Narrative Therapy Among Young People With Moderate Level of Mental Distress in Hong Kong

A Cluster Randomized Controlled Trial of Narrative Therapy Among Young People With Moderate Level of Mental Distress in Hong Kong

This cluster randomized controlled trial (cRCT) aims to evaluate the effectiveness of a narrative therapy (NT) intervention in (i) reducing mental distress, depressive symptoms, and anxiety, as well as (ii) enhancing perceived control and fostering a stronger sense of self among at-risk youth in Hong Kong. Participants are youths with moderate mental health concerns, indicated by K6 scores ranging from 11 to 14.

The study involves seven clusters, each based on community hubs, which will be randomly assigned to either the intervention group or a wait-list control group. Clusters assigned to the intervention group will receive six face-to-face sessions led by trained youth workers. Control clusters will receive the same intervention after the initial follow-up period.

Participants will be evaluated at baseline, post-intervention, and one-month follow-up. An interim analysis is built for the sake of evaluation of the collected data from the ongoing trial, in which the primary research question is addressed, and which has the potential for modifying the conduct of the study. Furthermore, a qualitative follow-up will be conducted after the trial, involving both participants and the workers delivering the NT intervention. This qualitative component aims to gather feedback on participants' experiences, and inform potential revisions to enhance future implementation.

It is hypothesized that youths receiving the NT intervention will show significantly greater improvements in perceived control and sense of self, along with reductions in mental distress, as well as depressive and anxiety symptoms, compared to those in the wait-list control group.

Study Overview

• Status: Recruiting
• Conditions: Mental Distress
• Intervention / Treatment: Behavioral: Narrative Therapy

• Study Type: Interventional
• Enrollment (Estimated): 770
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Christy Lai Ming Hui, PhD; Phone Number: +852 2255 4486; Email: christy@lmhui.com
• Study Contact Backup: Name: Yi Nam Suen, PhD; Phone Number: +852 3917 6612; Email: suenyn@hku.hk

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • Recruiting
    • University of Hong Kong
    • Contact: Christy Lai Ming Hui, PhD; Phone Number: +852 2255 4486; Email: christy@lmhui.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• JC LevelMind @ Community users at risk for mental distress (Tier 2), with K6 scores ranging from 11 to 14
• Aged between 12 and 24 years
• Sufficiently proficient in Chinese to comprehend verbal instructions
• Able to provide written informed consent (parental consent for participant aged 12-17)

Exclusion Criteria:

• Known diagnosis of intellectual disability
• Organic brain disorder
• Established psychiatric diagnosis
• Current substance abuse
• Receiving other structured psychological therapies such as module-based psychological therapy, mentalization-based therapy, low-intensity online interventions, cognitive-behavioral therapy, cognitive-behavioral therapy for insomnia, mindfulness, or art-informed therapy within the hub setting or any others outside the hub setting
• Presence of current or active suicidal ideation or attempts

