Improving adoption of mental health interventions among low-income university students in Brazil

Mental health conditions are the leading cause of disability among youth worldwide. These problems are more common among youth living in poverty. Mental health problems can have short- and long-term impacts on physical and mental health, education, employment and relationships. University students living in poverty have high rates of mental health problems and limited support. These students face strong pressures to perform and succeed and to support their families. These pressures also emerge during a life stage where there is greater potential to engage in risky behaviour, and increased pressure for academic achievement - which can further increase risk of mental health problems. Effective support for vulnerable students could improve their mental health and future life chances. Most youth, however, receive no care or support. In Brazil, around 80% of youth with mental health conditions receive no care and fewer receive evidence-based treatment. Although there is a great deal of evidence for effectiveness of psychotherapy (such as cognitive behavioural therapy [CBT]) for preventing and treating youth mental health problems, lack of services and trained providers significantly limits access. Moreover, barriers such as transportation, cost and stigma further limit access. These barriers are greater for poor vs. non-poor youth. Use of digital interventions could improve access to care. They are lower cost and could reduce stress on health systems and reach more users. They could also address stigma given they are more private. However, many digital interventions fail to engage users and sustain involvement. This limits their potential to improve the user's mental health. This research would test whether combining a digital mental health intervention with peer support and/or a conditional cash transfer (CCT) (i.e., monetary incentive conditional on intervention participation) could increase participation and engagement among low-income university students. Research suggests CCTs can increase healthy behaviours and promote engagement by enabling students to purchase books and food, thereby avoiding food insecurity, reducing financial stress to enable focus on intervention, and reduce shame. Other research shows peer support can reduce stigma and increase participation particularly among vulnerable populations. First, we would adapt and pilot a digital mental health intervention (e-CBT), shown to be effective among university students, in combination with CCT and/or peer support in collaboration with low-income university students. Following refinement, we would see whether combining the e-CBT with: (1) CCT; (2) peer support or (3) CCT+peer support improves participation and engagement. We would use innovative methods to explore longer-term social and economic impacts of the intervention in combination with CCT and peer support.