Collaborative Stepped Care and Peer Support Programme for Older People At-Risk of or With Depression

NCT ID: NCT03593889

Last Updated: 2024-07-29

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 3702 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-10-01
• Study Completion Date: 2022-04-30

Brief Summary

To develop a viable and sustainable best practice model to promote elderly mental wellness and prevent elderly depression for Hong Kong, the Hong Kong Jockey Club Charities Trust has initiated a pilot holistic support project entitled "JC JoyAge: Holistic Support Project for Elderly Mental Wellness". Commenced in October 2016, this 3-year project will deliver six programmes: (1) social services staff training; (2) peer supporters certificate training; (3) outreach and engagement activities for at-risk older adults; (4) standardized prevention and early intervention service; (5) community education programmes; and (6) public awareness and public education activities in four pilot districts in Hong Kong, namely Kwun Tong, Sham Shui Po, Kwai Chung, and Tseung Kwan O. The project aims specifically to:

1. Evaluate the effectiveness of a collaborative stepped care and peer support programme in engaging older people at-risk of or with depression;

2. Evaluate the efficacy of the programme in reducing symptoms/risks and promoting wellbeing in older people at-risk of or with depression;

3. Investigate the impact of the programme on care resources utilization in these older adults.

Detailed Description

Elderly depression is a neglected problem affecting our entire society with grave consequences and high societal costs. Early intervention and prevention can be effective in addressing the problem. The challenges in implementing early intervention and prevention within the existing service platforms, however, are threefold: (1) fragmented services; (2) reactive services; and (3) stigma and low awareness. These challenges resulted in the current service overload and mismatch, which will be compounded by rapid population ageing and mental health workforce shrinkage. The study can address these challenges by (1) realigning existing mental health and elderly services; (2) productive ageing for outreach and engagement; and (3) building up capacity of a preventive network in the neighbourhood. This pilot project therefore combines models of collaborative stepped care and productive ageing, with systematic education programmes, to empower the neighbourhood in providing effective early intervention and prevention for elderly depression. In the four representative pilot districts of Kwun Tong, Sham Shui Po, Kwai Chung, and Tseung Kwan O, community mental health and elderly services will collaborate to deliver a stepped care service protocol for preventing and detecting elderly depression. In 3 years, this project will deliver six programmes: (1) social services staff training; (2) peer supporters certificate training; (3) outreach and engagement activities for at-risk older adults; (4) standardized prevention and early intervention service; (5) community education programmes; and (6) public awareness and public education activities. This will produce a mature service model tested in one-fifth of the districts in Hong Kong with different demographic and service characteristics; create a strong team of Peer Supporters and Social Workers in Elderly Mental Health with clinical competence in preventing elderly depression and promoting elderly mental wellness; significantly raise public and neighbourhood awareness and care for elderly mental wellness; reach out and serve 2,880 at-risk older adults and 960 depressed older adults; and provide evidence on the social impact of the model for further service rollout.

Conditions

Depressive Symptoms

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Intervention group

The intervention group will receive a collaborative stepped care programme provided by registered social workers and trained peer supporters from elderly or mental health service units (NGOs) according to level of risks, symptom severity, and intervention response. Home visits or other format of contact will be delivered by trained peer supporters employed by NGOs to detect and engage hidden cases.

Group Type: EXPERIMENTAL

Collaborative stepped care and peer support programme

Intervention Type: BEHAVIORAL

For "at-risk" group, 4 weeks of "selective prevention" group sessions will be provided at the elderly service level by trained peer supporters with registered social worker supervision, on wellness topics tailored to the person's concern as entry point, packaged with mental health information, followed by a review.

For mild group, 6-8 weeks of indicated prevention with psychoeducation or low-intensity psychotherapy would be provided. For moderate group, 6-8 weeks high-intensity cognitive behavioral therapy (CBT) would be provided. All intervention for depressed elderly would be conducted by registered social workers. The trained peer supporters will be matched to individual older adults to walk them through the process with regular follow-up for 1 year.

Control group

The control group will receive treatment as usual, which will be determined by the responsible worker from NGO units.

Group Type: OTHER

Treatment as usual

Intervention Type: OTHER

The control group will receive treatment as usual, which will be determined by the responsible workers from NGO units.

Interventions

Collaborative stepped care and peer support programme

For "at-risk" group, 4 weeks of "selective prevention" group sessions will be provided at the elderly service level by trained peer supporters with registered social worker supervision, on wellness topics tailored to the person's concern as entry point, packaged with mental health information, followed by a review.