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: NT Intervention; This narrative therapy intervention will: (i) facilitate shared experiences among participants, (ii) support the reconstruction of personal identity, (iii) promote collective wisdom-sharing and skill development; and (iv) foster solidarity in imagining diverse life possibilities. This approach empowers young people to critically engage with dominant narratives and discover their own authentic paths. The NT intervention consists of six sessions, conducted in a small-group format (6 - 8 participants per group). Youths at similar life stages, such as secondary students, university students, and early-career young professionals, will be grouped together to encourage meaningful discussions and shared experiences. The program consists of six sessions, with the first five lasting 1.5 hours each, and the final session (Section 6) extending to 2 hours for a comprehensive closing. All sessions will be conducted face-to-face by frontline social or youth workers who have received prior training,	Behavioral: Narrative Therapy; In Hong Kong, deeply ingrained norms and expectations shape each stage of life. As young people navigate their growth, they are constantly influenced by mainstream narratives stemming from sociocultural traditions, family, educators, peers, or social media. These narratives often define socially approved notions of "good" versus "bad," "meaningful" versus "meaningless," and "successful" versus "failing." Many youths may not fully realize how these dominant discourses subtly influence their life choices, often leading them to unconsciously accept predetermined paths they believe they "should" follow. Whether they conform successfully or struggle with these expectations, young people frequently experience pressure and negative emotions. Even more concerning, some internalize these societal judgments, resulting in negative self-perceptions. Through this group program utilizing narrative intervention methods, we aim to provide a safe, supportive space for youth to re-examine and explore th
No Intervention: Waitlist Control; Participants allocated to the waitlist control group will wait for 10 weeks (6 + 4 weeks) before receiving the NT intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Psychological Distress	The 6-item Kessler Psychological Distress Scale (scores range from 0 to 24 where a higher score indicates a worse outcome)	Baseline, 6-week, and 10-week
Depression and anxiety Symptoms	Depression Anxiety Stress Scales (scores range from 0 to 63 where a higher score indicates more severe symptoms)	Baseline, 6-week, and 10-week
Perceived Control / Self-efficacy	Sense of Mastery Scale (scores range from 7 to 28 where a higher score indicates a a better outcome)	Baseline, 6-week, and 10-week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Narrative Identity	Narrative Identity Self-Evaluation Scale (scores range from 0 to 200 where a higher score indicates a better outcome)	Baseline, 6-week, and 10-week
Perceived Social Support	Multidimensional Scale of Perceived Social Support (scores range from 12 to 84 where a higher score indicates a better outcome)	Baseline, 6-week, and 10-week
Loneliness	UCLA Loneliness Scale (scores range from 20 to 80 where a higher score indicates a worse outcome)	Baseline, 6-week, and 10-week
Resilience	The 10-item Connor-Davidson Resilience Scale (scores range from 0 to 40 where a higher score indicates a better outcome)	Baseline, 6-week, and 10-week
Rumination	The 22-item Rumination-Reflection Questionnaire (scores range from 22 to 88 where a higher score greater rumination)	Baseline, 6-week, and 10-week
Self-stigma	The 9-item Internalized Stigma of Mental Illness Inventory (scores range from 1 to 4 where a higher score indicating high internalized stigma)	Baseline, 6-week, and 10-week
Hopefulness / Hopelessness	Beck Hopelessness Scale (scores range from 0 to 20 where a higher score indicates greater levels of hopelessness)	Baseline, 6-week, and 10-week
Service Utilization	Client Service Receipt Inventory	Baseline, 6-week, and 10-week

Collaborators and Investigators

• Sponsor: The University of Hong Kong
• Collaborators: The Hong Kong Jockey Club Charities Trust; Hong Kong Young Women's Christian Association; Caritas Medical Centre, Hong Kong; Tung Wah Group of Hospitals; The Salvation Army, Hong Kong and Macau Command; Hong Kong Christian Service; Hong Kong Sheng Kung Hui Welfare Council Limited; The Boys' and Girls' Clubs Association of Hong Kong; Yan Oi Tong; Chinese YMCA of Hong Kong; Hong Kong Playground Association (HKPA); Hong Kong Children and Youth Services (HKCYS); Hong Kong Federation of Youth's Group (HKFYG); Neighbourhood Advice-Action Council; St. James' Settlement
• Investigators: Principal Investigator: Christy Lai Ming Hui, PhD, The University of Hong Kong

Study record dates

Study Major Dates

• Study Start (Actual): December 3, 2025
• Primary Completion (Estimated): January 31, 2027
• Study Completion (Estimated): August 31, 2027

Study Registration Dates

• First Submitted: August 27, 2025
• First Submitted That Met QC Criteria: November 13, 2025
• First Posted (Actual): November 17, 2025

Study Record Updates

• Last Update Posted (Actual): March 30, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: cluster randomized controlled trial; narrative therapy; youths; mental distress
• Additional Relevant MeSH Terms: Psychotherapy; Behavioral Disciplines and Activities; Narrative Therapy
• Other Study ID Numbers: 20250818-006-000

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No