Mental Health, Teacher Stress and Student Achievement: Experimental Evidence from Pakistan

Last registered on October 17, 2022
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Pre-Trial

Trial Information

General Information

Title
Mental Health, Teacher Stress and Student Achievement: Experimental Evidence from Pakistan
RCT ID
AEARCTR-0009121
Initial registration date
March 31, 2022

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
March 31, 2022, 3:30 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
October 17, 2022, 10:47 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
Pakistan
Region
South Asia

Primary Investigator

Name
Sultan Mehmood
Affiliation
New Economic School Moscow
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Shaheen Naseer
PI Affiliation
LSE
PI Name
Daniel Chen
PI Affiliation
TSE

Additional Trial Information

Status
Completed
Start date
2022-02-15
End date
2022-03-22
Keywords
Behavior, Education, Gender, Welfare
Additional Keywords
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Is teacher stress holding back student achievement? Does stress transmit from teacher to students? How does psychological and pharmacological aid to teachers influence their mental health and students? We hope to answer these questions, by conducting a field experiment with one of the largest charter school networks in the world, the PEN Education Network of Pakistan. Using detailed data on teachers’ self-reported stress, life satisfaction, teachers stress hormonal concentrations in blood plasma, we explore whether and under which conditions do teacher stress is alleviated and whether this impacts student achievement. We randomize teachers into 6 treatment arms. The teachers are further cross-randomized into social signaling treatment using color-coded bracelets that aims to reduce stigma associated with mental health. In the first treatment group, we assign teachers in 4 weekly sessions with a psychologist practicing cognitive behavioral therapy. The second, third and fourth group is assigned a session with the psychiatrist with possibility to prescribe medicines where we subsidize the prescription medicines to varying degrees (0% vs 50% vs 100% subsidies of prescriptions). Finally, we randomly assign the teachers into 4 weekly sessions of mindfulness meditation of same length of time as the psychologist treatment.
External Link(s)

Registration Citation

Citation
Mehmood, Sultan, Daniel Chen and Shaheen Naseer. 2022. "Mental Health, Teacher Stress and Student Achievement: Experimental Evidence from Pakistan." AEA RCT Registry. October 17. https://doi.org/10.1257/rct.9121-1.4
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
T1) Psychology Treatment: 4-week of weekly sessions with a psychologist administrating cognitive behavioral therapy (4 individual sessions).
T2) Psychiatrist with no subsidy of prescription medicines: 1 session with a psychiatrist who has an option to prescribe medicines (zero subsidy of medicine: 100% payment from teachers own pocket) - 1 individual session
T3) Psychiatrist with full subsidization of prescription medicines- 1 session with a psychiatrist prescribing medicines, with the prescribed medications provided for free (100% subsidization) - 1 individual session
T4) Psychiatrist with co-paying - 1 session with a psychiatrist prescribing medicines and providing those medications for 50% of total costs (co-paying) - 1 individual session
T5) 4 sessions each week mindfulness meditation for one month (equal to time spent for psychologist treatment). - 4 sessions.

T6) Placebo lectures (4 lectures) on macroeconomic facts, concepts and trends of equal length and frequency of meetings with psychologist and mindfulness meditation (4 sessions).

Each treatment arm, including the placebo, are further cross-randomized into social signaling treatment using color-coded bracelets that aimed to reduce stigma associated with mental health.
Intervention (Hidden)





Intervention Start Date
2022-02-16
Intervention End Date
2022-03-21

Primary Outcomes

Primary Outcomes (end points)
Exact pre-registered primary outcome variables:
1) cortisol concentration in plasma, measured in micrograms per deciliter, using the Chemiluminescence Immunoassay (CLIA) technique
2) Teacher self-reported stress
3) Mathematics, Urdu, English test scores of students
Primary Outcomes (explanation)
The primary outcomes measure teacher stress in a self reported survey but as well as more objective hormonal secretion in response to stress i.e. cortisol concentration. Specifically, the first set of outcome variables concern teacher stress measured on a 5-point Likert Scale, Cohen Perceived Stress Scale (PSS), cortisol concentration in blood plasma that we will standardize to mean zero and standard deviation one. The second set of outcomes concern hours of teaching, attendance of teachers, whether medication was prescribed by the psychiatrist and self-reported use of prescribed medicine by the teacher. The third set of outcomes concern student outcomes that include students’ self-reported stress, Cohen Perceived Stress Scale (PSS), test scores in mathematics and Urdu language and self-reported corporal punishment by the teacher. Marlowe–Crowne framework will be used to rigorously speak to social desirability and misreporting concerns.

Secondary Outcomes

Secondary Outcomes (end points)
Exact pre-registered for heterogeniety anlaysis: (1) wrist bands public signaling the teacher goes to see a psychiatrist and (2) treatment impact on those that have higher pre-treatment self-reported stigma see a psychiatrist.
Other outcomes that may be used for exploratory analysis but analyzed only if the data becomes available:
1) Teacher score on analytical creativity task
2) Student creative writing test scores
3) A measure of extent of mental health stigma perceived by the teacher, pre and post-treatment.
Secondary Outcomes (explanation)
As a secondary outcomes, want to also assess how stress impacts teacher and their students stress level and if we can get data on creative writing scores of students also assess the impact on creativity achievement scores.

Experimental Design

Experimental Design
Our sample consists of 850 teachers with about 140 teachers per treatment arm and 25000 students across Punjab and Sindh provinces of Pakistan. We randomly assign teachers into the following 6 groups:

T1) Psychology Treatment: 4-week of weekly sessions with a psychologist administrating cognitive behavioral therapy.
T2) Psychiatrist with no subsidy of prescription medicines: 1 session with a psychiatrist who has an option to prescribe medicines (zero subsidy of medicine: 100% payment from teachers own pocket)
T3) Psychiatrist with full subsidization of prescription medicines- 1 session with a psychiatrist prescribing medicines, with the prescribed medications provided for free (100% subsidization).
T4) Psychiatrist with co-paying - 1 session with a psychiatrist prescribing medicines and providing those medications for 50% of total costs (co-paying)
T5) 4 sessions each week mindfulness meditation for one month (equal to time spent for psychologist treatment).
T6) Placebo lectures (4 lectures) on macroeconomic facts, concepts and trends of equal length and frequency of meetings with psychologist and mindfulness meditation.
The teachers are further cross-randomized into social signaling treatment using bracelets with message that aims to reduce stigma associated with mental health.
Experimental Design Details
Randomization Method
Randomization by computer
Randomization Unit
Individual teacher
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
850 teachers
Sample size: planned number of observations
25000 students and 850 teachers.
Sample size (or number of clusters) by treatment arms
About 4000 students and 150 teachers per treatment arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Lahore School of Economics Ethical Review Board
IRB Approval Date
2021-06-22
IRB Approval Number
RERC-062021-03
IRB Name
New Economic School Review Board
IRB Approval Date
2022-03-31
IRB Approval Number
00059/22
Analysis Plan

Analysis Plan Documents

Pre-Analysis Plan for the Project Mental Health Interventions

MD5: bcc0694c34c1f178b6c59d8409af65eb

SHA1: 67c363c7475e0e071a04a5631dc990f877cd2ac2

Uploaded At: October 17, 2022

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials