Cost-Effectiveness of an Economic Empowerment and Family Intervention on Mental Health Among School-Going Adolescent Girls in Uganda, 2017‒2022.

IF 9.6 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

American journal of public health Pub Date : 2025-06-26 DOI:10.2105/ajph.2025.308135

Fred M Ssewamala,Yesim Tozan,Rachel Brathwaite,Joshua Kiyingi,Phionah Namatovu,Ozge Sensoy Bahar,Proscovia Nabunya,Portia B Nartey,Torsten B Neilands

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Abstract

Objectives. To assess the cost-effectiveness of an economic empowerment and family intervention on mental health outcomes among school-going adolescent girls in Uganda from 2017 to 2022. Methods. We randomized adolescent girls aged 14 to 17 years into 3 arms: (1) health and sex education (usual care; n = 408), (2) youth development accounts (YDAs; n = 471), and (3) a combination intervention (YDA plus multiple family group [MFG]; n = 381). We fitted mixed-effects models and estimated intervention costs prospectively using the microcosting approach. Results. The combination intervention had a statistically significant impact on mental health outcomes (depressive symptoms, hopelessness, self-concept) at 12 and 24 months, except self-esteem at 24 months, relative to usual care, with incremental cost‒effectiveness ratios ranging from $51 to $100 per 0.2-SD change at 12 months, and $53 to $157 at 24 months per 0.2-SD change. Conclusions. The combination intervention positively and significantly impacted a higher number of mental health outcomes among school-going adolescent girls compared with YDA alone. The benefits were sustained in the short and long term, with the incremental cost-per-unit effect remaining comparable. Findings support the integration of combination interventions in school settings to promote adolescent girls' positive mental health functioning. Trial Registration. ClinicalTrials.gov registration no. NCT03307226. (Am J Public Health. Published online ahead of print June 26, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308135).

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2017-2022年乌干达学龄少女心理健康经济赋权和家庭干预的成本效益

目标。评估2017年至2022年乌干达学龄少女心理健康结果的经济赋权和家庭干预的成本效益。方法。我们将14 - 17岁的青春期女孩随机分为3组：(1)健康和性教育组(常规护理组；n = 408),(2)青年发展账户(YDAs；n = 471),(3)联合干预(YDA +多家族组[MFG]；n = 381)。我们拟合了混合效应模型，并使用微观成本法对干预成本进行了前瞻性估计。结果。与常规护理相比，联合干预在12个月和24个月时对心理健康结果（抑郁症状、绝望、自我概念）有统计学上显著的影响，24个月时的自尊除外，12个月时每0.2 sd变化增量成本-效果比为51至100美元，24个月时每0.2 sd变化增量成本-效果比为53至157美元。结论。与单独使用YDA相比，联合干预对学龄少女的心理健康结果产生了积极而显著的影响。这些效益在短期和长期都是持续的，单位成本的增量效应仍然具有可比性。研究结果支持在学校环境中整合综合干预措施，以促进青春期女孩的积极心理健康功能。试验注册。ClinicalTrials.gov注册号：NCT03307226。公共卫生。2025年6月26日在线出版：e1-e9。https://doi.org/10.2105/AJPH.2025.308135)。

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来源期刊

American journal of public health 医学-公共卫生、环境卫生与职业卫生

CiteScore

9.50

自引率

3.90%

发文量

1109

审稿时长

2-4 weeks

期刊介绍： The American Journal of Public Health (AJPH) is dedicated to publishing original work in research, research methods, and program evaluation within the field of public health. The journal's mission is to advance public health research, policy, practice, and education.