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Mental Health Care


Mental Health Care

    Mental health problems are one of the most common causes of disabilities worldwide. They are estimated to be one of the top ten causes of mortality/morbidity within this decade. Promotion of mental health and provision of timely interventions for people with mental health problems and their families are important areas to be developed locally, regionally, and globally.

    Members of the mental health care research theme are committed to building the capacity and developing a strong research profile in the field of mental health care. Our team has a focused research strategy, which has been established around two research areas that are closely linked to local, regional, and international mental health needs, services, and education.
Producing innovative and world-leading research in mental health care for local, regional, and international communities.
  • To identify most current mental health needs in both clinical and community settings
  • To establish evidence-based interventions for people with severe mental illnesses (SMI)
  • To promote mental health and well-being of people in various developmental life stages across different care settings

Interventions for people with Severe Mental Illnesses (SMI)

People with SMI are one of the most marginalised, misunderstood, and disadvantaged groups in today's society. There is a current need for evidence-based, patient-centered and usable interventions to be used in communities and treatment facilities for persons with SMI. Our research in this area produces scientific evidence and essential skills to develop, test and establish physical and psychosocial interventions for these people with SMI and their families to improve self-management and patient and illness outcomes. Our research focuses on, for example, the effectiveness of self-help interventions, eHealth, improvement of physical well-being, family-inclusive psychoeducational and supportive interventions, and psychological therapies for individuals with psychotic disorders. Throughout all our work, the needs and experiences of users are highly respected and valued to ensure person-centered approaches.


Challenging relationships, social adversity, and mental health

Poor relational qualities and social adversities have a direct and lasting impact on mental health. These problems are pervasive and may occur in any setting, such as homes, schools, workplaces, and communities. Our research in this area aims to understand the causes, risk factors, and mental health sequelae associated with challenging relationships and social adversities. Early prevention and mental health promotion for individuals and groups in vulnerable and sensitive environments are also key components of our work. Some of our current research focuses on violence or aggressive behaviors in care settings and mental health promotion for underserved populations. We actively work to motivate different professionals and engage patients and their families in our research and educational activities.

By implementing high quality research, interventions, and health promotion programmes, we aim to:

  • Enhance the individual, familial, and social understanding of mental health;
  • Inform mental healthcare services and policies;
  • Promote the social inclusion of people with mental health problems; and
  • Provide consultancy for mental health promotion, interventions, and service provision.

Research Theme Leader

Honorary Research Theme Members

Prof Richard GRAY

Professor of Clinical Nursing Practice and Director. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia

Prof Yu Tao XIANG

Professor – Faculty of Health Sciences, University of Macau, Macau SAR

Dr Kong Chun KING

Associate Consultant, Kwai Chung Hospital, Hong Kong

Ms Jolene MUI

General Manager (Nursing), Castle Peak and Siu Lam Hospitals, Hong Kong

Mr Lawrence POON

Chief Manager (Nursing), Hospital Authority, Hong Kong

Centre for Smart Health

The Centre for Smart Health aims to create healthcare innovations with technology, making positive impacts to practice and the quality of care. We conduct cross-disciplinary applied research that capitalizes on our expertise in technology, including virtual reality and artificial intelligence, and translates the results into practice to improve healthcare education, diagnosis and treatment.

Impact Stories

Improving the care and support of people with serious mental illness throughout their treatment journey

Mental illness accounts for >32% of global disease burden re: years lived with disability. Non-adherence to prescribed treatment and a lack of access to early online self-help treatment are major barriers to recovery for people with serious mental illness. These issues are associated with poor patient outcomes and greater disabilities. We addressed these unmet needs by developing a publicly available online eating disorders early-intervention programme and integrating nurse-facilitated evidence-based interventions to address treatment non-adherence in local psychiatric hospitals. Our research has directly improved patient outcomes and influenced local/international treatment guidelines and policy.

Key researchers:
Dr Daniel Bressington (Associate Professor)
Dr Sau Fong Leung (Associate Professor)
Prof. WT Chien (Professor, CUHK)
Prof. R Gray (Visiting Professor)


Facilitating access to self-help interventions for individuals with eating disorders
People with eating disorders require prompt intervention to promote recovery, however there was a lack of access to early self-help interventions. We designed and tested the effects of an online self-help programme (Smart Eating) to engage people with eating disorders in early intervention. The study involving 222 service-users[R1]demonstrated significant benefits in reducing severity of eating disorder psychopathology, depression and anxiety, and improved quality of life during a three-month follow-up. This study highlighted the importance of early intervention and improving access to self-help treatment. The online intervention was made available to members of the public after the trial.


