A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China

Sit, Hao Fong; Li, Gen; Chen, Wen; Sou, Elvo K. L.; Wong, Mek; Burchert, Sebastian; Hong, Ieng Wai; Sit, Ho Yi; Lam, Agnes Iok Fong; Hall, Brian J.

doi:10.1016/j.invent.2022.100579

Cited by 3 publications

(3 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, we consider the reliability of PSYCHLOPS as acceptable [ 42 ]. A more extensive description of the measures can be found in the trial protocol [ 43 ].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial

Li,

Sit,

Chen

et al. 2024

Transl Psychiatry

Self Cite

View full text Add to dashboard Cite

Common mental disorders among young people are rising globally. Current university-based interventions are inadequate to address the need for evidence-based interventions. We investigated the effectiveness and implementation of Step-by-Step (SbS), a WHO digital intervention to address depression, among Chinese university students with depressive symptoms. In this paper, we report a type 1 hybrid effectiveness-implementation randomized controlled trial conducted between September 2021 and September 2022. The control condition was enhanced treatment as usual (ETAU, psychoeducation). The primary outcome was improvement in depression symptoms. Secondary outcomes were improvements in psychological well-being, anxiety symptoms, and self-identified psychosocial problems. Effectiveness of the intervention was evaluated using generalized linear mixed models. Implementation outcomes were evaluated by thematic analysis of participant interviews. A total of 371 participants were enrolled to two treatment conditions in a 1:1 ratio. SbS resulted in a greater reduction in depressive symptoms at posttreatment (p = 0.004, Hedges’ g = 0.35), but no significant difference between SbS and ETAU was observed at three-month follow-up (p = 0.179, Hedges’ g = 0.16). The treatment effect was larger among those who adhered to the treatment (Hedges’ gs = 0.59 and 0.30). Subjective well-being also improved for SbS at both time points (Hedges’ gs = 0.31 and 0.30). In addition, SbS resulted in more improvement in anxiety symptoms at posttreatment (p = 0.029, Hedges’ g = 0.26), but not at three-month follow-up (p = 0.265, Hedges’ g = 0.13). The qualitative results demonstrated that the intervention was well-implemented as a self-help mental health service, with minimal support from peer supporters. In conclusion, Step-by-Step, a digital intervention developed by WHO, was effective in reducing depressive symptoms in the short term and improving psychological well-being in a longer term. The sustained effect on depression needs further investigation. Improving uptake and engagement in the program is needed for its scale-up implementation as a university-based mental health service for Chinese young adults. Trial registration: ChiCTR2100050214.

show abstract

“…Therefore, we consider the reliability of PSYCHLOPS as acceptable [ 42 ]. A more extensive description of the measures can be found in the trial protocol [ 43 ].…”

Section: Methodsmentioning

confidence: 99%

“…The quantitative data were analyzed using R by an independent biostatistician, blind to condition assignment, following the pre-registered study protocol [ 43 ]. Chi-square analyses and t-tests were performed to compare baseline characteristics between conditions and dropout status (e.g., sex, age, and educational level).…”

Section: Methodsmentioning

confidence: 99%

A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial

Li,

Sit,

Chen

et al. 2024

Transl Psychiatry

Self Cite

View full text Add to dashboard Cite

show abstract

“…The current qualitative study used the RE-AIM evaluation framework ( Glasgow et al, 1999 , Glasgow et al, 2019 ; Holtrop et al, 2021 ), which has recently been applied in other ICBT implementation research (e.g., Lundström et al, 2023 ; Sit et al, 2022 ), to assess PSP leaders' perceptions of PSPNET along five dimensions including: reach, effectiveness, adoption, implementation, and maintenance. Quantitative data has typically been used during evaluations using the RE-AIM framework; however, there has recently been increased emphasis on using qualitative data to provide insights into the five dimensions ( Holtrop et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework

Beahm,

McCall,

Carleton

et al. 2024

Internet Interventions

View full text Add to dashboard Cite

A Feasibility Study of the WHO Digital Mental Health Intervention Step-by-Step to Address Depression Among Chinese Young Adults

Sit

Hong²,

Burchert

et al. 2022

Front. Psychiatry

View full text Add to dashboard Cite

Background: Chinese young adults experience barriers to mental health treatment, including the lack of treatment providers and stigma around treatment seeking. Evidence-based digital mental health interventions are promising and scalable alternatives to face-to-face treatment for this population, but lack rigorous evidence to support scale-up in China.Aim: The study was a feasibility study for a large-scale RCT of Step-by-Step, a behavioral activation-based, mental health intervention to address depression and anxiety symptoms in Chinese young adults. It sought to assess feasibility of recruitment and of delivery of Step-by-Step in a University setting, to assess acceptability of the intervention, and to examine potential effectiveness.Method: An uncontrolled, feasibility trial was conducted to assess the feasibility and acceptability of Chinese Step-by-Step for Chinese University students with elevated depressive symptoms (PHQ-9 scores at or above 10) in Macao, China. Data was collected at two different time points (i.e., baseline and 8-weeks after baseline), administered via questionnaires embedded in an interventional mobile application. Participation rate and dropout rate were measured. Depressive and anxiety symptom severity, well-being, and self-defined stress were assessed. Satisfaction with the program was assessed using qualitative interviews.Results: A total of 173 students were screened, 22.0% (n = 38) were eligible, and 63.2% of them (n = 24) started the intervention. The dropout rate by post-test was 45.8%. Results from completers showed that Step-by-Step was potentially effective in reducing depressive and anxiety symptom severity, and self-defined stress. Students were generally satisfied with the program, but also offered suggestions for continued improvement. Qualitative feedback was reported within the RE-AIM framework, covering recruitment, effectiveness, adoption, implementation, and maintenance. Amendments to the program were made according to the feedback (e.g., adding notification for new session, modify the time zone).Conclusion: A minimally guided Step-by-Step protocol and the study procedure were successfully pilot tested for use for Chinese University students. The intervention was acceptable and no adverse events were reported. The results support the potential effectiveness and feasibility of a large-scale evaluation of the program.

show abstract

A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China

Cited by 3 publications

References 52 publications

A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial

A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial

Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework

A Feasibility Study of the WHO Digital Mental Health Intervention Step-by-Step to Address Depression Among Chinese Young Adults

Contact Info

Product

Resources

About