Overview

This cluster randomized controlled trial (cRCT) aims to evaluate the effectiveness of a narrative therapy (NT) intervention in (i) reducing mental distress, depressive symptoms, and anxiety, as well as (ii) enhancing perceived control and fostering a stronger sense of self among at-risk youth in Hong Kong. Participants are youths with moderate mental health concerns, indicated by K6 scores ranging from 11 to 14.

The study involves seven clusters, each based on community hubs, which will be randomly assigned to either the intervention group or a wait-list control group. Clusters assigned to the intervention group will receive six face-to-face sessions led by trained youth workers. Control clusters will receive the same intervention after the initial follow-up period.

Participants will be evaluated at baseline, post-intervention, and one-month follow-up. An interim analysis is built for the sake of evaluation of the collected data from the ongoing trial, in which the primary research question is addressed, and which has the potential for modifying the conduct of the study. Furthermore, a qualitative follow-up will be conducted after the trial, involving both participants and the workers delivering the NT intervention. This qualitative component aims to gather feedback on participants' experiences, and inform potential revisions to enhance future implementation.

It is hypothesized that youths receiving the NT intervention will show significantly greater improvements in perceived control and sense of self, along with reductions in mental distress, as well as depressive and anxiety symptoms, compared to those in the wait-list control group.

Eligibility

Inclusion Criteria:

• JC LevelMind @ Community users at risk for mental distress (Tier 2), with K6 scores ranging from 11 to 14
• Aged between 12 and 24 years
• Sufficiently proficient in Chinese to comprehend verbal instructions
• Able to provide written informed consent (parental consent for participant aged 12-17)

Exclusion Criteria:

• Known diagnosis of intellectual disability
• Organic brain disorder
• Established psychiatric diagnosis
• Current substance abuse
• Receiving other structured psychological therapies such as module-based psychological therapy, mentalization-based therapy, low-intensity online interventions, cognitive-behavioral therapy, cognitive-behavioral therapy for insomnia, mindfulness, or art-informed therapy within the hub setting or any others outside the hub setting
• Presence of current or active suicidal ideation or attempts