# **7.4 Impacts on Adolescent Mental Health and Hope**

The _Choices_ training curriculum tried to teach children the importance of having hope and encouraging hope in others, and make children understand how self-esteem affects the pursuit of hopes and dreams.

Table 7 presents treatment impacts on measures of mental health and hope. Table 7 columns 1 to 3 uses the Strengths and Difficulties Questionnaire (SDQ) which is a behavioral screening questionnaire validated for adolescents that consists of 25 statements: 10 attributes as strengths, 14 as difficulties, and 1 neutral that was developed by Goodman (1997). The statements are used to construct a total number of difficulties index measure that can be decomposed into 4 sub-scales: emotional problems, conduct problems, hyperactivity/inattention, and peer relationship problems.<sup>71</sup> Additionally in Table 7 columns 4 to 6 the outcome is a sub-scale from the SDQ that captures pro-social behavior which are behaviors that are intended to help others. The _Choices_ treatment leads to a decrease in the emotional and behavioral problems faced by boys who report that they experience a 1.061 standard deviation decrease in the total difficulties index at midline, and a 1.338 standard deviation decrease at endline, relative to boys in the control group. The direction of the treatment effects are similar for girls; however, these effects are marginally insignificant (Column 3, sharpened q-value 0.12). A decomposition of the total index shows that _Choices_ treatment effect for boys is significant across all sub-scales at endline: boys face fewer emotional symptoms, conduct problems, problems with inattention, and problems with peers; while girls face fewer emotional symptoms.

In Table 7 the outcome in columns 7 to 9 is the Children’s Hope Scale (CHS) which is a six-item scale developed by Snyder et al. (1997) that measures a child’s perception that their goals can be met. The CHS total score is presented in Table 7 and the scale can be decomposed into Agency Thinking and Pathway Thinking sub-scales.<sup>72</sup> We find evidence of a positive treatment impact on the adolescent’s perception that their goals can be met in the short-run. However, impacts are not sustained in the longer-run.

In addition to the SDQ and CHS, at endline we also measured the generalized self-efficacy (GSE) index scale as developed by Schwarzer and Jerusalem (1995) (not shown in Table 7).<sup>73</sup> The average GSE index score (ranging from 1-4) at endline is 2.83 and we find no significant difference in the average GSE scores of adolescent boys and girls in the sample. We find no evidence of a treatment impact on the self-efficacy outcome.

It is noteworthy that the improvements in mental health outcomes as a result of the _Choices_ program are experienced by both boys and girls. This is consistent with increasing evidence that gender inequality is undesirable for everyone (Baird et al., 2019).

> 71The sub-scales are not shown in Table 7 but are available on request.

> 72Agency Thinking captures the child’s perception on their ability to take action towards a goal, and Pathway Thinking is the child’s perceived capacity to find a way towards that goal. Note the sub-scales are not shown in Table 7.

> 73Self-efficacy has been found to be negatively correlated with anxiety, stress and depression (Schwarzer and Jerusalem, 1995).

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