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

Depressive Symptoms Clinical Trial

— JCJoyAge  

Official title:

Jockey Club JoyAge: Holistic Support Project for Elderly Mental Wellness

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03593889
• Other study ID #: EA1709021
• Status: Completed
• Phase: N/A
• Start date: October 1, 2017
• Est. completion date: April 30, 2022

Study information

• Verified date: May 2022
• Source: The University of Hong Kong
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 3702
• Est. completion date: April 30, 2022
• Est. primary completion date: December 31, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 60 Years and older

Eligibility

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

Related Conditions & MeSH terms

• Depression
• Depressive Symptoms

Intervention

Behavioral:
• Collaborative 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.

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

Locations

Country	Name	City	State
Hong Kong	Hong Kong Sheng Kung Hui Lady MacLehose Centre	Kwai Chung
Hong Kong	New Life Psychiatric Rehabilitation Association	Kwai Chung
Hong Kong	Christian Family Service Centre	Kwun Tong
Hong Kong	The Mental Health Association of Hong Kong	Kwun Tong
Hong Kong	Caritas Hong Kong	Sham Shui Po
Hong Kong	New Life Psychiatric Rehabilitation Association	Sham Shui Po
Hong Kong	Christian Family Service Centre	Tseung Kwan O
Hong Kong	Haven of Hope Christian Service	Tseung Kwan O

Sponsors (8)

Lead Sponsor	Collaborator
The University of Hong Kong	Caritas Medical Centre, Hong Kong, Christian Family Service Centre, Haven of Hope Christian Service, Hong Kong Sheng Kung Hui Lady MacLehose Centre, New Life Psychiatric Rehabilitation Association, The Hong Kong Jockey Club Charities Trust, The Mental Health Association of Hong Kong

Country where clinical trial is conducted

Hong Kong, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change from baseline depression at 12 months	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.	Baseline and 12-month follow-up
Secondary	Change from baseline loneliness at 12 months	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.	Baseline and 12-month follow-up
Secondary	Change from baseline life engagement at 12 months	Life engagement will be assessed using the typical day interview - a semi-structured interview asking clients about their typical day activities	Baseline and 12-month follow-up
Secondary	Change from baseline self-harm risk at 12 months	Self-harm risk will be measured by the self-harm risk assessment checklist.	Baseline and 12-month follow-up
Secondary	Change from baseline anxiety at 12 months	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.	Baseline and 12-month follow-up
Secondary	Change from baseline cognitive function at 12 months	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.	Baseline and 12-month follow-up
Secondary	Change from baseline social capital at 12 months	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.	Baseline and 12-month follow-up
Secondary	Change from baseline health-related quality of life at 12 months	Health-related quality of life will be measured by the EuroQoL 5 Dimensions 5 Levels (EQ-5D-5L).	Baseline and 12-month follow-up
Secondary	Change from baseline service utilization at 12 months	Service utilization will be measured by the Client Service Receipt Inventory (CSRI).	Baseline and 12-month follow-up