Collaborative Stepped-Care and Productive Ageing Program for Older People With Depressive Symptoms

NCT04863300 | Completed

• 1 other identifier: EA2003001
• Study Type: interventional
• Target: 5,239
• Locations: 1 country
• Sites: 43

Brief Summary

The Jockey Club Holistic Support Project for Elderly Mental Wellness (JC JoyAge) has developed and implemented a collaborative stepped care model for older persons at-risk of or with depression in four districts in Hong Kong since 2015 (Clinical Trials Identifier: NCT03593889). Results from JC JoyAge show that the collaborative stepped-care model is effective in improving older persons' mental wellness, and the specialised training and engagement of Peer Supporters are effective in building capacity in the community. The proposed impact extension programme lasts for four years (from 2020 to 2023), and the overall goal is to expand the JC JoyAge model to all 18 districts in Hong Kong, to provide integrated and evidence-based mental health services to older adults with subclinical depressive symptoms, with the hope of model adoption in regular service upon project completion.

Conditions

Depressive Symptoms

Keywords

Collaborative stepped care; Peer support; Productive ageing; Early case identification; Indicated prevention; Early treatment; Recovery oriented

Outcome Measures

Primary Outcomes (5)

• Change from Baseline Depression at 12 months

  Depression will be measured by the Patient Health Questionnaire (PHQ-9), a 9-item instrument that incorporates depression diagnostic criteria with other leading major depressive symptoms, and rates the frequency of the symptoms that factor into the scoring severity index. PHQ-9 total score ranges from 0 to 27, higher scores indicate higher levels of depression. Change scores of depression will be calculated by subtract the baseline PHQ-9 score from the follow-up PHQ-9 score, and negative results indicates reduction in depression.

  Baseline and 12-month follow-up

• Change from Baseline Anxiety at 12 months

  Anxiety will be measured by the Generalized Anxiety Disorder scale (GAD-7), a 7-item scale in which responses to each item are rated on a 4-point Likert scale ranging from 0 to 3. The total score will be used, ranging from 0 to 21. Higher scores indicate higher levels of anxiety symptoms. Change scores of anxiety will be calculated by subtract the baseline GAD-7 score from the follow-up GAD-7 score, and negative results indicates reduction in anxiety.

  Baseline and 12-month follow-up

• Change from Baseline Loneliness at 12 months

  Loneliness will be measured by the UCLA loneliness scale (UCLA-3), a 3-item self-report scale with each item evaluated with scores ranging from 0 (never) to 3 (often). The total score will be used, ranging from 0 to 9. Higher scores indicate greater loneliness. Change scores of loneliness will be calculated by subtract the baseline UCLA-3 score from the follow-up UCLA-3 score, and negative results indicates reduction in loneliness.

  Baseline and 12-month follow-up

• Change from Baseline Self-harm Risk at 12 months

  Self-harm risk will be assessed using eight items adapted from the Self-Harm Inventory, providing an overall assessment based on total score and clinical judgement. Social service staff assess participants' risk of self-harm (yes or no answers to 10 items) and harm to others (yes or no answers to 4 items). An overall evaluation of suicidal risk score ranges from 0 (No) to 3 (High). The overall evaluation score will be used. Change scores of self-harm risk will be calculated by subtract the baseline overall risk score from the follow-up risk score, and negative results indicates reduction in self-harm risk.

  Baseline and 12-month follow-up

• Change from Baseline Service Usage at 12 months

  Client Service Receipt Inventory (CSRI) will be used to collect the current types and level of social services which comprise the care package of each participant, and a locally adapted short version would be developed for this purpose. Participants report frequency of usage of different services in the past month when filling the questionnaire, higher frequency indicates more usage of that particular service.

