Effectiveness of an integrated prevention programme (“JoyAge”) for depressive symptoms, anxiety, and loneliness in older adults in Hong Kong: a pragmatic quasi-experimental trial

Abstract

Background: With population ageing and insufficient mental health workforce, there are huge treatment gaps for late-life depression. Real-world evidence of scalable preventive services is scarce. This study examines the effectiveness of an integrated selective and indicated prevention programme for late-life depression in a large group of older adults in Hong Kong. Methods: This was a pragmatic quasi-experimental trial of a new service (“JoyAge”) for older people with risk factors for late-life depression or subsyndromal depressive symptoms. Participants were recruited and allocated, based on their district of residence, to receive JoyAge (N=2975) or usual care (N=441). The primary outcome was depressive symptoms (PHQ-9) at 12-month follow-up; secondary outcomes were anxiety symptoms (GAD-7) and loneliness (UCLA-3). Analyses were conducted in an intention-to-treat framework using mixed modelling, with subgroup analyses based on baseline depressive symptoms, and sensitivity analyses in a 1:1 (N=422 each group) propensity score-matched sample. Results: The JoyAge participants had a greater reduction in depressive symptoms over the 12-month period compared to those assigned to usual care (adjusted mean difference [AMD]=1.65, 95% CI=1.24-2.07, p<.001), similarly in anxiety symptoms (AMD=1.47, 95% CI=1.01-1.93, p<.001), and loneliness (AMD=1.29, 95% CI=0.98-1.60, p<.001). Results were similar in propensity-score matched analyses. Subgroup analysis showed that JoyAge was particularly effective among people with moderate to moderately severe symptoms and those with risk factors only. Conclusions: Integrated late-life depression prevention can be effectively implemented at scale in rapidly ageing settings with a limited specialist mental health workforce. Economic analyses are needed to support further implementation.