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

Conditions

Depressive Symptoms

Keywords

Collaborative stepped care, Peer support, Early identification, Selective prevention, Indicated prevention

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.

Wong SMY, Leung DKY, Liu T, Ng ZLY, Wong GHY, Chan WC, Lum TYS.

2024-11-214 citations

10.1186/s12888-024-06281-2

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

Tianyin Liu, Man‐Man Peng, Frankie Ho Chun Wong, Dara Kiu Yi Leung, Wen Zhang et al. (7 authors)

Innovation in Aging2023-07-195 citations

10.1093/geroni/igad075

Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial.

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.

2022-04-1117 citations

10.1186/s13063-022-06122-1

Cognitive Changes in Older Adults Following a Stepped Care Intervention for Late-life Depression

Anna Yan Zhang, Shiyu Lu, Tianyin Liu, Dara Kiu Yi Leung, Gloria Hoi Yan Wong et al. (6 authors)

Innovation in Aging2021-12-01

10.1093/geroni/igab046.3110

Adapting the UCLA 3-item loneliness scale for community-based depressive symptoms screening interview among older Chinese: a cross-sectional study

Tianyin Liu, Shiyu Lu, Dara Kiu Yi Leung, Lesley Sze, Wai Wai Kwok et al. (9 authors)

BMJ Open2020-12-01112 citations

10.1136/bmjopen-2020-041921

Interventions

BEHAVIORALCollaborative 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.

OTHERTreatment as usual

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

Study design

Allocation

NON_RANDOMIZED

Intervention model

PARALLEL

Primary purpose

PREVENTION

Masking

NONE

Intervention model description

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

Eligibility

Sex/Gender

ALL

Age

60 Years to No maximum

Healthy volunteers

Yes

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

Design outcomes

Primary

Measure	Time frame	Description
Change from baseline depression at 12 months	Baseline and 12-month follow-up	Depression will be measured by the Patient Health Questionnaire (PHQ-9). The total score will be used, ranging from 0 to 27. Higher scores indicate higher levels of depressive symptoms.

Secondary

Measure	Time frame	Description
Change from baseline life engagement at 12 months	Baseline and 12-month follow-up	Life engagement will be assessed using the typical day interview - a semi-structured interview asking clients about their typical day activities
Change from baseline self-harm risk at 12 months	Baseline and 12-month follow-up	Self-harm risk will be measured by the self-harm risk assessment checklist.
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). The total score will be used, ranging from 0 to 21. Higher scores indicate higher levels of anxiety symptoms.
Change from baseline loneliness at 12 months	Baseline and 12-month follow-up	Loneliness will be measured by the UCLA loneliness scale (UCLA-3). The total score will be used, ranging from 0 to 9. Higher scores indicate greater loneliness.
Change from baseline social capital at 12 months	Baseline and 12-month follow-up	Participants will be asked to list out names of people who they would turn to when they feel down, and when they need help for trivial things.
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).
Change from baseline service utilization at 12 months	Baseline and 12-month follow-up	Service utilization will be measured by the Client Service Receipt Inventory (CSRI).
Change from baseline cognitive function at 12 months	Baseline and 12-month follow-up	Cognitive function will be measured by the Hong Kong Montreal Cognitive Assessment 5-Minute Protocol (HK-MoCA 5-Min). The total score will be used, ranging from 0 to 30. Higher scores indicate higher levels of cognitive function.

Countries

Hong Kong

Outcome results

None listed