A Study of Fragility, Entrepreneurship and Mental Health : Investing in Better Cognitive and Behavioral Skills for Small Medium Enterprise Entrepreneurs to Thrive in Conflict-Affected Areas of Pakistan
Mental health, well-being and lasting economic outcomes are intimately connected. However, in geographies marked by fragility, conflict and violence (FCV), entrepreneurs of small and medium size enterprises (SMEs) experience chronic stress and poor...
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| Format: | Report |
| Language: | English |
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World Bank, Washington, DC
2019
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| Online Access: | http://documents.worldbank.org/curated/en/162191558413194578/A-Study-of-Fragility-Entrepreneurship-and-Mental-Health-Investing-in-Better-Cognitive-and-Behavioral-Skills-for-Small-Medium-Enterprise-Entrepreneurs-to-Thrive-in-Conflict-Affected-Areas-of-Pakistan http://hdl.handle.net/10986/32145 |
| Summary: | Mental health, well-being and lasting
economic outcomes are intimately connected. However, in
geographies marked by fragility, conflict and violence
(FCV), entrepreneurs of small and medium size enterprises
(SMEs) experience chronic stress and poor mental health on a
regular basis. These issues can hamper performance and
quality of life for the entrepreneurs, and can dampen the
benefits of existing financial and business assistance
programs. Few proven rigorous interventions are known. This
study tests the hypothesis that a five-week group Cognitive
Behavioral Therapy (CBT) training called Problem Management
Plus for Entrepreneurs (PM+E) in combination with financial
assistance could be more effective at reducing psychological
stressors of SME entrepreneurs in FCV contexts than
financial assistance alone. Meaningful and statistically
significant improvements in mental health were achieved,
with improvements persisting and increasing beyond the
immediate post-intervention period. Three months after the
intervention, based on analysis of pooled data across two
follow-up rounds (at five weeks and three months post
intervention), entrepreneurs in the treatment group
experienced statistically significant reduction in the
intensity and prevalence of depression and anxiety symptoms
(measured by the Patient Health Questionnaire Anxiety and
Depression Scale) and higher levels of well-being (measured
by the WHO-5 Well-Being Index) compared with the control
group. The effect was marked for those experiencing
mild/moderate levels of depression and anxiety, indicating
the clinical value of such low-touch early interventions.
Overall, the study demonstrates that empirical research
through Randomized Control Trials (RCTs) can be conducted in
challenging, FCV settings through appropriate rapid training
of local researchers and non-specialist providers (NSPs) at
a low cost yielding scalable programmatic and policy level lessons. |
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