Collaborative Stepped-Care and Productive Ageing Program for Older People With Depressive Symptoms
- Conditions
- Depressive Symptoms
- Interventions
- Behavioral: Collaborative stepped care and peer support
- Registration Number
- NCT04863300
- Lead Sponsor
- The University of Hong Kong
- 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.
- Detailed Description
This four-year extension project includes three main elements: 1) Trainings, including different programmes for social services staff, Mental Wellness Ambassadors, and Peer Supporters; 2) Implementation of JoyAge service model: standardized collaborative stepped-care and Peer Support programmes for prevention and early intervention of depression in older adults; and 3) Public awareness campaign: coordinated programmes to increase mental health literacy and raise public awareness.
Specific goals of the programmes through the above three elements include:
1. To implement JC JoyAge clinical protocol and guidelines to coordinate care among community mental health and aged care services centres for elderly mental wellness in 18 districts;
2. To engage vulnerable and at-risk older adults in the community through productive ageing activities and mental wellbeing self-management training;
3. To enhance the capacity of social service staff in handling elderly depression through specialized and infusion training and knowledge exchange;
4. To raise public awareness and elderly mental health literacy among family members, neighbours, community stakeholders, and the general public to encourage early detection/help-seeking on depressive risk of older adults; and
5. To establish evidence of the effectiveness and cost-effectiveness of JC JoyAge Phase II model.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 3000
- age 60 years or above; and
- have depressive symptoms of mild level or above; and
- able to give informed consent to participate
- known history of autism, intellectual disability, schizophrenia-spectrum disorder, bipolar disorder, Parkinson's disease, or dementia; and
- (temporary exclusion criteria) imminent suicidal risk; and
- difficulty in communication
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Intervention group Collaborative stepped care and peer support 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.
- Primary Outcome Measures
Name Time Method Change from Baseline Depression at 12 months Baseline and 12-month follow-up 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.
Change from Baseline Self-harm Risk at 12 months Baseline and 12-month follow-up 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.
Change from Baseline Anxiety at 12 months Baseline and 12-month follow-up 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.
Change from Baseline Service Usage at 12 months Baseline and 12-month follow-up 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.
Change from Baseline Loneliness at 12 months Baseline and 12-month follow-up 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.
- Secondary Outcome Measures
Name Time Method Change from Baseline Cognition at 12 months Baseline and 12-month follow-up Cognition will be measured by the Hong Kong Montreal Cognitive Assessment 5-Minute Protocol (HK-MoCA 5-Min). It is a validated and reliable cognitive screen for stroke and transient ischemic attack, brief and highly feasible for telephone administration. It includes four items examining attention, verbal learning and memory, executive functions/language, and orientation extracted from the MoCA. Total scores range between 0 and 30, with higher scores indicating better cognition. Change scores of cognition will be calculated by subtract the baseline HK-MoCA 5-Min score from the follow-up score, and positive results indicates improvements in cognition.
Change from Baseline Daily Activities at 12 months Baseline and 12-month follow-up A semi-structured interview asking clients about their typical day activities in three domains: physical, social, and mental. A combination of being active in at least two domains would be used as one of the exit criteria. The changes of total numbers of activities reported will be calculated.
Change from Baseline Social Network at 12 months Baseline and 12-month follow-up Social support network is measured by a self-developed questionnaire asking participants to list out names of people who they would turn to (a) when they feel down, and (b) when they need help for trivial things. Participants can report up to 5 people to each condition. More people they can turn to indicates a wider social support network. Change in social support network will be calculated by subtract the baseline number of persons who they can turn to help from the follow-up number, positive results indicates increase in social support network.
Change from Baseline Health-related Quality of Life at 12 months Baseline and 12-month follow-up Health-related quality of life will be measured by the EuroQoL 5 Dimensions 5 Levels (EQ-5D-5L). The EQ-5D-5L is a generic preference-based measure of health on five dimensions (5D): mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each with five levels (5L) of problems. The traditional Chinese version for Hong Kong developed by EuroQol Group will be used. Results will be presented by the EQ-5D-5L index value.
Change from Baseline Self-rated Health at 12 months Baseline and 12-month follow-up A visual analogue scale (EQ VAS) will be used for participants to rate their general health from 0 to 100. Change scores of overall self-rated health will be calculated by subtract the baseline EQ VAS from the follow-up EQ VAS score, and positive results indicates improvement in self-rated health.
Trial Locations
- Locations (43)
Caritas Wellness Link Tsuen Wan
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Haven of Hope Christian Service
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Hong Kong Christian Service Bliss District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
New Life Psychiatric Rehabilitation Association (Sha Tin)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
New Life Psychiatric Rehabilitation Association (Yau Tsim Mong)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
New Life Psychiatric Rehabilitation Association Islands District
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
The Neighbourhood Advice-Action Council
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
The Salvation Army Tai Po Multi-service Centre for Senior Citizens
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
The Wellness Centre, New Life Psychiatric Rehabilitation Association (Kwai Chung)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Caritas Wellness Link - North District
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Chan Tseng Hsi Kwai Chung District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Jockey Club Wong Chi Keung District Elderly Community Centre - Aberdeen
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Caritas Cheng Shing Fung District Elderly Centre (Sham Shui Po)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Christian Family Service Centre (Kwun Tong)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Sage Eastern District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Aberdeen Kaifong Welfare Association Services Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Baptist Oi Kwan Social Service Integrated Community Centre for Mental Wellness (Kwai Tsing)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Christian Family Service Centre Wellness Zone - Integrated Community Centre for Mental Wellness
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Chuk Yuen Canon Martin District Elderly Community Centre_Wai Yuen House
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Ellen Li District Elderly Community Centre - Yung Shing Shopping Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Fong Shu Chuen District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
H.K.S.K.H. Lok Man Alice Kwok Integrated Service Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Sage Tsuen Wan District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Shun On District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
St. James' Settlement Central & Western District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
New Life Psychiatric Rehabilitation Association The Wellness Centre (Tin Shui Wai)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
St. James' Settlement Wan Chai District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
The Mental Health Association of Hong Kong Amity Place
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
The Mental Health Association of Hong Kong Tai Po District
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
The Society of Rehabilitation and Crime Prevention, Hong Kong
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
The Neighbourhood Advice-Action Counil Tung Chung Intergrated Service Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Tseung Kwan O Aged Care Complex, Jockey Club District Elderly Community Centre cum Day Care Unit
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Tung Wah Group of Hospitals Wilson T.S. Wang District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
TWGHs Lok Hong Integrated Community Centre for Mental Wellness
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Wong Cho Tong District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
YWCA Ming Yue District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Baptist Oi Kwan Social Service
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Caritas District Elderly Centre - Yuen Long(Tin Chak Centre)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
H.K.S.K.H. Lady MacLehose Centre Dr. Lam Chik Suen District Elderly Community Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
H.K.S.K.H. Western District Elderly Community Centre - Integrated Home Care Services Team
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
New Life Psychiatric Rehabilitation Association (Tuen Mun)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
Neighbourhood Advice-action Council (Shan King) Community Nursing Services (CNS) Centre
ðŸ‡ðŸ‡°Hong Kong, Hong Kong
S.K.H. Holy Carpenter Church District Elderly Community Centre (Kowloon)
ðŸ‡ðŸ‡°Hong Kong, Hong Kong