Discussion
depression, Depression
SAID
Our study seeks to expand the existing body of knowledge on the relationship between poverty, family dynamics, and mental health of adolescent girls in sub-Saharan Africa. This is one of the few robust evaluations in sub-Saharan Africa examining the impact of an integrated poverty reduction intervention that combines asset accumulation with a separate family strengthening component. Furthermore, our study is one of rare cases examining the impact of an integrated poverty reduction intervention on adolescent mental health while differentiating by family functioning. This differentiation is an important layer in understanding the intersection between poverty, family functioning, and mental health of adolescent girls in families affected by poverty and HIV/AIDS in sub-Saharan Africa.Research investigating the impact of asset accumulation programs on family functioning is limited, and contrary to few other studies reporting significant effect of asset accumulation interventions on reduced parental stress and improved family communication [This being said, we found significant improvement in family cohesion and quality of child-caregiver relationship among participants who received asset accumulation intervention combined with the MFG component. These findings are consistent with the scarce evidence from other integrated interventions suggesting that poverty reduction module combined with a separate family strengthening component may significantly improve parenting practices in poor households [Our findings demonstrate a significant positive association between family functioning—such as family cohesion, frequency and comfort of family communication and child-caregiver relationship—and mental health of adolescent girls in our sample. Moreover, we found that family functioning moderated the effect of the intervention on the Beck Hopelessness Scale and Depression. Specifically, results of our moderation analyses strongly suggest that the intervention was most effective in reducing score on Beck Hopelessness Scale for girls who came from families with lower levels of family functioning at the start of the intervention. Additionally, our findings suggest that combining the asset accumulation opportunity with the MFG component had a stronger effect on reducing adolescent depression than providing the asset accumulation opportunity alone. These findings are in line with the Family Stress Model [Our findings add to the scarce body of knowledge emphasizing the importance of interventions that combine asset accumulation and poverty reduction opportunities with a separate family strengthening component to help families build resilience and address the emotional and psychological stressors caused by poverty. These interventions provide families with economic opportunities—thus potentially reducing the effect of economic stressors on family functioning and adolescent mental health—as well as supportive space and skills to strengthen family relations and enhance family resilience.