  Baseline and 12-month follow-up

Secondary Outcomes (5)

• Change from Baseline Daily Activities at 12 months

  Baseline and 12-month follow-up

• Change from Baseline Cognition at 12 months

  Baseline and 12-month follow-up

• Change from Baseline Social Network at 12 months

  Baseline and 12-month follow-up

• Change from Baseline Health-related Quality of Life at 12 months

  Baseline and 12-month follow-up

• Change from Baseline Self-rated Health at 12 months

  Baseline and 12-month follow-up

Study Arms (1)

Intervention group

EXPERIMENTAL

Participants in the intervention group will receive a collaborative stepped care programme provided by registered social workers and trained Peer Supporters from aged care service units - the Districts Elderly Community Centres (DECC), and mental health service units - the Integrated Community Centre on Mental Wellness (ICCMW), all are local NGOs. In the collaborative stepped care model (see attachment Table 1), older persons are matched to the intervention module that most suits their current needs. The person does not have to start at the lowest level of intervention to progress to the next level of intervention. Rather, they enter the service with the intervention level aligned to their needs, e.g., level of risks, symptom severity (measured by the Patient Health Questionnaire, PHQ-9), and intervention response. Home visits or other format of contact will be delivered by trained Peer Supporters employed by the NGOs to detect and engage hidden cases.

Behavioral: Collaborative stepped care and peer support

Interventions

Collaborative stepped care and peer support BEHAVIORAL

Case identification will be done through open referral and outreach activities such as street booth, talks, and home visits. For older adults with mild depressive symptoms (PHQ-9 score 5-9), 6-8 weeks of indicated prevention with psychoeducation or low-intensity psychotherapy would be provided by the project social workers in DECC. For participants with moderate depressive symptoms (PHQ-9 score 10-14), 6-8 weeks high-intensity clinical intervention, mainly group cognitive behavioral therapy (CBT), would be provided by project social workers from DECC and ICCMW. For those with moderately severe depressive symptoms (PHQ-9 score 15-19), 8-10 weeks individual CBT or group CBT at higher frequency would be provided by the project social workers from ICCMW. In the progress review when a client is assessed to meet the discharge criteria, a 2-month exit plan involving a Peer Supporter follow-up is invoked.

Intervention group

Eligibility Criteria

• Age: 60 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• age 60 years or above; and
• have depressive symptoms of mild level or above; and
• able to give informed consent to participate

You may not qualify if:

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

Sponsors & Collaborators

• The University of Hong Kong: lead
• Aberdeen Kai-fong Welfare Association: collaborator
• Caritas Medical Centre, Hong Kong: collaborator
• Christian Family Service Centre: collaborator
• Haven of Hope Hospital: collaborator
• Hong Kong Christian Service: collaborator
• Hong Kong Sheng Kung Hui Lady MacLehose Centre: collaborator
• Hong Kong Sheng Kung Hui Welfare Council Limited: collaborator
• Hong Kong Young Women's Christian Association: collaborator
• New Life Psychiatric Rehabilitation Association: collaborator
• St. James' Settlement: collaborator
• The Hong Kong Society for the Aged: collaborator
• The Mental Health Association of Hong Kong: collaborator
• Neighbourhood Advice-Action Council: collaborator
• Tung Wah Group of Hospitals: collaborator

Study Sites (43)

Aberdeen Kaifong Welfare Association Services Centre

Hong Kong, Hong Kong

Location

Baptist Oi Kwan Social Service Integrated Community Centre for Mental Wellness (Kwai Tsing)

Hong Kong, Hong Kong

Location

Baptist Oi Kwan Social Service

Hong Kong, Hong Kong

Location

Caritas Cheng Shing Fung District Elderly Centre (Sham Shui Po)

Hong Kong, Hong Kong

Location

Caritas District Elderly Centre - Yuen Long(Tin Chak Centre)

Hong Kong, Hong Kong

Location

Caritas Wellness Link - North District

Hong Kong, Hong Kong

Location

Caritas Wellness Link Tsuen Wan

Hong Kong, Hong Kong

Location

Chan Tseng Hsi Kwai Chung District Elderly Community Centre

Hong Kong, Hong Kong

Location

Christian Family Service Centre (Kwun Tong)

Hong Kong, Hong Kong

Location

Christian Family Service Centre Wellness Zone - Integrated Community Centre for Mental Wellness