For mild group, 6-8 weeks of indicated prevention with psychoeducation or low-intensity psychotherapy would be provided. For moderate group, 6-8 weeks high-intensity cognitive behavioral therapy (CBT) would be provided. All intervention for depressed elderly would be conducted by registered social workers. The trained peer supporters will be matched to individual older adults to walk them through the process with regular follow-up for 1 year.

Intervention Type: BEHAVIORAL

Treatment as usual

The control group will receive treatment as usual, which will be determined by the responsible workers from NGO units.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• residing in Kwun Tong, Kwai Chung, Tseung Kwan O, or Sham Shui Po; and
• have one or more known risk factor(s) for developing depression; and/or
• have depressive symptoms of mild level or above; and
• able to give informed consent to participate

Exclusion Criteria

• known history of autism, intellectual disability, schizophrenia-spectrum disorder, bipolar disorder, Parkinson's disease, or dementia; and
• imminent suicidal risk; and
• difficulty in communication

• Minimum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

The Hong Kong Jockey Club Charities Trust

OTHER

Sponsor Role: collaborator

Caritas Medical Centre, Hong Kong

OTHER

Sponsor Role: collaborator

Christian Family Service Centre

OTHER

Sponsor Role: collaborator

Haven of Hope Hospital

OTHER

Sponsor Role: collaborator

Hong Kong Sheng Kung Hui Lady MacLehose Centre

UNKNOWN

Sponsor Role: collaborator

The Mental Health Association of Hong Kong

OTHER

Sponsor Role: collaborator

New Life Psychiatric Rehabilitation Association

OTHER

Sponsor Role: collaborator

The University of Hong Kong

OTHER

Sponsor Role: lead

Responsible Party

Professor Terry Y.S. Lum

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Terry Lum, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Social Work and Social Administration, The University of Hong Kong

Gloria Wong, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Social Work and Social Administration, The University of Hong Kong

Locations

Hong Kong Sheng Kung Hui Lady MacLehose Centre

Kwai Chung, , Hong Kong

New Life Psychiatric Rehabilitation Association

Kwai Chung, , Hong Kong

Christian Family Service Centre

Kwun Tong, , Hong Kong

The Mental Health Association of Hong Kong

Kwun Tong, , Hong Kong

Caritas Hong Kong

Sham Shui Po, , Hong Kong

New Life Psychiatric Rehabilitation Association

Sham Shui Po, , Hong Kong

Christian Family Service Centre

Tseung Kwan O, , Hong Kong

Haven of Hope Christian Service

Tseung Kwan O, , Hong Kong

Countries

Hong Kong

References

Wong SMY, Leung DKY, Liu T, Ng ZLY, Wong GHY, Chan WC, Lum TYS. Comorbid anxiety, loneliness, and chronic pain as predictors of intervention outcomes for subclinical depressive symptoms in older adults: evidence from a large community-based study in Hong Kong. BMC Psychiatry. 2024 Nov 21;24(1):839. doi: 10.1186/s12888-024-06281-2.

Reference Type: DERIVED

PMID: 39574082 (View on PubMed)

Liu T, Peng MM, Wong FHC, Leung DKY, Zhang W, Wong GHY, Lum TYS. Differential Associations Between Depressive Symptom-Domains With Anxiety, Loneliness, and Cognition in a Sample of Community Older Chinese Adults: A Multiple Indicators Multiple Causes Approach. Innov Aging. 2023 Jul 19;7(7):igad075. doi: 10.1093/geroni/igad075. eCollection 2023.

Reference Type: DERIVED

PMID: 37727600 (View on PubMed)

Liu T, Leung DKY, Lu S, Kwok WW, Sze LCY, Tse SSK, Ng SM, Wong PWC, Lou VWQ, Tang JYM, Wong DFK, Chan WC, Kwok RYK, Lum TYS, Wong GHY. Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial. Trials. 2022 Apr 11;23(1):280. doi: 10.1186/s13063-022-06122-1.

Reference Type: DERIVED

PMID: 35410292 (View on PubMed)

Liu T, Lu S, Leung DKY, Sze LCY, Kwok WW, Tang JYM, Luo H, Lum TYS, Wong GHY. Adapting the UCLA 3-item loneliness scale for community-based depressive symptoms screening interview among older Chinese: a cross-sectional study. BMJ Open. 2020 Dec 10;10(12):e041921. doi: 10.1136/bmjopen-2020-041921.

Reference Type: DERIVED

PMID: 33303463 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

EA1709021

Identifier Type: -

Identifier Source: org_study_id