The Effectiveness of a One-stop Electronic Clinic for Psychological Service (eClinic) in Hong Kong

With an increasing need for effective and accessible mental health services, telepsychology can be one promising solution to narrowing the gap between demand and supply. Our one-stop electronic clinic of psychological service (eClinic) aims to deliver evidence-based treatments to individuals with moderate to severe emotional disorders of various kinds in Hong Kong. This study examines the cost-effectiveness and cost-efficiency of a hybrid model of telepsychology, in which contact with therapists focuses on facilitating service users' self-learning based on our online interactive modules. Results will shed light on the benefits of telepsychology to promoting access to mental health services in Hong Kong.

Study Overview

• Status: Completed
• Conditions: Anxiety; Common Mental Disorder; Depression / Major Depressive Disorder
• Intervention / Treatment: Other: Internet-based Unified Protocol (UP) Intervention

• Study Type: Observational
• Enrollment (Actual): 420

Contacts and Locations

Study Locations

• Hong Kong
  • Hong Kong
    • Hong Kong, Hong Kong, Hong Kong
      • New Life Psychiatric Rehabilitation Association

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Non-Probability Sample

Study Population

Individuals aged between 15 and 35 years that are able to speak, read, and write Chinese, and present with moderate to severe depression or anxiety at the time of intake.

Description

Inclusion Criteria:

• Screened eligible for and enrolled in the eClinic service
• Age between 15 and 35 years
• Speak, read, and write Chinese
• Present with moderate to severe depression (i.e., Patient Health Questionnaire-9 (PHQ-9) total score ≥ 10) or anxiety (i.e., Generalized Anxiety Disorder-7 (GAD-7) total score ≥ 8)

Exclusion Criteria:

• Present with a history of psychosis in the recent 2 years
• Present with severe risk for self-harm/suicide (i.e., indicated as being at higher risk on the P4 suicidality screener during the service-related screening procedure prior to enrollment in the eClinic service)
• Present with active homicidal ideations (i.e., assessed during the service-related screening procedure prior to enrollment in the eClinic service)
• Demonstrate sub-average intelligence (e.g., based on a history of intellectual disability)
• Concurrently receive other psychological services

