JoyAge, an integrated prevention programme, effectively reduces symptoms of depression and anxiety as well as loneliness in older adults in Hong Kong, a pragmatic quasi-experimental trial has shown.
“With the ageing population and insufficient mental health workforce, there are huge treatment gaps for late-life depression,” wrote the researchers. “Real-world evidence for scalable preventive services is scarce.” [J Affect Disord 2026:402:121333]
The researchers therefore conducted a pragmatic quasi-experimental trial of a new service (JoyAge) for older adults with risk factors for late-life depression or subsyndromal depressive symptoms. In the intention-to-treat (ITT) sample, 3,416 participants were recruited to receive JoyAge (n=2,975; mean age, 77.1 years; female, 79.0 percent) or usual care (n=441; mean age, 75.56 years; female, 76.0 percent).
“JoyAge involves collaboration between aged care and mental health care units, evidence-based psychosocial interventions delivered by trained social workers, peer support, and stepped care according to depressive symptom level,” noted the researchers.
The primary outcome was depressive symptoms at 12 months, measured by the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes included anxiety symptoms (Generalized Anxiety Disorder 7-item scale [GAD-7]) and loneliness (3-item UCLA Loneliness Scale).
Overall, the JoyAge service had a better retention rate than usual care (9.4 vs 28.1 percent; z,11.35; p<0.001).
ITT analyses
In the ITT analyses, JoyAge was associated with significant improvement in depressive symptoms (adjusted mean difference [AMD],1.65; 95 percent confidence interval [CI] 1.24–2.07; p<0.001), anxiety symptoms (AMD, 1.47; 95 percent CI, 1.01–1.93; p<0.001), and loneliness (AMD,1.29; 95 percent CI, 0.98–1.60; p<0.001) vs usual care at 12 months.
Effect sizes in reducing depressive symptoms, anxiety symptoms, and loneliness, measured as standardized mean differences (SMDs), were 0.44, 0.40, and 0.37, respectively (p<0.001 for all).
“The significance of symptom reduction in non-clinical populations should be considered in the context of its scale,” commented the researchers.
PSM analyses
“To account for the unequal allocation of intervention groups, the same sets of analyses were conducted with a propensity score–matched [PSM] sample as sensitivity analyses,” noted the researchers. “Variables used in the propensity score model were demographic [ie, age and gender] and socioeconomics [ie, education, economic status and living status].”
After 1:1 PSM, 422 JoyAge cases (mean age, 76.07 years; female, 75.1 percent) were matched to 422 usual care cases (mean age, 75.55 years; female, 75.8 percent), with good balance between the two groups. Results were similar in the PSM analyses. JoyAge showed significantly larger effects in reducing depressive symptoms (AMD, 1.99; 95 percent CI, 1.34–2.64; p<.001), anxiety symptoms (AMD, 1.62; 95 percent CI, 0.95–2.29; p<0.001), and loneliness (AMD,1.03; 95 percent CI, 0.58–1.48; p<0.001) vs usual care. The corresponding effect sizes were 0.48, 0.37, and 0.34 (p<0.001 for all).
Clinical implications
“This study provided real-world evidence that integrated late-life depression prevention can be effectively implemented at scale to reduce depressive symptoms, anxiety symptoms, and loneliness, compared with traditional community-based mental health or aged care,” wrote the researchers. “Integrated late-life depression prevention can be effectively implemented at scale in rapidly ageing settings with a limited specialist mental health workforce.”