Pathways From Poverty to Child Mental Health in Burkina Faso: Longitudinal Mediation Analyses in a Cluster-Randomized Clinical Trial

Leyla Karimli; Leyla Ismayilova; Christine R Wells

doi:10.1016/j.jadohealth.2024.10.030

Pathways From Poverty to Child Mental Health in Burkina Faso: Longitudinal Mediation Analyses in a Cluster-Randomized Clinical Trial

J Adolesc Health. 2024 Dec 16:S1054-139X(24)00548-2. doi: 10.1016/j.jadohealth.2024.10.030. Online ahead of print.

Authors

Leyla Karimli¹, Leyla Ismayilova², Christine R Wells³

Affiliations

¹ Social Welfare Department, Luskin School of Public Affairs, University of California, Los Angeles (UCLA), Los Angeles, California. Electronic address: leylakarimli@luskin.ucla.edu.
² Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, Illinois.
³ Statistical Consulting Group, University of California, Los Angeles (UCLA), Los Angeles, California.

PMID: 39692681
DOI: 10.1016/j.jadohealth.2024.10.030

Abstract

Purpose: The study applies the Family Stress Model to examine the impact of an integrated intervention on the mental health of children facing chronic adversity in Burkina Faso. Its primary goal is to enhance understanding of individual and relational factors at the family level as mediators and specific mechanisms through which poverty reduction can impact child well-being.

Methods: Cross-lagged autoregressive longitudinal mediation analyses tested the intervention effect on child mental health, examining maternal depression, maternal anxiety, harsh parenting, and child exposure to abuse as potential mediators. Longitudinal data were collected over the course of 24 months in a cluster-randomized controlled trial conducted among 360 dyads (children aged 10-15 and their female caregivers) in Burkina Faso. Participants were randomized into a control arm, economic intervention using the Graduation approach (Treatment Arm 1), or a combination of economic strengthening and family coaching (Treatment Arm 2).

Results: In Treatment Arm 1, maternal depression fully mediated the intervention effect on child's depression (B = -0.09, 95% confidence interval [CI] from -0.26 to -0.003) and child's self-esteem (B = 0.05, 95% CI from 0.001-0.18). In Treatment Arm 2, violent parenting practices partially mediated the intervention effect on child's depression (B = -0.08, 95% CI from -0.29 to -0.01).

Discussion: Our study underscores the importance of multifaceted interventions merging economic empowerment with family-focused child protection strategies. This approach fosters a supportive family environment, reducing children's vulnerability to mental health issues in resource-poor communities. It enriches our understanding of how parental economic and behavioral interventions impact child mental health outcomes.

Keywords: Child and adolescent mental health; Cluster-randomized controlled trial; Cross-lagged longitudinal mediation model; Family Stress Model; Maternal mental health; Pathways from poverty to child mental health; Poverty-reduction interventions; Structural equation model (SEM); West Africa.