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

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.