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The proposed study will be a randomized, assessor-blind controlled trial embedding both outcome and process evaluations of a 6-week group LM intervention with/without self-tracking tools (Study I). The outcome evaluation will examine the effects of LM-S and LM alone vs. CAU, and the process evaluation will enhance the understanding of the causal assumptions that underpin LM to inform policy and clinical practice. Eligible participants with at least a moderate level of depression will be randomly assigned to the LM- S, LM alone, and CAU groups in a 1:1:1 allocation ratio. The study period will be 18 weeks. Assessments at baseline, week 7 (1-week post-intervention), and week 18 (12-week post-intervention) will be managed by an independent assessor (a research assistant, RA) who is blind to the group allocation. The proposed trial and the nested pilot study will follow the CONSORT and STROBE guidelines, respectively. The intervention will be provided free of charge.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lifestyle medicine intervention with self-tracking tools | Experimental | Lifestyle intervention including diet, sleep, exercise, relaxation, and mindfulness. Self-tracking tools including a smartphone application and an Actigraphy will be given. |
|
| Pure lifestyle medicine intervention | Experimental | Lifestyle intervention including diet, sleep, exercise, relaxation, and mindfulness. |
|
| Care-As-Usual | No Intervention | continue receiving the routine care as usual and be given a smartphone-based LM intervention after the completion of follow-up assessments |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group-based Lifestyle Medicine Program | Behavioral | Participants will receive four core modules that focus on lifestyle modifications. Core Module 1 will be Diets and Nutrition. This module aims to provide simple and evidence-based information regarding nutrition for improving and maintaining mental health. Core Module 2 will be Physical Activity. Participants will practice various types of gentle and adaptable exercises during the session and learn simple ways to incorporate exercise into their daily lives. Core Module 3 will be Sleep Management. This module will include basic facts about sleep, with a focus on psychoeducation on insomnia and how the relationship between circadian and social rhythms relate to sleep and mental health. Core Module 4 will be Stress Management. This module will include psychoeducation about stress, worry management, the cultivation of positive psychology, and relaxation techniques such as diaphragmatic breathing and progressive muscle relaxation. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in the Patient Health Questionnaire (PHQ-9) | The PHQ-9, a 20-item questionnaire used for screening, diagnosing, monitoring and measuring the severity of depression, which scores each of the nine DSM-IV criteria as "0" (not at all) to "3" (nearly every day). | [Time Frame: Baseline, immediately after treatment, and 12 weeks after the treatment sessions are completed] |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Insomnia Severity Index (ISI) | ISI is a 7-item scale designed to evaluate perceived insomnia severity. Ratings on the 5-point Likert scale are obtained on the perceived severity of sleep-onset, sleep-maintenance, early morning awakening problems, satisfaction with current sleep pattern, interference with daily functioning, noticeably of impairment attributed to the sleep problem, and level of distress caused by the sleep problem. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in the Credibility-Expectancy Questionnaire (CEQ) | The 6-item CEQ yielded ratings of treatment credibility, acceptability/satisfaction, and expectations for success. | [Time Frame: Baseline and immediately after treatment] |
| Treatment Acceptability Scale (TAS) |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Chinese University of Hong Kong | Recruiting | Shatin | Hong Kong |
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| ID | Term |
|---|---|
| D003863 | Depression |
| ID | Term |
|---|---|
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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| [Time Frame: Baseline, immediately after treatment, and 12 weeks after the treatment sessions are completed] |
| Change in the Health-Promoting Lifestyle Profile (HPLP II) | The 52-item HPLPII is composed of a total scale and six subscales to measure behaviors in the theorized dimensions of health-promoting lifestyle: spiritual growth, interpersonal relations, nutrition, physical activity, health responsibility, and stress management. | [Time Frame: Baseline, immediately after treatment, and 12 weeks after the treatment sessions are completed] |
| Change in the Sheehan Disability Scale (SDS) | SDS is a brief, 5-item self-report tool that assesses functional impairment in work/school, social life, and family life | [Time Frame: Baseline, immediately after treatment, and 12 weeks after the treatment sessions are completed] |
| Change in Quality-adjusted Life Years - The Short Form Six-Dimension (SF-6D) | The Short Form Six-Dimension (SF-6D) is a self-report measure that assesses health-related quality of life to estimate participant's quality-adjusted life years (QALYs). This instrument was validated in the Chinese population and widely applied in previous mental health research. | [Time Frame: Baseline, immediately after treatment, and 12 weeks after the treatment sessions are completed] |
| Change in Hospital Anxiety and Depression Scale (HADS) | HADS is a 14-item self-rated questionnaire which consists of two 7-item subscales that measure the presence of anxiety and depression symptoms respectively. Each item is rated on a 4-point-scale (0-3) by the participant. The greater the score, the more psychologically distressed the respondent is. | [Time Frame: Baseline, immediately after treatment, and 12 weeks after the treatment sessions are completed] |
An 8-item scale of the willingness to utilize or recommend the intervention. |
| [Time Frame: Baseline and immediately after treatment] |