Addressing treatment non-adherence to improve patient outcomes

Non-adherence to prescribed medication is one of the major causes of relapse and readmission in people with serious mental illness (SMI). We conducted (2008) a large-scale cross-sectional survey in Hong Kong to establish the extent of the clinical problem of non-adherence and to identify factors affecting medication adherence in people with psychosis(R2). Our results indicated over 30% (175/484) were intentionally non-adherent with treatment and highlighted that the efforts of nurses to improve adherence should help patients amplify the personal relevance of treatment and modify attitudes towards medication. Based on these initial findings, the first randomised controlled trial tested the effectiveness of a culturally adapted adherence therapy (AT) incorporated into a nurse-led psychosocial intervention programme in over 90 people with early stage psychosis(R3). Results indicated that the AT produced significant greater improvements in patients’ symptoms, insight into illness, re-hospitalisations, and quality of life than usual psychiatric care over a 12-month follow-up. This study informed the development of medication management staff training programmes.
A prospective case series study also explored how the medication management training incorporating AT intervention impacted upon Hong Kong nurses’ understanding and efforts to optimise patients’ medication adherence over a 9-month follow-up(R4). The results showed that the intervention was viewed as beneficial to both their patients and practices. A second controlled trial was conducted with 134 community SMI patients[R5]to test a refined version of the motivational-interviewing-based AT. Results confirmed that AT was effective to reduce symptom severity and length of re-hospitalizations over 18 months. Finally, to consolidate the latest knowledge about adherence therapy, the team led a group of international researchers from 8 countries to conduct a systematic review and meta-analysis of AT for patients with schizophrenia(R6). The findings suggest that AT is an effective adjunctive treatment to improve psychotic symptoms in schizophrenia spectrum disorders and challenge some current clinical guidelines.
This work informed the initial development and ongoing refinement of medication management staff training programmes, and the interventions have been widely and systematically implemented in Hong Kong psychiatric care services since 2013.

R1 Leung, S.F., Ma, J., & Russell, J. (2013). Self-help behaviours of clients with eating disorders in an online programme: An open trial.Journal of Advanced Nursing, 69 (1), 66-76.
Initial conference presentation:Leung, S.F., Ma, J., Russell, J., & Spence, I (2006). The “Smart Eating” self-help programme for people with eating disorders.Proceedings of the 2006 Conference of the Institute of Mental Health, Castle Peak Hospital: From Hospital to Community – Psychiatric Care in the New Era, Hong Kong, 10 November, p. 13


R2 Bressington, D., Mui, J. andGray, R. (2012). Factors associated with antipsychotic medication adherence in community based patients with Schizophrenia in Hong Kong – a cross sectional study.International Journal of Mental Health Nursing. 22(1), 35-46.


R3 Chien, W T.andBressington, D.(2015). A randomized controlled trial of a nurse-led structured psychosocial intervention program for people with first-onset mental illness in psychiatric outpatient clinics.Psychiatry Research, 229, 277-286.


R4 Bressington, D.,Mui, J., & Wells, H. (2013). The effects of medication-management training on clinicians' understanding and clinical practice in Hong Kong.Nurse education today, 33(9), 969-975.


R5 Chien, W. T.,Mui, J.,Gray, R.,& Cheung, E. (2016). Adherence therapy versus routine psychiatric care for people with schizophrenia spectrum disorders: a randomised controlled trial.BMC psychiatry, 16(1), 1.


R6 Gray, R., Bressington, D., Ivanecka, A., Hardy, S., Jones, M., Schulz, M., ... &Chien, W. T.(2016). Is adherence therapy an effective adjunct treatment for patients with schizophrenia spectrum disorders? A systematic review and meta-analysis.BMC psychiatry,16(1), 90.

