Income Volatility and Mental Health, Full Experiment

NCT ID: NCT06988410

Last Updated: 2025-05-31

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 2267 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-04-17
• Study Completion Date: 2025-10-12

Brief Summary

Income instability is a defining aspect of the lives of the poor, who also disproportionately suffer from poor mental and physical health. This research is the first to assess the causal effects of predictable and unpredictable income instability on the psychological and physical health of the poor. It will advance the scientific knowledge on the effects of economic instability as well as understanding of health gaps across populations.

Detailed Description

The poor suffer disproportionally from poor mental and physical health. Many causes for these differences have been considered, including low income. But, poor families' incomes are not only low, but also often unstable and unpredictable. This instability creates uncertainty about whether individuals will be able to safeguard their future well-being. According to the allostatic load framework, prolonged activation of physiological stress responses will cause "wear and tear" on the body, heightening risks of cardiovascular disease and of age-related metabolic diseases, promoting cognitive decline and dementia, and accelerating cellular aging.

This research will study the causal effects of income instability on the psychological and physical health of the poor. The study's specific aims are to: 1) Identify the causal effect of income instability on psychological health (e.g. depression, anxiety), and physical health (e.g. blood pressure), 2) Decompose the effects identified in aim 1 into the effects of predictable and unpredictable instability and compare to the impact of increasing the average level of income, and 3) Investigate the channels through which effects on health occur, including both economic and behavioral channels and estimate the impact of key moderating factors (e.g. age, baseline mental health).

The trial will be conducted in northern Ghana. It will manipulate income instability by varying the number of work hours (and hence earnings) of participants in a cash-for-work program. Participants in the first treatment arm will have a fixed work schedule, with the same hours and earning each period. The hours and earnings of a second treatment arm will vary over time, but the fluctuations will be known in advance. Finally, the number of work hours and earnings of a third treatment arm will fluctuate unpredictably. Each of these arms will be compared to a control group that is surveyed, but not offered additional work. Importantly, the study will vary income instability while holding the average level of income constant in order to disentangle the impact of instability from the level-effect.

The study will create 1,867 new jobs that would not otherwise be available during the lean season when jobs are scarce. The intervention has been designed so that the job opportunity cannot make the participants worse off than they would otherwise have been in the absence of research.

Conditions

Depression; Anxiety; Blood Pressure

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: NONE

Study Groups

Control

The Control arm will not be hired by the cash-for-work program but will be surveyed.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Stable Income Arm

The Stable Income arm will work the same amount and earn the same amount every period.

Group Type: EXPERIMENTAL

Work opportunities

Intervention Type: BEHAVIORAL

Individuals in the treated arms of the study will be offered work opportunities (sewing bags) to earn cash. The timing of these opportunities and knowledge of the amount and timing varies by experimental arm.

Predictable Instability Arm

The hours and earnings of the Predictable Instability arm will vary over time. In three periods, the participant will work longer hours and will earn more. In the remaining three periods, she will work fewer hours and will earn less. However, on average, the work offered will be the same as in the stable arm. Crucially, she will be able to predict all swings in her study earnings in the future-i.e., she will know her hours and earnings in each future period.

Group Type: EXPERIMENTAL

Work opportunities

Intervention Type: BEHAVIORAL

Individuals in the treated arms of the study will be offered work opportunities (sewing bags) to earn cash. The timing of these opportunities and knowledge of the amount and timing varies by experimental arm.

Unpredictable Instability Arm

The hours and earnings of the Unpredictable Instability arm will vary unpredictably over time. In any given period, there will be a 50% chance that she works longer hours and earns more and a 50% chance that she works fewer hours and earns less. The expected average earnings remain the same as the stable arm and the predictable arm, though specific individuals may earn more or less.

Group Type: EXPERIMENTAL

Work opportunities

Intervention Type: BEHAVIORAL

Individuals in the treated arms of the study will be offered work opportunities (sewing bags) to earn cash. The timing of these opportunities and knowledge of the amount and timing varies by experimental arm.

Interventions

Work opportunities

Individuals in the treated arms of the study will be offered work opportunities (sewing bags) to earn cash. The timing of these opportunities and knowledge of the amount and timing varies by experimental arm.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Between ages of 18 - 60
• Female
• Lives in a household with 5 or fewer adults

Exclusion Criteria

• Pregnancy

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 60 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: Yes

Sponsors

National Institute on Aging (NIA)

NIH

Sponsor Role: collaborator

Innovations for Poverty Action

OTHER

Sponsor Role: collaborator

Cornell University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Innovations for Poverty Action

Tamale, , Ghana

Site Status: RECRUITING

Countries

Ghana

Central Contacts

Heather Schofield, PhD

Role: CONTACT

hws44@cornell.edu

6178630726

Leandro Carvalho, PhD

Role: CONTACT

lcarvalh@usc.edu

Facility Contacts

Salifu Amadu

Role: primary

samadu@poverty-action.org

0000000000

Provided Documents

Document Type: Informed Consent Form

View Document

Other Identifiers

R01AG076655

Identifier Type: NIH

Identifier Source: secondary_id

View Link

OSP169128

Identifier Type: -

Identifier Source: org_study_id