The current application is a revision of proposal 1 R01 MH067981-01 initially reviewed in October 2002. Mental health problems are a significant public health concern among children and adolescents. We will evaluate relationships among zinc, mental health, and school performance in school-age children through a collaborative effort between the Department of International Health of Emory University and the Instituto Nacional de Salud Publica in Mexico. The central hypothesis is that zinc supplementation will improve the mental health and school performance of children in a population at risk for zinc deficiency and with significant mental health problems. This hypothesis will be tested by conducting a randomized double-blinded, placebo-controlled trial in central Mexico. ? ? Children, ages 7 to 11 (n=744), will be recruited to participate in a baseline assessment, six months of daily supplementation with 10 mg zinc or placebo, and a post-supplementation assessment. Information will be obtained from the children, primary caregivers, and teachers. The mental health outcomes include symptoms of depression and anxiety; other outcomes include school performance and problems of poor attention and low activity levels. Information will be obtained on biochemical indices of zinc status and anthropometry, and on potential confounders such as sociodemographics, illness/infection, anemia, micronutrient status (vitamin A, iron, folate), dietary intake, psychological status of the caregiver, and environmental stressors. Data analysis will include group comparisons (intent-to-treat) after ensuring effectiveness of randomization, along with analyses controlling for effects of potential confounders, and exploration of baseline relationships and the effects of zinc in light of potential mediating and moderating variables. The overall goal of the proposed research is to understand better how specific nutritional deficiencies and environmental stressors influence children's mental health and school performance, and to contribute preventive, complementary approaches to addressing the growing mental health needs of children worldwide. ? ?
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