Youth-for-Youth Mental Wellness Care and Action
1 other identifier
interventional
18,000
1 country
2
Brief Summary
This initiative aims to improve flourishing and quality of life of secondary school students, reduce mental distress (e.g., depression and suicidal ideation), enhance their understanding of mental health (e.g., mental health literacy) and help-seeking intention, and foster a supportive school environment (e.g., school climate-caring relationship, and sense of community). Also, this initiative aims to improve students' process of change in psychological (e.g., mattering, emotion regulation, empowerment) and social (e.g., trust belief) aspects and mental health awareness (e.g., mental health stigma). The feasibility, acceptability, and sustainability of the programme from multiple perspectives (e.g., students, student leaders, and stakeholders) will also be evaluated. In addition, the cost-effectiveness of delivering this programme (e.g., the incremental cost-effectiveness ratio (ICER)) among secondary schools in Hong Kong will be assessed. The programme will be implemented among students in 130 local secondary schools over three academic years. The first is a pilot phase (Year 1), which 40 schools will implement the intervention and student participants will be evaluated at pre- (T0) and post-intervention (T1) using questionnaires. In this stage, participatory research will be conducted before and after the intervention among students, student leaders, and stakeholders in 20 pilot schools to co-design the intervention, ensuring the programme meet the actual wellness needs of youth. In following two academic years, an additional 90 schools will participate in a cluster randomized controlled trial (RCT) with a 1:1 ratio between intervention and waitlist control groups. Each year, 45 schools will implement the intervention. Summative evaluation will be conducted among RCT schools at T0 and T1, and 3-month follow-up (T2). Quantitative data be collected to assess the effectiveness of intervention, and qualitative data will provide understanding of students' and stakeholders' perspectives of the intervention implementation. Cost outcomes will include intervention costs and cost savings, calculated from the payer (i.e., JC/government) perspective using administrative records or validated tools. The primary outcome of effectiveness will be the quality-adjusted life-years (QALYs) of students. Cost and QALYs will be used to evaluate the cost-effectiveness of the intervention, for example, estimate the incremental cost-effectiveness ratio (ICER).
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Aug 2025
Typical duration for not_applicable
2 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
April 23, 2025
CompletedFirst Posted
Study publicly available on registry
May 2, 2025
CompletedStudy Start
First participant enrolled
August 21, 2025
CompletedPrimary Completion
Last participant's last visit for primary outcome
August 31, 2027
ExpectedStudy Completion
Last participant's last visit for all outcomes
December 31, 2027
August 28, 2025
August 1, 2025
2 years
April 23, 2025
August 22, 2025
Conditions
Keywords
Outcome Measures
Primary Outcomes (22)
Flourishing
Students' psychological wellbeing is measured by the Mental Health Continuum-Short Form (MHC-SF). It is a 14 items validated measure for Chinese adolescent. Each item is scored from 0 (Never) to 5 (every day). Among the 14 items, 3 are emotional well-being questions and 11 are positive functioning questions. Adolescents are considered to be "flourishing" if they score 4 or above to at least 1 of the emotional questions and to at least 6 of the positive functioning questions; considered to be "languishing" if they score 1 or below to 1 or more of the 3 emotional questions and to 6 or more of the 11 positive functioning questions; considered to have "moderate mental health" if they are neither flourishing nor languishing.
From enrolment to the end of intervention program at 6 months
Depression and Anxiety
Depression and anxiety will be assessed with the 4-item Patient Health Questionnaire-4 (PHQ-4), an ultra-brief self-report questionnaire that consists of a 2-item anxiety scale (GAD-2) and a 2-item depression scale (PHQ-2). The PHQ-2 consists of the two core criteria for depressive disorders, with the two items determining depression and the two items of the GAD-2 assess the core criteria for generalized anxiety disorders. This tool has been validated and used in adolescent populations. Each item of this 4-item survey is graded on a 4-point Likert scale scoring from 0 (Not at all) to 3 (Nearly every day). The total score of each part is 6. Scale scores of ≥3 was suggested as cut-off points between the normal range and probable cases of depression or anxiety respectively PHQ-4 scores go from normal (0 -2), mild (3-5), moderate (6-8) to severe (9 -12).
