title: Small individual loans and mental health: a randomized controlled trial among South African adults.
abstract: BACKGROUND
  In the developing world, access to small, individual loans has been variously hailed as a poverty-alleviation tool - in the context of "microcredit" - but has also been criticized as "usury" and harmful to vulnerable borrowers. Prior studies have assessed effects of access to credit on traditional economic outcomes for poor borrowers, but effects on mental health have been largely ignored.
  
  
  METHODS
  Applicants who had previously been rejected (n = 257) for a loan (200% annual percentage rate - APR) from a lender in South Africa were randomly assigned to a "second-look" that encouraged loan officers to approve their applications. This randomized encouragement resulted in 53% of applicants receiving a loan they otherwise would not have received. All subjects were assessed 6-12 months later with questions about demographics, socio-economic status, and two indicators of mental health: the Center for Epidemiologic Studies - Depression Scale (CES-D) and Cohen's Perceived Stress scale. Intent-to-treat analyses were calculated using multinomial probit regressions.
  
  
  RESULTS
  Randomization into receiving a "second look" for access to credit increased perceived stress in the combined sample of women and men; the findings were stronger among men. Credit access was associated with reduced depressive symptoms in men, but not women.
  
  
  CONCLUSIONS
  Our findings suggest that a mechanism used to reduce the economic stress of extremely poor individuals can have mixed effects on their experiences of psychological stress and depressive symptomatology. Our data support the notion that mental health should be included as a measure of success (or failure) when examining potential tools for poverty alleviation. Further longitudinal research is needed in South Africa and other settings to understand how borrowing at high interest rates affects gender roles and daily life activities. CCT: ISRCTN 10734925.
authors.affiliation: School of Public Health, University of California, Berkeley, USA. fernald@berkeley.edu
authors.forename: Lia C H
authors.initials: LC
authors.lastname: Fernald
authors.forename: Rita
authors.initials: R
authors.lastname: Hamad
authors.forename: Dean
authors.initials: D
authors.lastname: Karlan
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Ozer
authors.forename: Jonathan
authors.initials: J
authors.lastname: Zinman
mesh_terms: D000328:Adult; D003863:Depression / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D003906:Developing Countries / Q000191:economics; D005260:Female; D005381:Financing, Organized / Q000379:methods*; D005382:Financing, Personal / Q000379:methods*; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D011203:Poverty / Q000191:economics / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012737:Sex Factors; D013019:South Africa / Q000453:epidemiology; D013315:Stress, Psychological / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control