229654 Does Alleviating Poverty Affect Mothers' Depression?: A Quasi-Experimental Investigation of Mexico's Oportunidades Program

Tuesday, November 9, 2010

Emily J. Ozer, PhD , University of California, Berkeley, Berkeley, CA
Lia C. Fernald, PhD, MBA , School of Public Health, University of California Berkeley, Berkeley, CA
Ann Weber, MS, MPH , School of Public Health, University of California Berkeley, Berkeley, CA
Emily Flynn, MA , School of Public Health (Berkeley) & School of Medicine (San Francisco), University of California Berkeley & University of California San Francisco, Berkeley, CA
Background: Depression is a major cause of disability worldwide, particularly among women, and is often caused by poverty. Beyond its direct effects, maternal depression can harm children's health and development. This study aimed to assess the effect of a large-scale anti-poverty program in Mexico (Oportunidades, formerly Progresa) on maternal depressive symptoms.

Methods: In 2003, 5,050 women living in rural communities that had participated in Oportunidades since its inception were assessed and compared to a group of 1,293 women from matched communities, whose families had received no exposure to Oportunidades at the time of assessment but who later enrolled. Self-reported depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Ordinary least squares regressions were used to evaluate the treatment effect of program participation on depression while adjusting for covariates and clustering at the community level.

Results: Women in the treatment group had lower depressive symptoms than those in the comparison group (CES-D scores: 16.99.8 versus 18.610.2). In multi-variate analyses, program participation was significantly associated with lower depression while controlling for maternal age, education, and household demographic, ethnicity, and socio-economic variables.

Conclusion: Although Oportunidades did not target maternal mental health directly, we found modest but potentially clinically meaningful effects on depression. Our rigorous quasi-experimental design permits stronger causal inference than observational studies that have linked poverty and depressive symptoms. There are several implications of these findings in the context of other economic and clinically-based approaches that aim to improve mental health among women living in poverty.

Learning Areas:
Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Social and behavioral sciences

Learning Objectives:
1. Describe social and economic factors that may mediate the relationship between poverty and maternal mental health in a Mexican sample. 2. Compare the impact of an economic intervention on depressive symptoms in a Mexican sample with the impact of clinically-based approaches to depression.

Keywords: Maternal Well-Being, Poverty

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I work as a graduate student researcher on maternal health, child development, and poverty with the other authors on this paper. I am also conducting a related analysis of the same data analyzed in this paper, using similar statistical methods.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.