CARE Study for Paramedics in Singapore

NCT07457801 | Completed

• 1 other identifier: 2020/2516
• Study Type: interventional
• Target: 63
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to compare the effectiveness of two different online education courses (Oxford-Online and Mind-Online) for preventing stress related conditions among paramedics who have been working during a period of COVID-19 occurrence in Singapore. The study aims to:

• Compare the efficacy of a locally-adapted version of internet-delivered cognitive training for resilience (Oxford Online) to an existing educational online training (Mind Online) on depressive symptom severity
• Compare the efficacy of Oxford Online to Mind Online for improving posttraumatic stress symptoms, resilience, general psychological distress, anxiety symptoms, social support, work engagement, and health-related quality of life Participants will:
• Complete an online battery of baseline questionnaires
• Be randomised to receive 6 modules of either Oxford Online or Mind Online, delivered once per week over a 6-week period
• Complete the same online questionnaire battery immediately following the intervention, and again at the 6-month and 12-month follow up

Conditions

Post Traumatic Stress Disorder; Depression; Anxiety Disorders and Symptoms; Burnout; Psychological Distress

Outcome Measures

Primary Outcomes (1)

• Change in Depression Symptoms

  Patient Health Questionnaire 9 (PHQ-9)

  Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention

Secondary Outcomes (10)

• Change in Posttraumatic Stress Symptoms

  Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention

• Change in Resilience

  Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention

• Change in Rumination

  Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention

• Change in Anxiety Symptoms

  Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention

• Change in Psychological Distress

  Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention

Study Arms (2)

Oxford-Online

EXPERIMENTAL

The Oxford-Online programme is a series of six modules that targets cognitive predictors of depression and posttraumatic stress disorder.

Behavioral: Oxford-Online

Mind-Online

ACTIVE COMPARATOR

Mind-Online is a series of six modules available online where participants read information and advice about stress, depression, posttraumatic stress, sleep problems, anger, and mindfulness.

Behavioral: Mind-Online

Interventions

Oxford-Online BEHAVIORAL

The Oxford Online programme targets cognitive predictors of depression and posttraumatic stress disorder. The core information is delivered in six 20-minute modules over a 6-week period. The modules include whiteboard videos to explain concepts, audio files for practicing concrete thinking, video testimonies and footage of paramedics on-call for use in experiential exercises. A trained online wellbeing coordinator will provide individual email feedback on participants' responses and send brief automated message reminders.

Oxford-Online

Mind-Online BEHAVIORAL

Mind Online is a series of six modules available online where participants read information and advice about stress, depression, posttraumatic stress, sleep problems, anger, and mindfulness. A trained online wellbeing coordinator will provide individual email feedback on participants' responses and send brief automated message reminders.

Mind-Online

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 21 and above
• English speaking
• Employed or subcontracted as paramedics by SCDF who have been working during the COVID-19 pandemic
• Able to provide informed consent and read study materials
• Willing to enter randomised trial

You may not qualify if:

• Non-English speaking
• Not working during COVID-19 outbreak (e.g. on medical or maternity leave)
• Working as trainees, conscripts, medics or ambulance drivers
• Unwilling or unable to complete study procedures
• Unwilling to enter randomised trial

Sponsors & Collaborators

• Singapore General Hospital: lead
• Duke-NUS Graduate Medical School: collaborator

Study Sites (1)

Duke-NUS Medical School

Singapore, 169857, Singapore

Location

Related Publications (19)

• Sung SC, Rush AJ. A timely investment: coordinated care for depression and anxiety disorders. Ann Acad Med Singap. 2011 Oct;40(10):436-8. No abstract available.

  PMID: 22206051 BACKGROUND

• Sung SC, Dryman MT, Marks E, Shear MK, Ghesquiere A, Fava M, Simon NM. Complicated grief among individuals with major depression: prevalence, comorbidity, and associated features. J Affect Disord. 2011 Nov;134(1-3):453-8. doi: 10.1016/j.jad.2011.05.017. Epub 2011 May 31.

  PMID: 21621849 BACKGROUND

• Sung SC, Haley CL, Wisniewski SR, Fava M, Nierenberg AA, Warden D, Morris DW, Kurian BT, Trivedi MH, Rush AJ; CO-MED Study Team. The impact of chronic depression on acute and long-term outcomes in a randomized trial comparing selective serotonin reuptake inhibitor monotherapy versus each of 2 different antidepressant medication combinations. J Clin Psychiatry. 2012 Jul;73(7):967-76. doi: 10.4088/JCP.11m07043. Epub 2012 May 29.

  PMID: 22687487 BACKGROUND

• Teo I, Sung SC, Cheung YB, Wong WHM, Abu Bakar Aloweni F, Ang HG, Ayre TC, Chai-Lim C, Chen R, Heng AL, Nadarajan GD, Ong MEH, Soh CR, Tan BH, Tan KBK, Tan BS, Tan MH, Tan PH, Tay KXK, Wijaya L, Tan HK. Burnout, anxiety and depression in healthcare workers during the early COVID-19 period in Singapore. Singapore Med J. 2024 Mar 1;65(Suppl 1):S26-S29. doi: 10.11622/smedj.2021156. Epub 2021 Oct 7. No abstract available.

  PMID: 34617698 BACKGROUND

• Yoon S, Goh H, Nadarajan GD, Sung S, Teo I, Lee J, Ong MEH, Graves N, Teo TL. Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study. J Med Internet Res. 2021 May 31;23(5):e26282. doi: 10.2196/26282.

