Depressive Symptoms
Conditions
Keywords
Modified mindfulness-based intervention
Brief summary
Preliminary findings from a previous study conducted by the investigators suggest that a task-shared approach with modified mindfulness-based cognitive therapy (MBCT) supported by social workers is beneficial in managing depressive symptoms and improving mindful non-reactivity among older adults. However, the possibility for social workers to lead a mindfulness-based intervention (MBI) independently to improve its scalability and service accessibility remains unclear. The project aims to: 1. Evaluate the effectiveness of social worker-led MBI in improving depression in older adults with mild to moderate depressive symptoms as compared to care as usual; 2. Examine the effectiveness of incorporating peer supporters in social worker-led MBI compared to those without peer supporters; 3. To identify potential mechanisms of change in MBI for depressive symptoms.
Detailed description
Mindfulness-based cognitive therapy (MBCT) is a promising approach to managing a series of health and psychological conditions among older adults. To increase its acceptability, feasibility, and scalability, MBCT has been adapted and delivered in a variety of formats. Apart from delivering the intervention in person by a certified mindfulness teacher, MBCT has been adapted to be self-taught, delivered online, or partially led by social workers. In a previous study conducted by the investigators, it was found that a task-shared approach with modified MBCT supported by social workers is effective in producing change in older adults' mental health and mindfulness. However, whether social workers are competent to lead a mindfulness-based intervention (MBI) informed by MBCT on their own and produce effective changes in outcome measures pertaining to mental health remains unclear. Furthermore, the effects of incorporating peer supporters into mental health interventions are unclear. The uses and implementation of peer support across mental health contexts vary greatly and the effects are mixed. In a pilot study on men with advanced prostate cancer, it has been suggested that the presence of peer support in modified mindfulness-based cognitive therapy group intervention may reinforce intervention effects. Furthermore, in an online intervention for older adults with elevated depressive symptoms, peer support has been found to improve engagement and adherence to the intervention. However, in a systematic review and meta-analysis, it has been found that while incorporating one-to-one peer support in mental health services has a modest positive impact on self-reported psychosocial outcomes such as self-rated recovery and empowerment, there is no evidence for improvement in clinical outcomes. With the growing older people population and a need for greater social welfare capacity to promote older adults' well-being, the current study aims to examine the effectiveness of social worker-led MBI informed by MBCT in improving depression in older adults with mild to moderate depressive symptoms. In addition, the effectiveness of incorporating peer supporters into the intervention will be examined.
Interventions
BEHAVIORALMindfulness-based intervention (MBI) (enhanced with peer supporters)
Mindfulness-based intervention combines mindfulness meditation with cognitive behavioural therapy (CBT) elements to reduce or prevent recurrent major depressive disorders. On-site support and regular follow-up by peer supporters.
BEHAVIORALExperimental: social worker-led MBI (without peer supporters)
Mindfulness-based intervention combines mindfulness meditation with cognitive behavioural therapy (CBT) elements to reduce or prevent recurrent major depressive disorders.
Sponsors
The Hong Kong Jockey Club Charities Trust
Christian Family Service Centre
The Mental Health Association of Hong Kong
The Salvation Army, Hong Kong and Macau Command
Haven of Hope Hospital
Hong Kong Sheng Kung Hui
Tung Wah Group of Hospitals
Aberdeen Kai-fong Welfare Association
Hong Kong Society for the Aged
Neighbourhood Advice-Action Council
The University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants in the intervention group will receive mindfulness-based intervention from social workers either with or without peer supporters involved. The care as usual group will receive usual service provided in District Elderly Community Centres (DECC) and Integrated Community Centre for Mental Wellness (ICCMW).
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 60 years or older * have depressive symptoms of mild level or above, as indicated by scoring 5-14 on PHQ-9 * can give informed consent to participate
Exclusion criteria
* known history of autism, intellectual disability, schizophrenia-spectrum disorder, bipolar disorder, Parkinson's disease, or dementia * current abuse of drugs or alcohol * difficulty in communication * imminent suicidal risk * timing or training is unsuitable for the participant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline depression at Week 6 and Week 18 | Baseline and Week 6, Week 18 | Depression will be measured by the validated Chinese version of 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. |
| Change from baseline anxiety at Week 6 and Week 18 | Baseline and Week 6, Week 18 | Anxiety will be measured by the validated Chinese version of 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. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline quality of life at Week 6 and Week 18 | Baseline and Week 6, Week 18 | Health-related quality of life will be measured by the European Quality of life 5 Dimensions 5 Level Version (EQ-5D-5L) in traditional Chinese. The measure assesses five dimensions of health (i.e., mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) at five levels (no problem, slight problems, moderate problems, severe problems, and extreme problems). An index value ranging from 0 to 1 will be used, with a score closer to 1 indicating a better health state. Current self-rated health will be measured using a visual analogue scale ranging from 0 to 100, with higher scores indicating better self-rated health. |
| Change from baseline self-compassion at Week 6 and Week 18 | Baseline and Week 6, Week 18 | Self-compassion will be measured by the Chinese version of the Self-Compassion Scale-Short Form (SCS-SF). The total score will be used, ranging from 12 to 60. Higher scores indicate higher self-compassion. |
| Change from baseline rumination at Week 6 and Week 18 | Baseline and Week 6, Week 18 | Rumination will be measured by the Brooding Subscale of the Ruminative Response Scale (RRS-10 Chinese version). The total score will be used, ranging from 5 to 20. Higher scores indicate a greater rumination tendency. |
| Change from baseline mindfulness at Week 6 and Week 18 | Baseline and Week 6, Week 18 | Mindfulness will be measured by the Chinese validated Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF). The total score of the FFMQ-SF (ranging from 20 to 100) as well as the sum (ranging from 4 to 20) of the five subscales (i.e., observe, describe, acting with awareness, nonjudging, and nonreactivity) will be used. Higher scores indicate higher mindfulness. |
| Change from baseline resilience at Week 6 and Week 18 | Baseline and Week 6, Week 18 | Resilience will be measured by the Chinese version of the 2-item Connor-Davidson Resilience Scale (CD-RISC2). The total score will be used, ranging from 0 to 8. Higher scores indicate higher resilience. |
| Change from baseline general health status at Week 6 and Week 18 | Baseline and Week 6, Week 18 | General health status will be assessed using one non-comparative and two comparative questions pertaining to health. Health status will be measured on a scale ranging from 0 to 4. Higher scores indicate poorer health status. |
| Change from baseline self-efficacy at Week 6 and Week 18 | Baseline and Week 6, Week 18 | Self-efficacy will be measured by the Chinese version of the General Self-Efficacy Scale. The total score will be used, ranging from 10 to 40. Higher scores indicate greater self-efficacy. |
| Change from baseline stress at Week 8 and Week 18 | Baseline and Week 6, Week 18 | Stress will be measured by a single-item subjective level of stress (SLS-1), which is rated on a scale from 0 to 10. A higher score indicates a greater subjective level of stress |
Countries
Hong Kong
Contacts
Primary ContactDara KY Leung, PhD
Backup ContactZuna LY Ng
Outcome results
None listed