From enrolment to the end of intervention program at 6 months
Suicidal ideation and attempt
Suicidal ideation and attempt will be assessed by 2 questions from the PHQ-A, "Has there been a time in the past month when you have had serious thoughts about ending your life?" and "Have you ever, in your whole life, tried to kill yourself or made a suicide attempt?"
From enrolment to the end of intervention program at 6 months
Social support
A 3-item subscale of the Comprehensive Inventory of Thriving (CIT) will be employed to measure the level of social support perceived from the environment for adolescents. Each item of the subscale is graded on a 5-point Likert scale scoring from 1 (Strongly disagreed) to 5 (Strongly agreed). The three questions are 'There are people I can depend on to help me', 'There are people who give me support and encouragement' and 'There are people who appreciate me as a person'. Higher score indicates higher level of perceived social support.
From enrolment to the end of intervention program at 6 months
School climate-caring relationship
The availability of caring persons for students will be measured by three items of caring relationship measure from the California Healthy Kids Resilience Module. Items include presence of an adult who "cares about me", "notices when I am not there", "who listens to me when I have something to say", each item are rating on a 4-point scale.
From enrolment to the end of intervention program at 6 months
Sense of community
Sense of community (SOC) will be assessed by the 8-item Brief sense of community scale (BSCS) for adolescents. Each item of the scale is graded on a 5-point Likert type scoring from 1 (Strongly disagreed) to 5 (Strongly agreed). Four domains of the scales include Needs Fulfilment (items 1 and 2), Group Membership (items 3 and 4), Influence (items 5 and 6), and Emotional Connection (items 7 and 8). The score of each domain is calculated by taking the mean of the items. Higher score indicates higher level of perceived sense of community.
From enrolment to the end of intervention program at 6 months
Mental health literacy
Mental health literacy will be measured by 9 items from the Mental Health Literacy Scale. The scale assesses individuals' understanding on the various aspect of mental health. In the present study, 9 items that are related to understanding of depression, anxiety, and professional help-seeking will be selected. Items are rated on a 4-point Likert Scale from 1 (very unlikely) to 4 (very likely).
From enrolment to the end of intervention program at 6 months
Help seeking intention
The willingness to seek help if they encounter mental health problems is assessed with the General Help-Seeking Questionnaire. It asks how likely it for students is to seek help from a list of people (such as their peers, sisters or brothers in schools) for personal or emotion problems, from 1 (Extremely unlikely) to 7 (Extremely likely).
From enrolment to the end of intervention program at 6 months
Quality of life (EQ-5D-Y)
The EQ-5D Youth Version (EQ-5D-Y) is a generic, child-friendly self-complete instrument measuring HRQoL in children and adolescents aged 8 to 15 years. Its design is based on the EQ-5D-3L instrument, which was developed to measure HRQoL in adults. It evaluates five dimensions of health-related quality of life: mobility, self-care, participation in usual activities, pain/discomfort, and anxiety/depression. Each dimension of EQ-5D-Y is measured across three levels of severity, from "no problems" to "having a lot of problems". This instrument has been validated and used among adolescent population in Hong Kong, however, its value set has not yet been derived in the local context.
From enrolment to the end of intervention program at 6 months
Quality of life (CHU9D)
The CHU9D has been validated for its sensitivity in capturing the effectiveness of health interventions among children and adolescents, with age range from 7 to 17 years. It encompasses nine dimensions: worried, sad, pain, tired, annoyed, schoolwork/homework, sleep, daily routine, and activities, each with five-level responses. The Chinese version of CHU9D has also been validated in a school-based sample in mainland China. The instrument has not been validated among Hong Kong adolescents, and we can examine its reliability and validity in this evaluation.