  PMID: 33979296 BACKGROUND

• Sung SC, L.Y., Chen AM, Chay J, Tewani K, Yeo LF, Tan HK. , Psychological Resilience among Healthcare Workers during the COVID-19 Pandemic in Singapore, in SingHealth Duke-NUS Scientific Congress. 2021: Singapore

  BACKGROUND

• Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH, Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann Intern Med. 2020 Aug 18;173(4):317-320. doi: 10.7326/M20-1083. Epub 2020 Apr 6. No abstract available.

  PMID: 32251513 BACKGROUND

• Tan BYQ, Kanneganti A, Lim LJH, Tan M, Chua YX, Tan L, Sia CH, Denning M, Goh ET, Purkayastha S, Kinross J, Sim K, Chan YH, Ooi SBS. Burnout and Associated Factors Among Health Care Workers in Singapore During the COVID-19 Pandemic. J Am Med Dir Assoc. 2020 Dec;21(12):1751-1758.e5. doi: 10.1016/j.jamda.2020.09.035. Epub 2020 Oct 5.

  PMID: 33256955 BACKGROUND

• Wild J, Smith KV, Thompson E, Bear F, Lommen MJ, Ehlers A. A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychol Med. 2016 Sep;46(12):2571-82. doi: 10.1017/S0033291716000532. Epub 2016 Jun 28.

  PMID: 27348599 BACKGROUND

• Wild, J., S. El-Salahi, and M. Degli-Eposti, The effectiveness of interventions aimed at improving wellbeing and resilience to stress in first responders: A systematic review. European Psychologist, in press

  BACKGROUND

• Wild J, El-Salahi S, Tyson G, Lorenz H, Pariante CM, Danese A, Tsiachristas A, Watkins E, Middleton B, Blaber A, Ehlers A. Preventing PTSD, depression and associated health problems in student paramedics: protocol for PREVENT-PTSD, a randomised controlled trial of supported online cognitive training for resilience versus alternative online training and standard practice. BMJ Open. 2018 Dec 31;8(12):e022292. doi: 10.1136/bmjopen-2018-022292.

  PMID: 30598484 BACKGROUND

• Ehring T, Ehlers A, Glucksman E. Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study. J Consult Clin Psychol. 2008 Apr;76(2):219-30. doi: 10.1037/0022-006X.76.2.219.

  PMID: 18377119 BACKGROUND

• Ehlers A, Clark DM, Hackmann A, McManus F, Fennell M, Herbert C, Mayou R. A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Arch Gen Psychiatry. 2003 Oct;60(10):1024-32. doi: 10.1001/archpsyc.60.10.1024.

  PMID: 14557148 BACKGROUND

• Ehring T, Ehlers A, Glucksman E. Contribution of cognitive factors to the prediction of post-traumatic stress disorder, phobia and depression after motor vehicle accidents. Behav Res Ther. 2006 Dec;44(12):1699-716. doi: 10.1016/j.brat.2005.11.013. Epub 2006 Feb 7.

  PMID: 16460669 BACKGROUND

• Shepherd L, Wild J. Emotion regulation, physiological arousal and PTSD symptoms in trauma-exposed individuals. J Behav Ther Exp Psychiatry. 2014 Sep;45(3):360-7. doi: 10.1016/j.jbtep.2014.03.002. Epub 2014 Mar 26.

  PMID: 24727342 BACKGROUND

• Shepherd L, Wild J. Cognitive appraisals, objectivity and coping in ambulance workers: a pilot study. Emerg Med J. 2014 Jan;31(1):41-4. doi: 10.1136/emermed-2011-200511. Epub 2013 Jan 10.

  PMID: 23307756 BACKGROUND

• White R, Wild J. "Why" or "How": The Effect of Concrete Versus Abstract Processing on Intrusive Memories Following Analogue Trauma. Behav Ther. 2016 May;47(3):404-15. doi: 10.1016/j.beth.2016.02.004. Epub 2016 Feb 24.

  PMID: 27157033 BACKGROUND

• Pile V, Barnhofer T, Wild J. Updating versus Exposure to Prevent Consolidation of Conditioned Fear. PLoS One. 2015 Apr 22;10(4):e0122971. doi: 10.1371/journal.pone.0122971. eCollection 2015.

  PMID: 25902141 BACKGROUND

• Wild J, Warnock-Parkes E, Grey N, Stott R, Wiedemann M, Canvin L, Rankin H, Shepherd E, Forkert A, Clark DM, Ehlers A. Internet-delivered cognitive therapy for PTSD: a development pilot series. Eur J Psychotraumatol. 2016 Nov 8;7:31019. doi: 10.3402/ejpt.v7.31019. eCollection 2016.

  PMID: 27837579 BACKGROUND

MeSH Terms

Conditions

Stress Disorders, Post-Traumatic; Depression; Anxiety Disorders; Burnout, Psychological

Condition Hierarchy (Ancestors)

Stress Disorders, Traumatic; Trauma and Stressor Related Disorders; Mental Disorders; Behavioral Symptoms; Behavior; Stress, Psychological

Study Officials

• Gayathri Devi Nadarajan

  SGH

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Parallel group block RCT design

Study Record Dates

• First Submitted: May 30, 2023
• First Posted: March 9, 2026
• Study Start: September 12, 2020
• Primary Completion: June 30, 2025
• Study Completion: June 30, 2025
• Last Updated: March 9, 2026

Record last verified: 2025-05

Locations

SG (1)