This initiative aims to improve flourishing and quality of life of secondary school students, reduce mental distress (e.g., depression and suicidal ideation), enhance their understanding of mental health (e.g., mental health literacy) and help-seeking intention, and foster a supportive school environment (e.g., school climate-caring relationship, and sense of community). Also, this initiative aims to improve students' process of change in psychological (e.g., mattering, emotion regulation, empowerment) and social (e.g., trust belief) aspects and mental health awareness (e.g., mental health stigma). The feasibility, acceptability, and sustainability of the programme from multiple perspectives (e.g., students, student leaders, and stakeholders) will also be evaluated. In addition, the cost-effectiveness of delivering this programme (e.g., the incremental cost-effectiveness ratio (ICER)) among secondary schools in Hong Kong will be assessed.
The programme will be implemented among students in 130 local secondary schools over three academic years. The first is a pilot phase (Year 1), which 40 schools will implement the intervention and student participants will be evaluated at pre- (T0) and post-intervention (T1) using questionnaires. In this stage, participatory research will be conducted before and after the intervention among students, student leaders, and stakeholders in 20 pilot schools to co-design the intervention, ensuring the programme meet the actual wellness needs of youth. In following two academic years, an additional 90 schools will participate in a cluster randomized controlled trial (RCT) with a 1:1 ratio between intervention and waitlist control groups. Each year, 45 schools will implement the intervention. Summative evaluation will be conducted among RCT schools at T0 and T1, and 3-month follow-up (T2). Quantitative data be collected to assess the effectiveness of intervention, and qualitative data will provide understanding of students' and stakeholders' perspectives of the intervention implementation. Cost outcomes will include intervention costs and cost savings, calculated from the payer (i.e., JC/government) perspective using administrative records or validated tools. The primary outcome of cost-effectiveness will be the quality-adjusted life-years (QALYs) of students. Cost of implementing the intervention program and QALYs will be used to evaluate the cost-effectiveness of the intervention, for example, estimate the incremental cost-effectiveness ratio (ICER).
student in Hong Kong secondary school
Studying at Form 1 to Form 3 at the time of recruitment
Competence in comprehending written Chinese or English
Competence in speaking Cantonese or English
Not studying at Form 1 to 3 in Hong Kong secondary school
Incompetence in comprehending written Chinese or English
Incompetence in speaking Cantonese or English
No written consent from students or their legal guardian
Crossover
School-based intervention program on improving adolescent mental wellbeing
BehavioralStudents participating in the intervention program will attend the school talk and workshops about mental health. They are also required to organize whole-school activities to promote peer mental wellbeing at school. All attended students will be guided by registered social workers and trained research personnel throughout the intervention program.
Control-no treatment
Other interventionStudents participating at control group will not receive intervention program during the academic year compared with their counterparts in active comparator group. They will live and attend the class as usual at school. After the academic year, they will receive the intervention program on the alternative academic year.
Flourishing
Students' psychological wellbeing is measured by the Mental Health Continuum-Short Form (MHC-SF). It is a 14 items validated measure for Chinese adolescent. Each item is scored from 0 (Never) to 5 (every day). Among the 14 items, 3 are emotional well-being questions and 11 are positive functioning questions. Adolescents are considered to be "flourishing" if they score 4 or above to at least 1 of the emotional questions and to at least 6 of the positive functioning questions; considered to be "languishing" if they score 1 or below to 1 or more of the 3 emotional questions and to 6 or more of the 11 positive functioning questions; considered to have "moderate mental health" if they are neither flourishing nor languishing.
Depression and Anxiety
Depression and anxiety will be assessed with the 4-item Patient Health Questionnaire-4 (PHQ-4), an ultra-brief self-report questionnaire that consists of a 2-item anxiety scale (GAD-2) and a 2-item depression scale (PHQ-2). The PHQ-2 consists of the two core criteria for depressive disorders, with the two items determining depression and the two items of the GAD-2 assess the core criteria for generalized anxiety disorders. This tool has been validated and used in adolescent populations. Each item of this 4-item survey is graded on a 4-point Likert scale scoring from 0 (Not at all) to 3 (Nearly every day). The total score of each part is 6. Scale scores of ≥3 was suggested as cut-off points between the normal range and probable cases of depression or anxiety respectively PHQ-4 scores go from normal (0 -2), mild (3-5), moderate (6-8) to severe (9 -12).
Suicidal ideation and attempt
Suicidal ideation and attempt will be assessed by 2 questions from the PHQ-A, "Has there been a time in the past month when you have had serious thoughts about ending your life?" and "Have you ever, in your whole life, tried to kill yourself or made a suicide attempt?"
Social support
A 3-item subscale of the Comprehensive Inventory of Thriving (CIT) will be employed to measure the level of social support perceived from the environment for adolescents. Each item of the subscale is graded on a 5-point Likert scale scoring from 1 (Strongly disagreed) to 5 (Strongly agreed). The three questions are 'There are people I can depend on to help me', 'There are people who give me support and encouragement' and 'There are people who appreciate me as a person'. Higher score indicates higher level of perceived social support.
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Chinese University of Hong Kong
Lead sponsor
New Life Psychiatric Rehabilitation Association
Collaborator
The University of Hong Kong
Collaborator
The Hong Kong Jockey Club Charities Trust
Collaborator
The Hong Kong Polytechnic University
Collaborator
