A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial
Abstract 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 depre...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Publishing Group
2024-02-01
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| Series: | Translational Psychiatry |
| Online Access: | https://doi.org/10.1038/s41398-024-02812-3 |
| _version_ | 1797273114659258368 |
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| author | Gen Li Hao Fong Sit Wen Chen Kunpeng Wu Elvo Kuai Long Sou Mek Wong Ze Chen Sebastian Burchert Ieng Wai Hong Ho Yi Sit Agnes Iok Fong Lam Brian J. Hall |
| author_facet | Gen Li Hao Fong Sit Wen Chen Kunpeng Wu Elvo Kuai Long Sou Mek Wong Ze Chen Sebastian Burchert Ieng Wai Hong Ho Yi Sit Agnes Iok Fong Lam Brian J. Hall |
| author_sort | Gen Li |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-07T14:39:56Z |
| format | Article |
| id | doaj.art-98999b2eb710468b88abdb1d7bb0ceb0 |
| institution | Directory Open Access Journal |
| issn | 2158-3188 |
| language | English |
| last_indexed | 2024-03-07T14:39:56Z |
| publishDate | 2024-02-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Translational Psychiatry |
| spelling | doaj.art-98999b2eb710468b88abdb1d7bb0ceb02024-03-05T20:26:23ZengNature Publishing GroupTranslational Psychiatry2158-31882024-02-0114111110.1038/s41398-024-02812-3A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trialGen Li0Hao Fong Sit1Wen Chen2Kunpeng Wu3Elvo Kuai Long Sou4Mek Wong5Ze Chen6Sebastian Burchert7Ieng Wai Hong8Ho Yi Sit9Agnes Iok Fong Lam10Brian J. Hall11Center for Global Health Equity, New York University ShanghaiDepartment of Psychology, The University of Hong KongDepartment of Medical Statistics, School of Public Health, Sun Yat-sen UniversityDepartment of Medical Statistics, School of Public Health, Sun Yat-sen UniversityStudent Affairs Office, University of MacauStudent Affairs Office, University of MacauCentre for Macau Studies, University of MacauDepartment of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität BerlinMoon Chun Memorial College, University of MacauShiu Pong College, University of MacauCentre for Macau Studies, University of MacauCenter for Global Health Equity, New York University ShanghaiAbstract 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.https://doi.org/10.1038/s41398-024-02812-3 |
| spellingShingle | Gen Li Hao Fong Sit Wen Chen Kunpeng Wu Elvo Kuai Long Sou Mek Wong Ze Chen Sebastian Burchert Ieng Wai Hong Ho Yi Sit Agnes Iok Fong Lam Brian J. Hall A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial Translational Psychiatry |
| title | A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial |
| title_full | A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial |
| title_fullStr | A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial |
| title_full_unstemmed | A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial |
| title_short | A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial |
| title_sort | who digital intervention to address depression among young chinese adults a type 1 effectiveness implementation randomized controlled trial |
| url | https://doi.org/10.1038/s41398-024-02812-3 |
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