Improving mental health among ultra-poor children: Two-year outcomes of a cluster-randomized trial in Burkina Faso.

Rationale: There is limited evidence about interventions improving child mental health in francophone West Africa. Behavioral mental health interventions alone may have limited effects on children's emotional well-being in families living in abject poverty, especially in low-income countries.

Objective: This study tests the effects of economic intervention, alone and in combination with a family-focused component, on the mental health of children from ultra-poor households in rural Burkina Faso.

Methods: The three-arm cluster randomized trial included children in the age range of 10-15 years old (N = 360), from twelve villages in Nord region of Burkina Faso (ClinicalTrial.gov ID: NCT02415933). Villages were randomized (4 villages/120 households per arm) to the waitlist arm, the economic intervention utilizing the Graduation approach (Trickle Up/TU arm), or to the economic strengthening plus family coaching component (TU + arm). Intervention effects were tested using repeated-measures mixed-effects regressions that account for the clustered nature of the data.

Results: Children from the TU + arm showed a reduction in depressive symptoms at 12 months (medium effect size Cohen's d = -0.41, p = .001) and 24 months (d = -0.39, p = .025), compared to the control condition and the economic intervention alone (at 12 months d = -0.22, p = .020). Small effect size improvements in self-esteem were detected in the TU + group, compared to the control arm at 12 months (d = 0.21) and to the TU arm at 24 months (d = 0.21). Trauma symptoms significantly reduced in the TU + group at 12 months (Incidence Risk Ratio/IRR = 0.62, 95% CI = 0.41, 0.92, p = .042), compared to the control group.

Conclusion: Integrating psychosocial intervention involving all family members with economic empowerment strategies may be an innovative approach for improving emotional well-being among children living in extreme poverty.