Hong Kong, Hong Kong

Location

Chuk Yuen Canon Martin District Elderly Community Centre_Wai Yuen House

Hong Kong, Hong Kong

Location

Ellen Li District Elderly Community Centre - Yung Shing Shopping Centre

Hong Kong, Hong Kong

Location

Fong Shu Chuen District Elderly Community Centre

Hong Kong, Hong Kong

Location

H.K.S.K.H. Lady MacLehose Centre Dr. Lam Chik Suen District Elderly Community Centre

Hong Kong, Hong Kong

Location

H.K.S.K.H. Lok Man Alice Kwok Integrated Service Centre

Hong Kong, Hong Kong

Location

H.K.S.K.H. Western District Elderly Community Centre - Integrated Home Care Services Team

Hong Kong, Hong Kong

Location

Haven of Hope Christian Service

Hong Kong, Hong Kong

Location

Hong Kong Christian Service Bliss District Elderly Community Centre

Hong Kong, Hong Kong

Location

Jockey Club Wong Chi Keung District Elderly Community Centre - Aberdeen

Hong Kong, Hong Kong

Location

Neighbourhood Advice-action Council (Shan King) Community Nursing Services (CNS) Centre

Hong Kong, Hong Kong

Location

New Life Psychiatric Rehabilitation Association (Sha Tin)

Hong Kong, Hong Kong

Location

New Life Psychiatric Rehabilitation Association (Tuen Mun)

Hong Kong, Hong Kong

Location

New Life Psychiatric Rehabilitation Association (Yau Tsim Mong)

Hong Kong, Hong Kong

Location

New Life Psychiatric Rehabilitation Association Islands District

Hong Kong, Hong Kong

Location

New Life Psychiatric Rehabilitation Association The Wellness Centre (Tin Shui Wai)

Hong Kong, Hong Kong

Location

S.K.H. Holy Carpenter Church District Elderly Community Centre (Kowloon)

Hong Kong, Hong Kong

Location

Sage Eastern District Elderly Community Centre

Hong Kong, Hong Kong

Location

Sage Tsuen Wan District Elderly Community Centre

Hong Kong, Hong Kong

Location

Shun On District Elderly Community Centre

Hong Kong, Hong Kong

Location

St. James' Settlement Central & Western District Elderly Community Centre

Hong Kong, Hong Kong

Location

St. James' Settlement Wan Chai District Elderly Community Centre

Hong Kong, Hong Kong

Location

The Mental Health Association of Hong Kong Amity Place

Hong Kong, Hong Kong

Location

The Mental Health Association of Hong Kong Tai Po District

Hong Kong, Hong Kong

Location

The Neighbourhood Advice-Action Council

Hong Kong, Hong Kong

Location

The Neighbourhood Advice-Action Counil Tung Chung Intergrated Service Centre

Hong Kong, Hong Kong

Location

The Salvation Army Tai Po Multi-service Centre for Senior Citizens

Hong Kong, Hong Kong

Location

The Society of Rehabilitation and Crime Prevention, Hong Kong

Hong Kong, Hong Kong

Location

The Wellness Centre, New Life Psychiatric Rehabilitation Association (Kwai Chung)

Hong Kong, Hong Kong

Location

Tseung Kwan O Aged Care Complex, Jockey Club District Elderly Community Centre cum Day Care Unit

Hong Kong, Hong Kong

Location

Tung Wah Group of Hospitals Wilson T.S. Wang District Elderly Community Centre

Hong Kong, Hong Kong

Location

TWGHs Lok Hong Integrated Community Centre for Mental Wellness

Hong Kong, Hong Kong

Location

Wong Cho Tong District Elderly Community Centre

Hong Kong, Hong Kong

Location

YWCA Ming Yue District Elderly Community Centre

Hong Kong, Hong Kong

Location

Related Publications (1)

• 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.

  PMID: 39574082 DERIVED

MeSH Terms

Conditions

Depression

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior

Study Officials

• Terry Lum, PhD

  The University of Hong Kong

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

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

Study Record Dates

• First Submitted: April 23, 2021
• First Posted: April 28, 2021
• Study Start: January 1, 2020
• Primary Completion: December 31, 2023
• Study Completion: June 30, 2024
• Last Updated: March 26, 2025

Record last verified: 2025-03

Locations

HK (43)