Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial

Tianyin Liu, Dara Kiu Yi Leung, Shiyu Lu, Wai-Wai Kwok, Lesley Cai Yin Sze, Samson Shu Ki Tse, Siu Man Ng, Paul Wai Ching Wong, Vivian Wei Qun Lou, Jennifer Yee Man Tang, Daniel Fu Keung Wong, Wai Chi Chan, Ricky Yu Kwong Kwok, Terry Yat Sang Lum, Gloria Hoi Yan Wong, Tianyin Liu, Dara Kiu Yi Leung, Shiyu Lu, Wai-Wai Kwok, Lesley Cai Yin Sze, Samson Shu Ki Tse, Siu Man Ng, Paul Wai Ching Wong, Vivian Wei Qun Lou, Jennifer Yee Man Tang, Daniel Fu Keung Wong, Wai Chi Chan, Ricky Yu Kwong Kwok, Terry Yat Sang Lum, Gloria Hoi Yan Wong

Abstract

Background: Late-life depression is common, modifiable, yet under-treated. Service silos and human resources shortage contribute to insufficient prevention and intervention. We describe an implementation research protocol of collaborative stepped care and peer support model that integrates community mental health and aged care services to address service fragmentation, using productive ageing and recovery principles to involve older people as peer supporters to address human resource issue.

Methods/design: This is a non-randomised controlled trial examining the effectiveness and cost-effectiveness of the "Jockey Club Holistic Support Project for Elderly Mental Wellness" (JC JoyAge) model versus care as usual (CAU) in community aged care and community mental health service units in 12 months. Older people aged 60 years and over with mild to moderate depressive symptoms or risk factors for developing depression will be included. JoyAge service users will receive group-based activities and psychoeducation, low-intensity psychotherapy, or high-intensity psychotherapy according to the stepped care protocol in addition to usual community mental health or aged care, with support from an older peer supporter. The primary clinical outcome, depressive symptoms, and secondary outcomes, self-harm risk, anxiety symptoms, and loneliness, will be measured with the Patient Health Questionnaire-9 (PHQ-9), Self-Harm Inventory, Generalized Anxiety Disorder 7-item scale (GAD-7), and UCLA Loneliness 3-item scale (UCLA-3) respectively. Cost-effectiveness analysis will assess health-related quality of life using the EQ-5D-5L and service utilisation using the Client Service Receipt Inventory (CSRI). We use multilevel linear mixed models to compare outcomes change between groups and calculate the incremental cost-effectiveness ratio in terms of quality-adjusted life years.

Discussion: This study will provide evidence about outcomes for older persons with mental health needs receiving collaborative stepped care service without silos and with trained young-old volunteers to support engagement, treatment, and transitions. Cost-effectiveness findings from this study will inform resource allocation in this under-treated population.

Trial registration: ClinicalTrials.gov NCT03593889. Registered on 20 July 2018.

Keywords: Collaborative stepped care; Cost-effectiveness; Depressive symptoms; Early intervention; Effectiveness; Older adults; Peer support; Prevention.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Collaborative stepped care and peer support services flowchart
Fig. 2
Fig. 2
Consolidated Standards of Reporting Trials (CONSORT) flow chart of JoyAge trial

