Depression
Conditions
Keywords
Depressive symptoms, Mental health, Medical-social collaboration, Integrated health and social care, Stepped-care intervention
Brief summary
The goal of this clinical trial is to learn if a medical-social collaboration model works to reduce depressive symptoms in middle-aged and older adults with depressive symptoms who are waiting for their first psychiatric appointment. Secondary outcomes of the study include reduced anxiety symptoms, reduced loneliness, reduced rumination, reduced self-criticism, improved self-reassurance, improved resilience, improved self-efficacy, improved health-related quality of life, as well as improved quality-adjusted life years, and reduced healthcare service utilisation. Researchers will compare a medical-social collaboration model to a self-management booklet. Participants will: * Receive CBT-based stepped-care interventions through the medical-social collaboration model or a self-management booklet. * Complete a survey about their mental health and service use every three months until their first psychiatric appointment.
Interventions
BEHAVIORALCognitive behavioural therapy-based stepped-care intervention
After initial clinical assessment, participants will be offered interventions based on their depressive symptom severity (Patient Health Questionnaire-9-item \[PHQ-9\]). Mild symptoms (PHQ-9=5-9): 6 weekly low intensity CBT-based group intervention sessions led by trained clinical social workers, with 2 booster sessions as necessary. Moderate symptoms (PHQ-9=10-14): 6 weekly high intensity CBT-based group intervention sessions led by trained clinical social workers, with 2 booster sessions as necessary. Moderately severe symptoms (PHQ-9≥15): high intensity individual or group CBT-based intervention. Trained peer supporters will be matched to participants to walk them through the process with regular follow-up.
OTHERSelf-management booklet
The booklet incorporates components of behavioural activation, which encourages participants to engage in meaningful activities in daily life to change their mood. Trained research assistants will regularly check in with the participants to monitor their depressive symptoms.
Sponsors
The University of Hong Kong
Hospital Authority Hong Kong West Cluster
Kowloon Hospital, Hong Kong
Pamela Youde Nethersole Eastern Hospital
United Christian Hospital
Kwai Chung Hospital
Castle Peak Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
Masking was not possible in this study.
Eligibility
Sex/Gender
ALL
Age
45 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Currently awaiting psychiatric services provided by the Hospital Authority * Have depressive symptoms of at least mild severity * Able to provide informed consent
Exclusion criteria
* A known history of autism spectrum disorder, intellectual disability, schizophrenia-spectrum disorder, bipolar disorder, Parkinson's disease, or dementia * Imminent suicidal risk (temporary exclusion) * Communication difficulties that preclude participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in Depressive Symptoms | Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months | Patient Health Questionnaire-9 (PHQ-9); range 0-27; higher scores indicate higher levels of depressive symptoms (worse outcome) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in Anxiety Symptoms | Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months | Generalized Anxiety Disorder 2-item scale (GAD-2); range 0-6; higher scores indicate higher levels of anxiety symptoms (worse outcome) |
| Changes in Loneliness | Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months | UCLA Loneliness Scale (UCLA-3); range 0-9; higher scores indicate higher levels of perceived loneliness (worse outcome) |
| Changes in Health Service Use | Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months | Self-reported use of mental health services and medication in the past three months. Service data from Hospital Authority, covering information on outpatient visits, hospitalisation days, Accident and Emergency service utilisation, types of medications and operations, and any other major cost items that may be affected by depression with cost implications. |
| Changes in Health-Related Quality of Life | Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months | EQ-5D-5L; range 0-1; higher scores indicate higher levels of health-related quality of life (better outcome) |
Countries
Hong Kong
Contacts
CONTACTYao Du, PhD
CONTACTWalker SH Au
PRINCIPAL_INVESTIGATORTerry YS Lum, PhD
The University of Hong Kong
PRINCIPAL_INVESTIGATORGloria HY Wong, PhD
University of Reading
PRINCIPAL_INVESTIGATORWai Chi Chan, MBChB
The University of Hong Kong
Outcome results
None listed