Suen Yi Nam, Hui Christy Lai Ming, Lei Lauren Ka Shun, Leung Chung Ming, Wong Stephanie Ming Yin, Lai Gabriel Chun Hei, Chau Esther Hang Sze, Wong Michael Tak Hing, Chan Sherry Kit Wa, Wong Gloria Hoi Yan, Chen Eric Yu Hai
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
JAMA Netw Open. 2025 Jan 2;8(1):e2454675. doi: 10.1001/jamanetworkopen.2024.54675.
Mental health issues among young people are increasingly concerning. Conventional psychological interventions face challenges, including limited staffing, time commitment, and low completion rates.
To evaluate the effect of a low-intensity online intervention on young people in Hong Kong experiencing moderate or greater mental distress.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from May 12, 2022, to September 22, 2023, in Hong Kong. Participants (aged 12-30 years) were recruited from a community project, self-reported moderate to severe distress (Kessler Psychological Distress Scale score ≥5), and were randomized 1:1 to receive the low-intensity online intervention or self-help tips (waitlist group).
The low-intensity online intervention group received 4 weekly 1-on-1 online sessions on stress management, sleep, or problem-solving delivered by trained psychological well-being practitioners. The waitlist group received weekly mental health tips via text messaging.
Primary outcomes were changes in Kessler Psychological Distress Scale scores and depression and anxiety subscale scores of the Depression, Anxiety, and Stress Scale. Secondary outcomes included general stress, overall negative emotions, quality of life, sleep quality, resilience, and self-efficacy. The primary outcome analysis was based on intention to treat with the last observation carried forward approach. Sensitivity analyses were conducted using per-protocol and multiple imputation methods.
Of 332 screened participants, 120 (mean [SD] age, 22.4 [3.4] years; 87 [72.5%] female) were randomized. From baseline to 4 weeks, the low-intensity online intervention group and the control group both saw reductions in scores for depression (mean [SD] difference, 6.0 [7.7] and 4.8 [7.9]; P = .17; ηp2 = 0.02), anxiety (mean [SD] difference, 6.0 [7.7] and 3.5 [7.7]; P = .07; ηp2 = 0.03), and psychological distress (mean [SD] difference, 3.8 [3.8] and 2.9 [3.8]; P = .24; ηp2 = 0.01), but none of these differences were statistically significant. However, the intervention group showed greater reductions in general stress (mean [SD] difference, 7.5 [7.2] vs 4.4 [7.2]; P = .02; ηp2 = 0.05), negative emotion (mean [SD] difference, 20.3 [19.2] vs 12.7 [19.2]; P = .03; ηp2 = 0.04), and increased resilience (mean [SD] difference, 0.5 [0.6] vs 0.2 [0.6]; P = .01; ηp2 = 0.05) compared with the waitlist group. Younger participants and those with lower initial distress experienced greater improvements. The findings were supported by the per-protocol analysis but not by multiple imputation analysis.
A low-intensity online intervention did not significantly improve distress, depressive, or anxiety symptoms but showed some potential in reducing general stress and negative emotions and improving resilience. These findings are encouraging but not definitive, and caution is needed due to missing data. These data suggest that a low-intensity online intervention may offer a scalable option for youth mental health.
ClinicalTrials.gov Identifier: NCT05510453.
年轻人的心理健康问题日益受到关注。传统的心理干预面临挑战，包括人员配备有限、时间投入大以及完成率低。
评估低强度在线干预对香港有中度或更严重心理困扰的年轻人的效果。
设计、地点和参与者：这项随机临床试验于2022年5月12日至2023年9月22日在香港进行。参与者（年龄在12 - 30岁之间）从一个社区项目中招募，自我报告有中度至重度困扰（凯斯勒心理困扰量表得分≥5），并以1:1的比例随机分组，接受低强度在线干预或自助小贴士（候补名单组）。
低强度在线干预组接受由训练有素的心理健康从业者提供的为期4周的每周1次一对一在线课程，内容涉及压力管理、睡眠或问题解决。候补名单组通过短信接收每周的心理健康小贴士。
主要结局是凯斯勒心理困扰量表得分以及抑郁、焦虑和压力量表的抑郁和焦虑子量表得分的变化。次要结局包括一般压力、总体负面情绪、生活质量、睡眠质量、心理韧性和自我效能感。主要结局分析基于意向性分析，并采用末次观察结转法。使用符合方案分析和多重填补法进行敏感性分析。
在332名筛查参与者中，120人（平均[标准差]年龄，22.4[3.4]岁；87人[72.5%]为女性）被随机分组。从基线到4周，低强度在线干预组和对照组的抑郁得分（平均[标准差]差异，6.0[7.7]和4.8[7.9]；P = 0.17；ηp2 = 0.02）、焦虑得分（平均[标准差]差异，6.0[7.7]和3.5[7.7]；P = 0.07；ηp2 = 0.03）和心理困扰得分（平均[标准差]差异，3.8[3.8]和2.9[3.8]；P = 0.24；ηp2 = 0.01）均有所下降，但这些差异均无统计学意义。然而，与候补名单组相比，干预组在一般压力（平均[标准差]差异，7.5[7.2]对4.4[7.2]；P = 0.02；ηp2 = 0.05）、负面情绪（平均[标准差]差异，20.3[19.2]对12.7[19.2]；P = 0.03；ηp2 = 0.04）方面下降幅度更大，心理韧性有所提高（平均[标准差]差异, 0.5[0.6]对0.2[0.6]；P = 0.01；ηp2 = 0.05）。较年轻的参与者和初始困扰较低的参与者改善更大。符合方案分析支持了这些发现，但多重填补分析未支持。
低强度在线干预并未显著改善困扰、抑郁或焦虑症状，但在减轻一般压力和负面情绪以及提高心理韧性方面显示出一定潜力。这些发现令人鼓舞但不具有决定性，由于存在数据缺失，需要谨慎对待。这些数据表明，低强度在线干预可能为青少年心理健康提供一种可扩展的选择。
ClinicalTrials.gov标识符：NCT05510453。