Impact on clinical services to improve patient outcomes
Our work has directly informed the development of a medication management training programme (incorporating the culturally-adapted AT) for mental health professionals in the Hong Kong Hospital Authority. Around 550 clinical staff have been trained in AT via the modified medication management programme since 2013. Three train-the-trainers courses have also been delivered at Kwai Chung Hospital (2013, 2015) and at Castle Peak Hospital (2018). To-date, around 30 nurse trainers are delivering the training to other clinical staff to implement the intervention within many inpatient, outpatient, and community settings in the two hospitals.
Feedback from senior nursing managers at the two hospitals confirms it is a key service provision and highlights the benefits of the intervention/training:“staff members evaluate the training very positively, mentioning an improvement in their knowledge, skills and confidence in addressing medication non-adherence”, “The Medication Management interventions benefit our patients greatly, and are now implemented into routine clinical care” and “the intervention is still provided to all inpatients and service users in the community”.
Hospital records show the intervention was conducted with 728 acute inpatients since 2013. The research studies have also influenced and been cited by influential and widely used evidence-based guidelines for the pharmacological treatment of schizophrenia (i.e. recommendations from the British Association for Psychopharmacology and The Maudsley Guidelines on Advanced Prescribing in Psychosis).


Impact on improving public access to eating disorders early self-help interventions
The team’s research on early self-help interventions for eating disorders has resulted in the development of a publicly available intervention that has been widely used and receives excellent evaluations. The ongoing Smart Eating online programme was awarded the maximum score of 5 stars for clarity, reliability, comprehensiveness, and research basis of content by the Commonwealth Department of Health and Ageing in Australia and has a very positive impact on users’ recovery. The testimonials of users highlight the benefits of the self-help interventions, for example:“the programme has helped me to ensure I think rationally and don’t let bulimia get the best of me”and“Thanks to the programme my journey has ended in a recovered state, mentally now as well as physically”. The programme has received 89,000 visitors since 2013 and from December 2014 the programme has been used by members of the public who have self-referred to the integrative health clinic at The Hong Kong Polytechnic University.

Barnes, T. R., Drake, R., Paton, C., Cooper, S. J., Deakin, B., Ferrier, I. N., ... & Joyce, E. M. (2020). Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology.Journal of Psychopharmacology, 34(1), 3-78.


Morrison, P., Taylor, D. M., & McGuire, P. (2019).The Maudsley Guidelines on Advanced Prescribing in Psychosis. John Wiley & Sons.


“Eating Disorders Information and Support for Australians – Resource review 2010” (p.75), accessible from:


Smart Eating website recovery stories (website):

Ongoing Research Students


PhD Student

Chung Yan LAM

PhD Student (Part-time)

Man Hon Oscar CHUNG

PhD Student (Part-time)

Externally Funded Projects

Coolminds, a Mind HK and KELY Support Group Initiative: A Service Evaluation

Investigators Name:
PI: Dr Wing Ka Grace HO

Funding Scheme/ Source of Funding: Mind Mental Health Hong Kong Limited

Total Grant: HK$75,000

Commencement Date: 1-Jun-22

穴位按壓對居於社區的脊髓損傷患者便秘的成效研究:一項隨機對照試驗 Effectiveness of caregiver-administrated acupressure intervention for community-dwelling spinal cord patients with constipation A randomized controlled trial

Investigators Name:
PI: Dr Yan LI
Co-I: Dr Wing Fai YEUNG, Dr Yuen Shan HO, Dr Yu Lok WONG, Dr Shi Ping ZHANG, Dr Wai Kit WONG, Dr Yiu Cho KWAN

Funding Scheme/ Source of Funding: Chinese Medicine Development Fund - Industry Support Programme

Total Grant: HK$810,590

Commencement Date: 1-Apr-22

本研究將開展對穴位按壓對居於社區的脊髓損傷患者便秘及生活品質的成效研究。中醫穴位按壓配合綜合干預措施能更加有效(1)緩解患者便秘的嚴重程度(2)提高患者的生活品質(3)減少患者使用瀉藥的頻率。 本研究將採用雙盲,雙組,隨機對照試驗來比較干預組(中醫穴位按壓)與對照組 (假組) 的效果。研究將於干預前,干預後及干預後一個月對參加者的社會人口學資料,疾病狀況及研究結果指標進行測量。焦點小組訪談在對研究對象進行干預後第二次評估後(1個月隨訪後)將進一步瞭解研究干預方案的益處以及局限性。

