Clinical trial NCT03593889: Collaborative Stepped Care and Peer Support Programme for Older People At-Risk of or With Depression
Official title: Jockey Club JoyAge: Holistic Support Project for Elderly Mental Wellness
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Depressive Symptoms
Keywords: Collaborative stepped care
Peer support
Early identification
Selective prevention
Indicated prevention
Lead sponsor: The University of Hong Kong
Sponsor class: OTHER
Collaborators: name: The Hong Kong Jockey Club Charities Trust
name: Caritas Medical Centre, Hong Kong
name: Christian Family Service Centre
name: Haven of Hope Hospital
name: Hong Kong Sheng Kung Hui Lady MacLehose Centre
name: The Mental Health Association of Hong Kong
name: New Life Psychiatric Rehabilitation Association
First posted: 2018-07-20
Enrollment: 3702
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
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.
Primary purpose: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Change from baseline depression at 12 months
timeFrame: Baseline and 12-month follow-up
Secondary outcomes:
measure: Change from baseline loneliness at 12 months
timeFrame: Baseline and 12-month follow-up
measure: Change from baseline life engagement at 12 months
timeFrame: Baseline and 12-month follow-up
measure: Change from baseline self-harm risk at 12 months
timeFrame: Baseline and 12-month follow-up
measure: Change from baseline anxiety at 12 months
timeFrame: Baseline and 12-month follow-up
measure: Change from baseline cognitive function at 12 months
timeFrame: Baseline and 12-month follow-up
measure: Change from baseline social capital at 12 months
timeFrame: Baseline and 12-month follow-up
measure: Change from baseline health-related quality of life at 12 months
timeFrame: Baseline and 12-month follow-up
measure: Change from baseline service utilization at 12 months
timeFrame: Baseline and 12-month follow-up
Other outcomes:
Locations:
city: Kwai Chung
country: Hong Kong
facility: Hong Kong Sheng Kung Hui Lady MacLehose Centre
city: Kwai Chung
country: Hong Kong
facility: New Life Psychiatric Rehabilitation Association
city: Kwun Tong
country: Hong Kong
facility: Christian Family Service Centre
city: Kwun Tong
country: Hong Kong
facility: The Mental Health Association of Hong Kong
city: Sham Shui Po
country: Hong Kong
facility: Caritas Hong Kong
city: Sham Shui Po
country: Hong Kong
facility: New Life Psychiatric Rehabilitation Association
city: Tseung Kwan O
country: Hong Kong
facility: Christian Family Service Centre
city: Tseung Kwan O
country: Hong Kong
facility: Haven of Hope Christian Service
Study officials:
affiliation: Department of Social Work and Social Administration, The University of Hong Kong
name: Terry Lum, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Department of Social Work and Social Administration, The University of Hong Kong
name: Gloria Wong, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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. Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial. Trials. 2022 Apr 11;23(1):280. doi: 10.1186/s13063-022-06122-1.
citation: Liu T, Lu S, Leung DKY, Sze LCY, Kwok WW, Tang JYM, Luo H, Lum TYS, Wong GHY. Adapting the UCLA 3-item loneliness scale for community-based depressive symptoms screening interview among older Chinese: a cross-sectional study. BMJ Open. 2020 Dec 10;10(12):e041921. doi: 10.1136/bmjopen-2020-041921.