Low-Intensity Online Intervention for Mental Distress Among Help-Seeking Young People in Hong Kong: A Randomized Clinical Trial

Abstract

<p><strong>Importance</strong> Mental health issues among young people are increasingly concerning. Conventional psychological interventions face challenges, including limited staffing, time commitment, and low completion rates.</p><p><strong>Objective</strong> To evaluate the effect of a low-intensity online intervention on young people in Hong Kong experiencing moderate or greater mental distress.</p><p><strong>Design, Setting, and Participants</strong> 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).</p><p><strong>Intervention</strong> 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.</p><p><strong>Main Outcomes and Measures</strong> 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.</p><p><strong>Results</strong> 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]; <em>P</em> = .17; η_p² = 0.02), anxiety (mean [SD] difference, 6.0 [7.7] and 3.5 [7.7]; <em>P</em> = .07; η_p² = 0.03), and psychological distress (mean [SD] difference, 3.8 [3.8] and 2.9 [3.8]; <em>P</em> = .24; η_p² = 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]; <em>P</em> = .02; η_p² = 0.05), negative emotion (mean [SD] difference, 20.3 [19.2] vs 12.7 [19.2]; <em>P</em> = .03; η_p² = 0.04), and increased resilience (mean [SD] difference, 0.5 [0.6] vs 0.2 [0.6]; <em>P</em> = .01; η_p² = 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.</p><p><strong>Conclusions and Relevance</strong> 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.</p><p><strong>Trial Registration</strong> ClinicalTrials.gov Identifier: <a href="https://clinicaltrials.gov/study/NCT03819153">NCT05510453</a></p>