中醫情志養生治療抑鬱症- 課程建構及初步試驗 Emotional Health Preservation in Chinese Medicine for Depression: Course Development and Pilot Testing

Investigators Name:
PI: Dr Wing Fai YEUNG
Co-I: Dr Yuen Shan HO, Dr Cheuk Chi Teris CHEUNG, Dr Wing Yan LEE, Dr Fiona Yan Yee HO, Dr Hai Yong CHEN, Dr Wai Chi CHAN, Dr Cheuk Wing AU

Funding Scheme/ Source of Funding: Chinese Medicine Development Fund - Industry Support Programme

Total Grant: HK$992,576

Commencement Date: 1-Apr-22

Effects of a Physical-Psychological Integrative (PPI) intervention on Physical inactivity, Depression and Chronic pain for Community-Dwelling Spinal Cord Injury Survivors: a Pilot Randomized Controlled trial

Investigators Name:
PI: Dr Yan LI
Co-I: Dr Wing Fai YEUNG, Dr Yu Lok WONG, Prof. Alexandros MOLASIOTIS, Dr Zonghao MA, Dr Pui Kin KOR, Ms Chor Pik Rabi YIM, Dr Daniel Thomas BRESSINGTON

Funding Scheme/ Source of Funding: HMRF Research Fellowship Scheme

Total Grant: HK$952,685

Commencement Date: 1-Sep-21

Objectives: To examine the feasibility, acceptability, and preliminary effects of a Physical-Psychological Integrative (PPI) online group intervention on Physical inactivity, Depression, and Chronic pain for Community-Dwelling Spinal Cord Injury Survivors over a 3-month follow-up. Design and subjects: An assessor-blind two-arm (i.e., 36 per study group) randomized controlled trial with repeated measures (pre-, post-intervention, and 3-month follow-up) design. Intervention: The PPI intervention includes a DVD programme for physical activity training and eight-week online group psychological interventions using skills of motivational interviewing and mindfulness-based stress reduction. Main outcome measure: Duration of being physically active, depression, and chronic pain. Data analysis: Generalized estimating equations with covariate adjustments will be employed to examine the preliminary effects of PPI intervention. Expected results: Participants showed perceived benefits of the PPI intervention, and they will indicate enhanced engagement in physical activity and improvements in depressive symptoms and chronic pain, which will further lead to improved quality of life.

Time to Change Hong Kong: Reducing Stigma Around Mental Health in Hong Kong – A Service Evaluation

Investigators Name:
PI: Dr Wing Ka Grace HO
Co-I: Mr Man Hon CHUNG, Prof. Daniel Thomas BRESSINGTON, Ms Odile THIANG

Funding Scheme/ Source of Funding: Mind Mental Health Hong Kong Limited

Total Grant: HK$73,238

Commencement Date: 1-Jun-21

It is estimated that one in six Hong Kong adults suffer from a diagnosable mental illness and the number of people requiring treatment have been rising over the last 5 years. However, negative stigmatized attitudes towards mental illness and its treatment are still commonplace locally, leading to discriminatory behaviour and isolation. This creates stigma, dissuades those suffering from a mental illness to seek help, and prevents their re-integration into the community. Improving the public’s attitudes towards mental illness and its treatment is therefore crucial.
Previous studies have shown that a variety of educational interventions can have positive effects, but it is still very unclear how best to reduce stigmatized attitudes of Hong Kong citizens. The Time to Change Hong Kong programme is offered by Mind HK. This is a new campaign that involves training ambassadors with personal experience of mental health challenges to facilitate face-to-face educational events with the public.

Study aims

  • Explore the ambassadors’ experiences and views of the programme in focus groups before starting their training and 3-months later.
  • Measure changes in the attendees’ attitudes and understanding towards mental illness, and their attitudes towards people with mental health problems both currently, and in their intended behaviour at three time points (before attending the story telling events, immediately following the events, and three months after attending).
  • Evaluate the achievement of Mind HK’s defined key performance indicators over a 6-month period.

Design and methods
This service evaluation will adopt a prospective cohort mixed-methods study design. All attendees from September 2020 to March 2021 will be invited to take part. Participants will complete a set of questionnaires measuring their attitudes towards mental illness and treatment using paper based questionnaires or the online system. They will be asked to re-complete these questionnaires immediately after their visit and at 3-months follow-up. Focus group interviews will be also be conducted with the ambassadors before their training and at 3-months follow up to explore their experiences of attending the training and delivering the workshop events.

The findings are expected to provide essential information about the effectiveness of Time to Change Hong Kong programme in reducing stigma and increasing public understanding, and highlight experiences of the ambassadors in participating in the programme.

The Impact of Video Gaming on Cognitive Functioning of People with Schizophrenia (GAME-S)

Investigators Name:
PI: Prof. Maritta Anneli VAELIMAEKI
Co-I: Dr Daniel Thomas BRESSINGTON, Dr Hing Chiu Charles CHANG, Dr Eric CHEUNG, Dr Tella LANTTA, Dr Hong LEE, Dr Simon Sai-Yu LUI, Dr Matias PALVA, Dr Satu PALVA, Mrs Jolene MUI, Mr Dan YU, Prof. Min YANG

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK$1,161,999

Commencement Date: 1-Jan-19

Schizophrenia is severe chronic disease. Cognitive impairments, a core feature of schizophrenia, is the strongest predictor of functioning and psychosocial outcomes and single most important factor in determining a patient's ability to engage in daily life and adhere to treatment. Prior approaches to improve functional outcomes in schizophrenia are limited in their efficacy and they have high dropout rates. Recently video gaming has opened new opportunities for patients in improving attention, working memory, problem-solving, feedback, emotional expression, and socialization. If video gaming is targeted in a brain-disorder-specific manner to improve dysfunctional brain circuits and renormalizing healthy brain dynamics, it might be suited to be a well scaling and low-cost therapeutic intervention. In this randomised, exploratory, single-blind, pragmatic, three-arms parallel-group trial, patients with schizophrenia will be enrolled and randomly assigned using an internet-based randomisation and stratification across study sites with a computer-generated block randomisation to either (1) cognitive training with computerized exercises, (2) entertainment gaming or (3) non-gaming “treatment-as-usual”. This study will be one of the first trials to address the effectiveness of video gaming on improving cognitive and neurocognitive functioning in people with schizophrenia. It would be of key importance to discover an individual co-variation in the cognitive measures, clinical indicators and the brain data. The study will offer new information to confirm short and long-term benefits of using video gaming to patients’ health and well-being and new approaches to patient care in mental health services in Hong Kong. It hold promise for other health conditions in which motivational problems are related to health outcomes.

An Evaluation of the Effectiveness of a Professional-supported Problem-solving-based Self-learning Program for Family Carers of People with Recent-onset Psychosis: A Randomized Controlled Trial

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Dr Daniel Thomas BRESSINGTON, Ms Shuk Yi CHAN, Ms Lai King YIP, Prof Thanos KARATZIAS, Prof Dan I. LUBMAN 

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK$697,060

Commencement Date: 1-Aug-18

Objectives:This RCT is to test the effects of a professional-supported problem-solving-based self-learning program(PBSP) on family carers' and patients' outcomes over a 12-month follow-up. Hypotheses:When compared with psycho-education group and/or routine family care only, the PBSP participants will indicate significantly greater improvements in carers' coping, social problem-solving skills, caregiving experiences, and family functioning, and reductions of perceived burden and patients' symptom severity, re-hospitalization rate and level of recovery, at 1-week, 6-month and/or 12-month post-interventions. Design and subjects:A multi-center randomized controlled trial with repeated-measures, three-arm design will be adopted to evaluate/compare the effects between two alternative interventions(PBSP and PG, in addition to routine care) and TAU only for family carers (66 per group) of people with recent-onset psychosis (ROP) attending one of 6 family centres over a 12-month follow-up, with outcome and process evaluation. lnstruments:Family Burden Interview Schedule and Revised Social-Problem-Solving Inventory (primary outcomes); Experience of Caregiving Inventory, frequency and length of re-hospitalizations, Questionnaire about Process of Recovery, Family Assessment Device, and focus-group interviews (for formative evaluation of two treatment programs) Data analysis: Family and patients outcomes will be compared over 12-month follow-up (baseline and 3 posttests) using MANOVA/Mixed-model technique/ANOVAs; their clinical significant differences will be assessed. Group interview data for two treatment modalities will be content analyzed. Expected results:The findings provide evidence of the effectiveness of the problem-solving, self-learning family intervention (PBSP) on improving carers', families' and patients' psychosocial health and well-being over 12-month follow-up, thus reducing family burden/distress in caregiving, patients' relapse and medical costs.

Mental Health Literacy and Health Seeking Behavior in the Western Pacific

Investigators Name:
PI: Prof. Maritta Anneli VAELIMAEKI
Co-I: Dr Daniel Thomas BRESSINGTON, Dr Wing Ka Grace HO, Dr Sau Fong LEUNG, Dr Yee Man Angela LEUNG, Prof. Alexandros MOLASIOTIS

Funding Scheme/ Source of Funding: World Health Organization

Total Grant: HK $170,757

Commencement Date: 25-Nov-16

Background: Mental health disorders are highly prevalent in all regions of the world. However, it is estimated that less than 25% of people with mental disorders from low income countries receive appropriate treatment. Even when mental health support services are available, many people have a strong reluctance to seek professional help. This reluctance may be attributed to low levels of mental health literacy, which is broadly defined as the knowledge and beliefs about mental disorders that may influence how they are recognized, treated, and prevented in different communities. Currently, there is very limited information on mental health literacy in developing countries within the Western Pacific Region. Consequently, little is known about the types and extent of mental health knowledge and support people in this region need, and how best to promote their mental health given the limited resources that are available to them. As a starting point, this study focused on examining mental health literacy related to two highly prevalent forms of mental health disorders, depression and dementia, which combine to affect close to 400 million people worldwide. Aim: The overall aim of the study was to describe mental health literacy and health seeking behavior across three countries within the Western Pacific region (Cambodia, Philippines, and Fiji). Methods: In collaboration with local implementing partners, data were collected between November 2016 and May 2017 from three countries in the Western Pacific region: Cambodia (Phnom Penh, Kandal Province), Philippines (Manila, Quezon and Caloocan City), and Fiji (Suva). A mixed-methods design was used to capture mental health literacy both quantitatively and qualitatively. Survey questionnaires were used to measure knowledge, attitudes, and help seeking behaviors related to depression and dementia. In parallel, focus group discussions were held to generate in-depth explorations on knowledge, attitudes, and patterns of health seeking behaviors within the context of their culture and local communities. In total, this study includes findings from 12 focus group discussions and over 900 completed surveys across the three countries. Findings from surveys and focus group discussions were analyzed and merged to draw a fuller picture on mental health literacy related to depression and dementia in each of these three countries. Findings: In generally, participants viewed mental illness as a common occurrence in their communities, but high levels of stigma towards mental illness were evident. For example, 17% of respondents in Cambodia, 44% in Fiji, and 46% in the Philippines believed that people with mental illness commonly have a propensity for violence. The focus group discussions also support this finding, where some participants expressed negative attitudes towards mental illness (e.g. blaming people for developing depression). Additionally, many participants reported having no previous contact with someone with a mental illness, and this may explain some of the misconceptions and fears that were expressed. Across the three countries, most people could identify the common signs/symptoms of depression. However, many also attributed unrelated symptoms (e.g. hearing voices, being reckless) to the illness. Both the survey and focus group discussions revealed that participants recognized the need to be empathetic and supportive towards people with depression, but struggled most with understanding which treatments are most effective. On the other hand, knowledge about Alzheimer’s disease, a leading cause of dementia, was quite low in all three countries. There were a number of misunderstandings about dementia; particularly in relation to its causes and treatment. Participants were concerned about the safety of people with dementia living in the community, and were generally able to identify the need to help provide for their basic needs, but they underestimated the potential abilities of people with dementia and consequently may adopt unhelpful supportive strategies. There was some clear reluctance towards seeking professional psychological help in the three countries. The focus group discussions showed that people in these countries commonly identify families as the first source of help for mental health issues. Although participants generally viewed health care professionals as a trusted source of help, seeking professional help often remained a last resort and would only be considered if family members, friends, or neighbors could not cope with helping the mentally ill. Barriers towards seeking professional help may relate to a belief that families should be able to cope, a lack of recognition that professional help is needed, and concerns about the overall negative views towards people with mental illness.

