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 subsyndromal 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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
192
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.
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.
The University of Hong Kong
Hong Kong, Hong Kong
RECRUITINGChanges in Depressive Symptoms
Patient Health Questionnaire-9 (PHQ-9); range 0-27; higher scores indicate higher levels of depressive symptoms (worse outcome)
Time frame: Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months
Changes in Anxiety Symptoms
Generalized Anxiety Disorder 2-item scale (GAD-2); range 0-6; higher scores indicate higher levels of anxiety symptoms (worse outcome)
Time frame: Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months
Changes in Loneliness
UCLA Loneliness Scale (UCLA-3); range 0-9; higher scores indicate higher levels of perceived loneliness (worse outcome)
Time frame: Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months
Changes in Health Service Use
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.
Time frame: Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months
Changes in Health-Related Quality of Life
EQ-5D-5L; range 0-1; higher scores indicate higher levels of health-related quality of life (better outcome)
Time frame: Baseline, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months, 21 months
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