From enrolment to the end of intervention program at 6 months
quality-adjusted life-years (QALYs)
In this evaluation, the dual approach allows us to capture a broader health dimensions relevant to the adolescent population, and both instruments will be used to estimate the quality-adjusted life-years (QALYs) of secondary students for evaluating the programme's effectiveness. Responses from the CHU9D will be transformed into QALYs weights derived from a UK general population sample using an algorithm developed by Stevens, producing a utility value set of between 0.33 (worst health state) and 1 (best health state), and a utility score of zero denotes death.
From enrolment to the end of intervention program at 6 months
Mattering
Mattering refers to the perception of importance, significance and being valued by others. It is measured by the General Mattering Scale (GMS). It is a 5-items scales that asks questions such as "How important do you feel you are to other people?" and "How much do other people depend on you?". Each item is rated from 1 (Not at all) to 4 (A lot).
From enrolment to the end of intervention program at 6 months
Hope
Hope is defined as an indicator of psychological resilience and positive future orientation. The 6-item Snyder's State Hope Scale will be used here to assess how participants hold the belief in own capacity to initiate and sustain actions (agency) as well as the belief in own capacity to generate routes (pathways) to reach their goal. Each item of the scale is graded on an 8-point Likert type scoring from 1 (Definitely false) to 8 (Definitely true). Two domains of the scales include Agency (items 2, 4 and 6), and pathways (items 1, 3 and 5). Subscale scores for agency or pathways are derived by adding the three even- and odd-numbered items, and the total score of State Hope Scale is the sum of all six items.
From enrolment to the end of intervention program at 6 months
Resilience
The two-item version of the Connor-Davidson Resilience Scale (CD-RISC2) will be used to measure the ability to cope with stress and adverse effects of traumatic events. The total score is calculated by the average of the two items.
From enrolment to the end of intervention program at 6 months
Emotion Regulation
The use of emotion regulation strategies: cognitive reappraisal and expressive suppression is measured with the Emotion Regulation Questionnaire (ERQ-9). It is a 9-items questionnaire rated from 1 (Strongly disagree) to 7 (Strongly agree). Example statements are "I control my emotions by not expressing them." "When I'm faced with a stressful situation, I make myself think about it in a way that helps me stay calm."
From enrolment to the end of intervention program at 6 months
Empowerment
The Self-subscale of the Youth Empowerment Scale-Mental Health (YES-MH) consists of 7 items used to measure the extent to which students are encouraged to take an active role in managing their mental health. Sample items included "I know how to take care of my mental or emotional health".
From enrolment to the end of intervention program at 6 months
Perceived Stress
Stress level is measured by the 4-items Perceived Stress Scale (PSS-4). It consists of items such as "How often have you felt that you were unable to control the important things in your life?" and "How often have you felt that things were going your way?" and is rated with a point scale ranging from 1 to 5.
From enrolment to the end of intervention program at 6 months
Trust belief
Trust belief will be measured by the General Trust Questionnaire. It contains 6 items that measure individuals' beliefs about honesty and trustworthiness of others. In the present study, participants will be asked to evaluate the items with references to the people in their school. Items are rated on a 5-point Likert Scale, from 1 (strongly disagree) to 5 (strongly agree). Sample items are "Most people in the school are trustworthy."
From enrolment to the end of intervention program at 6 months
Engagement
Students' engagement in the program will be measured by the Tiffany-Eckenrode Program Participation Scale (TEPPS). The "Voice/Influence" 4-items subscale is selected, each item is rated from 1 (Not at all) to 5 (Very true for me). Examples are "I feel I have a lot of voice/power to influence decisions about the program." "I am very involved in the program activities."
From enrolment to the end of intervention program at 6 months
Sense of Place
Sense of place will be assessed by the 11-item self-report Place Subscale of Sense of Place Scale. Items 1-3 measure the emotional bond whereas items 4-7 measure the continuity as a sub-dimension of place identity. Item 8 reflects the importance of the place in supporting important or desired activities and goals. Item 9 measure the place dependence. Items 10 and 11 assess the memories of the place. A 5-point rating scale ranging from 1 (strongly disagree) to 5 (strongly agree) was used. Total score is the summation of all items from the subscale. Higher score indicates the higher level of perceived sense of place.