References

    1. Volkert J, et al. The prevalence of mental disorders in older people in Western countries–a meta-analysis. Ageing Res Rev. 2013;12(1):339–353.
    1. Sun WJ, et al. Depressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort study. Soc Psychiatry Psychiatr Epidemiol. 2012;47(4):505–514.
    1. Chi I, et al. Prevalence of depression and its correlates in Hong Kong’s Chinese older adults. Am J Geriatr Psychiatry. 2005;13(5):409–416.
    1. United Nations Department of Economic and Social Affairs, P.D . World Population Prospects 2019: Data Booklet. New York: United Nations; 2019.
    1. van Zoonen K, et al. Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. Int J Epidemiol. 2014;43(2):318–329.
    1. Schoevers RA, et al. Prevention of late-life depression in primary care: do we know where to begin? Am J Psychiatry. 2006;163(9):1611–1621.
    1. Greenberg PE, et al. The economic burden of adults with major depressive disorder in the United States (2005 and 2010) J Clin Psychiatry. 2015;76(2):155–162.
    1. Van’t Veer-Tazelaar PJ, et al. Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. Arch General psychiatry. 2009;66(3):297–304.
    1. Wang PDO, Olfson M, Pincus HA, Wells KB, Kessler RC. Changing profiles of service sectors used for mental health care in the United States. Am J Psychiatry. 2006;163:1187–1198.
    1. Nip PT. Social Welfare Development in Hong Kong: Changes and Challenges in Building a Caring and Harmonious Society. Asia Pacific J Soc Work Dev. 2010;20(1):71–72.
    1. Chan WC, Lam LCW, Chen EYH. Hong Kong: recent development of mental health services. BJ Psych Adv. 2015;21(1):71–72.
    1. Schreiber RJ. Patient centered medical homes and the care of older adults. Public Policy Aging Report. 2017;27(suppl_1):S7–S11.
    1. Carlat D. 45,000 More Psychiatrists, Anyone? 2010. . Accessed 15 Feb 2019.
    1. Barney LJ, et al. Stigma about depression and its impact on help-seeking intentions. Aust N Z J Psychiatry. 2006;40(1):51–54.
    1. Mickus M, Colenda CC, Hogan AJ. Knowledge of mental health benefits and preferences for type of mental health providers among the general public. Psychiatr Serv. 2000;51:199–202.
    1. Yang LH. Application of mental illness stigma theory to Chinese societies: synthesis and new direction. Singap Med J. 2007;48(11):977.
    1. Chung K, Wong M. Experience of stigma among Chinese mental health patients in Hong Kong. Psychiatr Bull. 2004;28(12):451–454.
    1. Katon W, et al. Collaborative management to achieve treatment guidelines: impact on depression in primary care. Jama. 1995;273(13):1026–1031.
    1. Katzelnick DJ, et al. Randomized trial of a depression management program in high utilizers of medical care. Arch Fam Med. 2000;9(4):345.
    1. Chew-Graham CA, et al. A randomised controlled trial to test the feasibility of a collaborative care model for the management of depression in older people. Br J Gen Pract. 2007;57(538):364–370.
    1. Unützer J, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. Jama. 2002;288(22):2836–2845.
    1. Unützer J, et al. Improving primary care for depression in late life: the design of a multicenter randomized trial. Med Care. 2001:785–99.
    1. Bower P, Gilbody S. Stepped care in psychological therapies: Access, effectiveness and efficiency. National literature review. Br J Psychiatry. 2005;186:1–17.
    1. Richards D, et al. Delivering stepped care: an analysis of implementation in routine practice. Implementation Science. 2012;7(1):3.
    1. van Straten A, et al. Stepped care for depression in primary care: what should be offered and how? Med J Aust. 2010;192(11):S36–S39.
    1. Clark DM, et al. Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behav Res Ther. 2009;47(11):910–920.
    1. Clark DM. Realizing the mass public benefit of evidence-based psychological therapies: the IAPT program. Ann Rev Clin Psychol. 2018;14
    1. Clark DM, et al. Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet. 2018;391(10121):679–686.
    1. Eaton J, et al. Scale up of services for mental health in low-income and middle-income countries. Lancet. 2011;278:1592–1603.
    1. World Health Organization. Joint WHO/OGAC Technical Consultation on Task Shifting: Key Elements of a Regulatory Framework in Support of In-country Implementation of Task Shifting. 2007. . Accessed 1 Jan 2019.
    1. Davidson L, B.C., Guy K, Miller R Peer support among persons with severe mental illnesses: A review of evidence and experience. World Psychiatry, 2012(11): p. 123–128.
    1. Repper J, Carter T. A review of the literature on peer support in mental health services. J Mental Health. 2011;20(4):392–411.
    1. Pfeiffer PN, et al. Efficacy of peer support interventions for depression: a meta-analysis. Gen Hosp Psychiatry. 2011;33(1):29–36.
    1. Kroenke K, Spitzer RL, Williams JB. The Phq-9. J Gen Int Med. 2001;16(9):606–613.
    1. Chan A-W, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207.
    1. Bystedt S, et al. Clinicians' Perspectives on Negative Effects of Psychological Treatments. Cogn Behav Ther. 2014;43(4):319–331.
    1. Condon HE, Maurer LF, Kyle SD. Reporting of adverse events in cognitive behavioural therapy for insomnia: A systematic examination of randomised controlled trials. Sleep Med Rev. 2021;56:101412.
    1. Chan SS, et al. Outcomes of a two-tiered multifaceted elderly suicide prevention program in a Hong Kong Chinese community. Am J Geriatr Psychiatry. 2011;19(2):185–196.
    1. Stice E, et al. A meta-analytic review of depression prevention programs for children and adolescents: factors that predict magnitude of intervention effects. J Consult Clin Psychol. 2009;77(3):486–503.
    1. van Straten A, et al. Stepped care treatment delivery for depression: a systematic review and meta-analysis. Psychol Med. 2015;45(2):231–246.
    1. Sverdlov O, Ryeznik Y. Implementing unequal randomization in clinical trials with heterogeneous treatment costs. Stat Med. 2019;38(16):2905–2927.
    1. Gratz KL. Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. J Psychopathol Behav Assess. 2001;23:253–263.
    1. Spitzer RL, et al. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Arch Intern Med. 2006;166(10):1092–1097.
    1. Hughes ME, et al. A short scale for measuring loneliness in large surveys results from two population-based studies. Res Aging. 2004;26(6):655–672.
    1. Herdman M, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20(10):1727–1736.
    1. EuroQol Research Foundation. EQ-5D-5L User Guide. . Accessed 1 Oct 2017.
    1. Chisholm D, et al. Client Socio-Demographic and Service Receipt Inventory-European Version: development of an instrument for international research. Br J Psychiatry. 2000;177(39):s28–s33.
    1. Hong Kong Government Secretariat. Head 140 — Government Secretariat: Food And Health Bureau (Health Branch). 2019. . Accessed 29 Mar 2020.
    1. HK Social Welfare Department. Salary Scale of Common Posts in the Non-governmental Organisations. 2018. . Accessed 30 May 2020.
    1. Wong A, et al. Montreal Cognitive Assessment 5-minute protocol is a brief, valid, reliable, and feasible cognitive screen for telephone administration. Stroke. 2015;46(4):1059–1064.
    1. Des Jarlais DC, et al. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004;94(6):361–366.
    1. Leyrat C, et al. Cluster randomized trials with a small number of clusters: which analyses should be used? Int J Epidemiol. 2018;47(1):321–331.
    1. StataCorp, Stata Statistical Software: Release 14. 2015, College Station, TX: StataCorp LP.
    1. National Institute for Health and Care Excellence. Developing NICE guidelines: the manual (PMG20). 2014. . Accessed 1 Mar 2020.
    1. Luyten J, Naci H, Knapp M. Economic evaluation of mental health interventions: an introduction to cost-utility analysis. Evidence-Based Mental Health. 2016;19(2):49–53.
    1. Wong, K. and M. Yeung. Population ageing trend of Hong Kong. Econ Letter 2019/02 2019; Available from: .

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться