Poverty-reduction interventions combined with psychological interventions: A systematic literature review – Nature

Executive Summary

This report presents a systematic review of interventions that integrate poverty-reduction and mental health components, analyzing their potential to create a virtuous cycle of development and well-being. This approach directly addresses the interconnected nature of the Sustainable Development Goals (SDGs), particularly SDG 1 (No Poverty) and SDG 3 (Good Health and Well-being). A synthesis of seventeen studies reveals that combined interventions are more consistently associated with improvements in mental health, psychological well-being, and socioeconomic outcomes when compared to inactive controls. The most common strategies involved psychosocial support from non-specialists and direct economic aid through cash or asset transfers. While combined approaches showed benefits over psychological-only interventions, their marginal benefit over poverty-reduction interventions alone was less consistent, indicating that contextual and implementation factors are critical for success. These findings underscore the potential of integrated strategies to address both social and psychological determinants of health, offering a pathway to accelerate progress on the 2030 Agenda for Sustainable Development.

Introduction: Addressing Interlinked SDGs through Integrated Interventions

The global challenges of poverty and poor mental health are significant barriers to achieving the Sustainable Development Goals. These issues are causally and bidirectionally linked, creating a cycle of disadvantage that undermines progress on SDG 1 (No Poverty), SDG 3 (Good Health and Well-being), and SDG 10 (Reduced Inequalities). Mental disorders are a leading cause of disability worldwide, while poverty exacerbates the risk of mental illness and limits access to care. Standalone interventions often fall short; mental health treatments may not address underlying economic stressors, and poverty-reduction programs may not resolve psychological barriers to economic mobility. This review examines integrated approaches that tackle both dimensions simultaneously, recognizing that holistic strategies are essential for sustainable human development.

Objectives of the Review

1. To identify the types of poverty-reduction and psychological interventions used in combination and their delivery mechanisms.
2. To determine the target populations and settings for these integrated interventions.
3. To investigate the feasibility and implementation challenges of combining interventions.
4. To analyze the mediators and moderators influencing intervention outcomes.
5. To assess the impact of these combined interventions on outcomes related to mental health (SDG 3) and socioeconomic status (SDG 1, SDG 8).

Analysis of Integrated Interventions and SDG Alignment

The systematic review included 17 studies evaluating interventions that combine psychological and poverty-reduction components. These studies span diverse populations and contexts, from low- and middle-income countries (LMICs) to high-income settings, reflecting a global effort to address these intertwined challenges.

Profile of Target Populations

• Age Groups: The majority of studies (59%) focused on adults, with a significant portion (29%) targeting adolescents and young adults.
• Gender Focus: While most studies included all genders, 42% specifically targeted females, aligning with SDG 5 (Gender Equality) by addressing the unique vulnerabilities faced by women and girls.
• Targeting Criteria: Interventions targeted populations based on economic and mental health vulnerability. This included beneficiaries of government assistance programs, low-income individuals, and those with specific mental health conditions like depression. This dual focus is critical for reaching those furthest behind, a core principle of SDG 10 (Reduced Inequalities).

Types of Interventions Deployed

• Psychological Components (SDG 3): The most common approach was psychosocial intervention delivered by non-specialist professionals (47%), a key strategy for scaling up mental health support in resource-limited settings. Cognitive Behavioral Therapy (CBT) was the most frequently cited psychological framework (35%).
• Poverty-Reduction Components (SDG 1): The primary strategies were direct economic support through cash or asset transfers (53%), followed by case management for housing or employment (24%), and financial advice or savings groups (18%). These interventions directly contribute to poverty alleviation and economic stability.

Implementation Context and Challenges

Few studies formally investigated implementation challenges, though several noted barriers that hindered progress toward development goals. These challenges highlight the need for context-specific design and robust partnerships, as emphasized in SDG 17 (Partnerships for the Goals).

• Structural Barriers: Interventions in LMICs faced difficulties addressing broader structural drivers like limited infrastructure, post-conflict conditions, and lack of access to social services.
• Delivery Modality: A phone-based CBT intervention in India showed limited mental health improvements, suggesting that the modality may not have been suitable for building rapport with older adults, a key implementation consideration.
• Participant Engagement: One study reported limited adherence despite culturally adapting the program, highlighting the complexities of engaging vulnerable populations.

Impact Assessment on SDG-Related Outcomes

Impact on Mental Health Problems (SDG 3)

The review found that integrated interventions demonstrated a positive impact on mental health, a core target of SDG 3.