From enrolment to the end of intervention program at 6 months
Mental health stigma
The Peer Mental Health Stigmatization Scale-Revised (PMHSS-R) has 11 statements which are rated on a 5-point Likert scale, 1 (Disagree completely) to 5 (Agree completely).
From enrolment to the end of intervention program at 6 months
Help seeking attitudes
The Self-Stigma of Seeking Help (SSOSH) scale consists of 10 items that measure attitudes toward and intent to seek psychological help. It is rated on a 5-point scale. Examples are "I would feel okay about myself if I made the choice to seek professional help" and "Seeking psychological help would make me feel less intelligent".
From enrolment to the end of intervention program at 6 months
Study Arms (2)
Receiving school-based intervention program on adolescent mental wellbeing
ACTIVE COMPARATORStudents at secondary school receiving school-based intervention program on adolescent mental wellbeing during a academic year. They will complete the questionnaires before and after the intervention program at their first year.
Not receiving school-based intervention program on adolescent mental wellbeing
NO INTERVENTIONStudents at secondary school not receiving school-based intervention program on adolescent mental wellbeing during the first academic year. They will complete the questionnaires before and after the active comparator's intervention program at their first year. In addition, they will receive the intervention program and complete the questionnaires before and after the said intervention program during the second academic year.
Interventions
Students participating in the intervention program will attend the school talk and workshops about mental health. They are also required to organize whole-school activities to promote peer mental wellbeing at school. All attended students will be guided by registered social workers and trained research personnel throughout the intervention program.
Students participating at control group will not receive intervention program during the academic year compared with their counterparts in active comparator group. They will live and attend the class as usual at school. After the academic year, they will receive the intervention program on the alternative academic year.
Eligibility Criteria
You may qualify if:
- student in Hong Kong secondary school
- Studying at Form 1 to Form 3 at the time of recruitment
- Competence in comprehending written Chinese or English
- Competence in speaking Cantonese or English
- Written consent from students and their legal guardian
You may not qualify if:
- Not studying at Form 1 to 3 in Hong Kong secondary school
- Incompetence in comprehending written Chinese or English
- Incompetence in speaking Cantonese or English
- No written consent from students or their legal guardian
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- Chinese University of Hong Konglead
- New Life Psychiatric Rehabilitation Associationcollaborator
- The University of Hong Kongcollaborator
- The Hong Kong Jockey Club Charities Trustcollaborator
- The Hong Kong Polytechnic Universitycollaborator
Study Sites (2)
Centre for Health Behaviours Research, JCSPHPC, CUHK
Hong Kong, HONG KONG, 00000, Hong Kong
Centre for Health Behaviours Research, JCSPHPC, CUHK
Hong Kong, HONG KONG, 00000, Hong Kong
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Phoenix Kit Han Mo, PhD
Chinese University of Hong Kong
- PRINCIPAL INVESTIGATOR
Winnie Wing Sze Mak, PhD
Chinese University of Hong Kong
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- HEALTH SERVICES RESEARCH
- Intervention Model
- CROSSOVER
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Associate Professor
Study Record Dates
First Submitted
April 23, 2025
First Posted
May 2, 2025
Study Start
August 21, 2025
Primary Completion (Estimated)
August 31, 2027
Study Completion (Estimated)
December 31, 2027
Last Updated
August 28, 2025
Record last verified: 2025-08
Data Sharing
- IPD Sharing
- Will share
- Shared Documents
- STUDY PROTOCOL, ICF
- Time Frame
- The IPD and supporting information will be available from beginning the 1st year and ending 3 years after the publication of results.
- Access Criteria
- A formal non-commercial study proposal must be made in writing to the study principal investigator and the detailed use and analysis of the IPD have to be described.
The overall results of masked IPD can be shared upon request made to the study principal investigator.