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Health Questionnaire-9 (PHQ-9)	The PHQ-9 measures the presence of depressive symptoms in the recent two weeks. The scale measures the nine diagnostic criteria of major depressive disorder on a scale from 0 = not at all to 3 = nearly every day, according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Total score on the PHQ-9 ranges from 0 to 27, with higher scores indicating higher distress.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 1-, 2-, 3-, 6-, and 12-month follow-up
Generalized Anxiety Disorder-7 (GAD-7)	The GAD-7 assesses Generalized Anxiety Disorder (GAD) symptoms in the recent two weeks. It consists of 7 items, each rated on a 4-point Likert scale from 0 = not at all to 3 = nearly every day. Total score on the GAD-7 ranges from 0 to 21. A higher GAD-7 score indicates more severe impairment related to GAD symptoms.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 1-, 2-, 3-, 6-, and 12-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brief Experiential Avoidance Questionnaire (BEAQ)	The 15-item BEAQ assesses several domains of experiential avoidance. Items are rated on a 6-point Likert scale of 1 = strong disagree to 6 = strong agree. Total score of the BEAQ ranges from 15 to 90, with a higher score representing greater experiential avoidance.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 3- and 12-month follow-up
Difficulties in Emotion Regulation Scale-16 (DERS-16)	The DERS-16 assesses level of difficulties with emotion regulation. Each of the 16 items is rated on a 5-point Likert scale of 1 = almost never to 5 = almost always, with a total score ranges from 16 to 80.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 3- and 12-month follow-up
Cognitive Distortions Questionnaire (CD-Quest)	The CD-Quest is a self-report measure that contains 15 bi-dimensional items that measure the frequency and intensity of 15 cognitive distortions. For each type of cognitive distortions, participants indicate if it has occurred or not; for any occurrence, individuals rate the frequency and intensity of the cognitive distortion on a 3x3 grid. Therefore, score on each item ranges from 0 = no (it did not occur) to 5 = occurs almost all the time and with an intensity of more than 70%. Total score of the CD-Quest ranges from 0 to 75, with a higher score representing a higher frequency and intensity of cognitive distortions.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 3- and 12-month follow-up
Cognitive Flexibility Inventory (CFI)	The CFI is a self-report measure of cognitive flexibility. 20 items of the CFI are rated on a 7-point Likert scale of 1 (strongly disagree) to 7 (strongly agree). Total score of the CFI ranges from 20 to 140, with higher scores indicating greater cognitive flexibility.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 3- and 12-month follow-up
Gratitude Questionnaire-5 (GQ-5)	The GQ-5 is a self-reported instrument that assesses gratitude. Five items of the GQ-5 are rated on a 7-point Likert scale from 1 = strongly disagree to 7 = strongly agree. Total score of the GQ-5 ranges from 5 to 35, with higher scores indicating higher level of gratitude.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 3- and 12-month follow-up
Penn State Worry Questionnaire (PSWQ)	The PSWQ is a 16-item self-report instrument designed to measure the construct of worry. Each item is rated on a 5-point Likert scale that ranges from 1 = not at all typical of me to 5 = very typical of me. Five items are reversely scored to obtain a total score ranges from 16 to 80.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 1-, 2-, 3-, 6-, and 12-month follow-up
Liebowitz Social Anxiety Scale (LSAS)	The LSAS assesses fear and avoidance related to social anxiety disorder. The 24-item scale is divided into two broad domains of situations, with 11 items on social anxiety and 13 items on performance fear. Each of the 24 items is rated on a 4-point Likert scale of 0 = none to 3 = severe for anxiety items or usually for avoidance items. The total score of LSAS ranges from 0 to 144.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 1-, 2-, 3-, 6-, and 12-month follow-up
Obsessive-Compulsive Inventory-Revised (OCI-R)	The OCI-R is an 18-item self-report scale for measuring the severity of obsessive-compulsive symptoms. Each item is rated on a 5-point Likert scale of 0 = not at all to 4 = extremely. The OCI-R total score ranges from 0 to 72, with higher scores indicating a greater likelihood of OCD.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 1-, 2-, 3-, 6-, and 12-month follow-up
Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5)	The PCL-5 is a self-report measure of posttraumatic stress disorder (PTSD) symptom severity, based on its diagnostic criteria in Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5). Each of the 20 items is rated on a 5-point Likert scale of 0 = not at all to 4 = extremely. The PCL-5 total score ranges from 0 to 80, with higher scores indicating greater PTSD severity.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 1-, 2-, 3-, 6-, and 12-month follow-up
Insomnia Severity Index (ISI)	The ISI evaluates the nature, severity, and impact of insomnia. It consists of 7 items rated on a 5-point Likert scale from 0 = no problem to 4 = very severe problem, with a total score ranging from 0 to 28. Higher scores on the ISI indicate more severe insomnia.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 1-, 2-, 3-, 6-, and 12-month follow-up
Short Health Anxiety Inventory (SHAI)	The SHAI is an 18-item self-report measure that assesses an individual's concern about possibly having health illnesses of different kinds, and the catastrophic thinking about having the illnesses. Total score of the SHAI ranges from 0 to 54, where higher scores indicate greater health anxiety.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 1-, 2-, 3-, 6-, and 12-month follow-up
Work and Social Adjustment Scale (WSAS)	The WSAS is a 5-item scale that measures self-report severity of impairment across five domains of functioning. Each item is rated on a 9-point Likert scale of 0 = not at all to 8 = very severely. Total score of the WSAS ranges from 0 to 40, where higher scores indicate greater functional impairment.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 3- and 12-month follow-up
Rosenberg Self-Esteem Scale (RSES)	The RSE has 10 items that assess self-esteem, each rated on a 4-point Likert scale of 1 = strongly agree to 4 = strongly disagree. Total score of the RSE ranges from 0 to 30, with lower scores suggesting lower self-esteem.	Baseline (week 0), post-intensive (week 5; after completion of core modules), posttreatment (week 14; completion of the intervention), and 3- and 12-month follow-up

Collaborators and Investigators

• Sponsor: New Life Psychiatric Rehabilitation Association
• Collaborators: Chinese University of Hong Kong; The Hong Kong Jockey Club Charities Trust

Study record dates

Study Major Dates

• Study Start (Actual): December 28, 2022
• Primary Completion (Actual): October 31, 2025
• Study Completion (Actual): October 31, 2025

Study Registration Dates

• First Submitted: May 8, 2026
• First Submitted That Met QC Criteria: May 14, 2026
• First Posted (Actual): May 20, 2026

Study Record Updates

• Last Update Posted (Actual): May 20, 2026
• Last Update Submitted That Met QC Criteria: May 14, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Mood Disorders; Depressive Disorder; Behavior; Anxiety Disorders; Depression; Depressive Disorder, Major; Investigative Techniques; Methods
• Other Study ID Numbers: 2022.106

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