009 [54%] female and 17 911 134 [44%] male; 188 033 [0.49%] Asian, 2 238 344 [5.80%] Black, 280 859 [0.73%] Indigenous, 22 123 435 [57.36%] Pardo [includes individuals with Black or mixed ancestry, including European, African, and Indigenous heritage], and 12 749 758 [33.05%] White) were included in the analysis. A total of 56 646 individuals (0.1%) had a psychiatric disorder hospitalization during the study period. Individuals who received a cash transfer from the BFP had a 23% lower risk of psychiatric disorders hospitalization (hazard ratio [HR], 0.77; 95% CI, 0.76-0.79). The association was stronger among Pardo (HR, 0.72; 95% CI, 0.69-0.74) and Black (HR, 0.78; 95% CI, 0.72-0.85) individuals who lived in the poorest municipalities (HR, 0.67; 95% CI, 0.63-0.71) regardless community mental health care. Conclusions and Relevance: In this cohort study of the 100 Million Brazilian Cohort, a national cash transfer program was associated with lower risk of psychiatric hospitalizations, especially among at-risk populations who experience health inequalities.