• When compared to control groups, 50% of studies found improvements in at least one mental health outcome, particularly for adult depression, anxiety, and distress.
• When compared to psychological interventions alone, 40% of studies found that adding a poverty-reduction component led to significant reductions in mental health problems.
• However, no studies found a significant marginal benefit on mental health problems when adding a psychological component to a poverty-reduction intervention, suggesting that alleviating economic distress is a powerful mechanism for mental health improvement.

Impact on Positive Mental Health and Well-being (SDG 3)

Combined interventions were also associated with improvements in positive indicators of mental health, such as psychological well-being, self-esteem, and resilience.

• Compared to control groups, 57% of studies reported improvements in outcomes like subjective well-being and happiness.
• The findings suggest that combined interventions are more frequently associated with improvements in positive mental health than either component alone, contributing to the broader goal of promoting well-being for all.

Impact on Socioeconomic Outcomes (SDG 1, SDG 8)

The impact on socioeconomic outcomes, which are central to SDG 1 (No Poverty) and SDG 8 (Decent Work and Economic Growth), showed promising but varied results.

• Compared to control groups, 50% of studies found significant improvements in at least one socioeconomic outcome, such as food security, household assets, and consumption.
• The combined approach demonstrated more consistent positive impacts on socioeconomic outcomes than either single component alone, especially at long-term follow-up (over one year).
• This suggests that addressing psychological barriers alongside economic constraints can lead to more sustainable improvements in economic well-being and livelihoods.

Discussion: Implications for Achieving Sustainable Development Goals

Synthesizing Evidence for Integrated Approaches

This review provides clear evidence that combined psychological and poverty-reduction interventions can advance multiple SDGs simultaneously. The most consistent benefits were seen when comparing combined interventions to inactive controls, particularly for outcomes related to SDG 3 (depression, anxiety, psychological well-being). The findings support a multi-sectoral approach, as advocated by SDG 17, where health and social protection systems work in concert to address the root causes of vulnerability.

Addressing Inequalities and Vulnerable Populations (SDG 10, SDG 5)

The interventions reviewed often targeted vulnerable groups, including women, adolescents, and low-income families, thereby contributing to SDG 10 (Reduced Inequalities) and SDG 5 (Gender Equality). However, the effectiveness of interventions can be moderated by factors like gender. One study found that treatment combinations had beneficial impacts on mental health for women but not men, underscoring the need for gender-responsive program design. To effectively reduce inequalities, interventions must be tailored to the specific socio-political contexts and needs of the target populations.

Gaps in Research and the Path Forward

Future research must address several gaps to build a more robust evidence base for scaling these integrated models.

• More research is needed on children and adolescents, as early interventions can have a lasting impact on health and life chances.
• Socioeconomic outcomes were under-reported, particularly in studies led by health professionals. Greater interdisciplinary collaboration between economists and mental health experts is needed.
• Few studies used a four-arm design (control, psychological-only, poverty-only, combined), which is essential for disentangling the unique and synergistic effects of each component.

Conclusion: Advancing the 2030 Agenda through Multi-Sectoral Collaboration

This systematic review demonstrates that combining poverty-reduction and psychological interventions is a promising strategy for breaking the cycle of disadvantage and promoting sustainable development. By simultaneously targeting SDG 1 (No Poverty) and SDG 3 (Good Health and Well-being), these integrated approaches can generate synergistic benefits for individuals and communities. The evidence suggests that robust economic support is a critical driver of both socioeconomic and mental health improvements. To maximize impact, policymakers and practitioners must foster inter-sectoral collaboration, as envisioned in SDG 17, to design and implement contextually appropriate programs that address the complex, interrelated needs of people experiencing poverty and mental health problems. Such efforts are fundamental to reducing inequalities and ensuring that no one is left behind in the pursuit of the 2030 Agenda.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article addresses several Sustainable Development Goals (SDGs) by focusing on the interconnectedness of poverty, mental health, and socioeconomic well-being. The primary SDGs identified are:

• SDG 1: No Poverty: The article is fundamentally about poverty and interventions designed to alleviate it. It examines “poverty-reduction components” such as “cash or asset transfers” and targets populations described as “low-income or poor participants” and “beneficiaries of government assistance programmes.” This directly aligns with the goal of ending poverty in all its forms.
• SDG 3: Good Health and Well-being: This is a central theme, as the article systematically reviews the impact of interventions on mental health. It explicitly discusses “mental health problems,” “psychological wellbeing,” “depression,” “anxiety,” “suicide,” and “substance use.” The analysis of “psychosocial interventions” and other therapeutic approaches is directly related to promoting health and well-being.
• SDG 8: Decent Work and Economic Growth: The article evaluates the “impacts of combined interventions on socioeconomic outcomes,” including “employment,” “household/personal revenue,” and “economic performance.” It explores how integrated interventions can break the “vicious cycle of disadvantage” and potentially lead to “sustained economic mobility,” which is a core aspect of achieving decent work and economic growth.
• SDG 10: Reduced Inequalities: The article highlights how the cycle of poverty and poor mental health “contributes to persistent socioeconomic inequality.” By studying interventions that target vulnerable populations such as “orphans,” “low-income pregnant women,” and specific gender groups, the research addresses the need to empower and improve the conditions of marginalized groups, thereby contributing to the reduction of inequalities.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the interventions and outcomes discussed, the following specific SDG targets are relevant:

1. Under SDG 1 (No Poverty):
   • Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions. The article’s focus on interventions like cash transfers for “low-income or poor participants” aims to directly reduce economic hardship and improve living standards, contributing to this target.
   • Target 1.3: Implement nationally appropriate social protection systems and measures for all… and achieve substantial coverage of the poor and the vulnerable. The poverty-reduction strategies analyzed, such as “cash or asset transfer,” “government welfare/assistance benefits,” and “savings groups,” are all forms of social protection systems discussed in the article.
2. Under SDG 3 (Good Health and Well-being):
   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article’s core objective is to evaluate interventions that improve “mental health problems” (like depression and anxiety) and promote “psychological wellbeing,” directly aligning with this target. The mention of a study focusing on “suicide” further reinforces this connection.
   • Target 3.5: Strengthen the prevention and treatment of substance abuse. The article includes “substance use” as one of the outcome measures for the combined interventions, connecting the research to this specific target.
3. Under SDG 8 (Decent Work and Economic Growth):
   • Target 8.5: By 2030, achieve full and productive employment and decent work for all women and men. The article assesses the impact of interventions on socioeconomic outcomes like “employment,” “household/personal revenue,” and “economic performance,” which are central to achieving this target.
4. Under SDG 10 (Reduced Inequalities):
   • Target 10.2: By 2030, empower and promote the social and economic inclusion of all. The interventions studied in the article are designed for vulnerable and economically disadvantaged groups. By improving their mental health and socioeconomic status, these programs aim to foster greater inclusion and reduce the disparities they face.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions or implies several indicators that align with the official SDG indicator framework and can be used to measure progress:

• For SDG 1 (No Poverty): The article evaluates socioeconomic outcomes that serve as direct or proxy indicators for poverty reduction. These include:
  • Economic hardship: A direct measure of poverty.
  • Daily/monthly consumption: A common indicator for measuring poverty levels (related to Indicator 1.2.1).
  • Household assets and revenue: Measures of economic stability and wealth accumulation.
  • Food security: An indicator of extreme poverty and deprivation (related to SDG 2, but also a dimension of poverty under SDG 1).
• For SDG 3 (Good Health and Well-being): The article details numerous mental health outcomes that are used to measure well-being. These include:
  • Symptoms of depression, anxiety, and distress: These are key metrics for mental health status.
  • Suicidal ideation: Directly related to measuring progress on mental health and reducing mortality (related to Indicator 3.4.2).
  • Substance use outcomes: Used to measure the effectiveness of interventions targeting substance abuse (related to Indicator 3.5.1).
  • Psychological wellbeing: Measured through concepts like “self-esteem,” “self-efficacy,” “resilience,” and “happiness,” which are positive indicators of mental health.
• For SDG 8 (Decent Work and Economic Growth): The article assesses progress through socioeconomic indicators related to employment:
  • Employment status / Probability of work: A direct measure of participation in the labor market.
  • Household/personal revenue: An indicator of the economic returns from work.
• For SDG 10 (Reduced Inequalities): Progress is implicitly measured by comparing outcomes across different demographic groups.
  • Gender-disaggregated data: The article notes that one study found beneficial impacts “in women but not men,” indicating an analysis of how interventions affect genders differently.
  • Focus on vulnerable populations: By measuring improvements in mental health and economic status for groups like “orphans” or “low-income” individuals, the studies provide data on reducing the gap between these groups and the general population.

4. Summary Table of SDGs, Targets, and Indicators

Source: nature.com