A Randomized Controlled Trial of the Effectiveness of a Mindfulness-Based Psycho-Education Program for People with Recent-onset Psychosis

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Prof. Sally W.C. CHAN, Prof. Terence V. McCANN, Prof. David Robert THOMPSON, Mr Eric F.C. CHEUNG, Ms Lai King YIP

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $688,222

Commencement Date: 1-Jan-16

Many people with recent-onset (≦6 months) psychosis often experience disruptive residual symptoms, impaired psychosocial functioning and high illness relapse rate. A few psychoeducatonal and motivational illness management programs in the U.S. and Europe for early-stage psychosis have reported significant improvements on patients' functioning and relapse. Yet few intervention studies have focused on patients’ mindfulness, changing their negative thoughts towards their symptoms and related suffering, which has been shown to empower patients' self-management of their illness and functioning and distressing thoughts and perception. This proposed research is designed to test the effects of a Mindfulness-Based Psycho-education program (MBPP) for Chinese patients with schizophrenia on their mental state, psychosocial functioning and insight into illness/treatment. A randomized controlled trial will be conducted with 144 Chinese patients diagnosed with psychotic disorders (within the past six months) at two psychiatric outpatient clinics using repeated-measures, three-arm design. They will be randomly selected from the patient lists and after baseline measurement, randomly assigned to either the MBPP, a psycho-education group or usual psychiatric care (n=48 in each group). The MBPP consists of 12 bi-weekly, 2-hour group sessions and is designed to teach patients about illness management skills and help them attain more awareness of, relating differently to and accepting and/or managing their thoughts and perceptions towards their symptoms and make positive changes to their thoughts and behaviors concerning the illness and its symptoms. The psycho-education program also consists of twelve 2-hour group sessions (every two or three weeks) based on the research team’s psychoeducation programs for psychosis care in 2008-2010. Patients' symptom severity and re-hospitalization rates (primary outcomes), and their functioning, social support and insight into illness/treatment, will be measured at recruitment and at one week and six and 12 months after the interventions. Based on an intention-to-treat principle, multivariate analyses of variance(or covariance) followed by Helmert contrasts test on individual post-tests will be performed to compare changes in all patient outcomes within-group and between-groups over the 12-month follow-up. Semi-structured interviews will be conducted with 10 MBPP and 10 psycho-education group participants after the first post-test and their contents analyzed to identify their perceived benefits and weaknesses, therapeutic components of the interventions, and major difficulties in their participation. If any significant positive patient outcomes found, this innovative MBPP can be adopted by community mental health teams in Hong Kong and/or Chinese populations to improve early-stage psychosis sufferers’ mental state and functioning and thus their illness relapses.

Power Dynamics in the Student-Teacher Relationship: the Voices of Nursing Students

Investigators Name:
PI: Dr Chung Yee Zenobia CHAN
Co-I: Prof. Wai Tong CHIEN, Dr Saras HENDERSON

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $205,440

Commencement Date: 1-Jan-16

Power relations are inherent in the interaction between experts, referred to here as teachers, and non-experts, referred to as students. In nursing education the teacherstudent relationship is still an under-explored area of power dynamics. In this study, nursing students’ perspectives on the power dynamics between themselves and their teachers will be explored, as well as their understanding of the context of the power relations within the campus and in clinical settings. A descriptive qualitative study will be conducted over a period of 18 months using two methods of collecting data (focus group interviews and personal essays). Through convenience sampling, a total of 90 nursing students from one university, with 30 each from Years 1, 3, and 5, will be invited to participate in the study. They will first be asked to write a personal essay using a metaphor of their subjective experience of the teacher-student relationship in the realm of power dynamics. They will then participate in a focus group interview in groups of 6-8. Two semi-structured interview guides exploring the power dynamics within the teacher-student relationship have been designed. Each guide will have a central theme based on the students’ exposure and the relevance of their learning experiences. Year 1 students and final year (Year 5) students will be asked questions about power dynamics in the teacher-student relationship in a campus learning context, while the questions put to Year 3 students and final year students will focus on a clinical learning context. The data will be analysed using a content analysis approach. The PI and RA will separately conduct an initial analysis. A comparison of their findings will then be made.

A final thematic analysis will constitute the core themes, which will be authenticated by the nursing students. It is hoped that a power model for teacher-student relationships that is specific to the discipline of nursing can be developed. In addition to publishing the research results, to strengthen the impact of this study, training workshops and seminars for nursing educators will be held to disseminate the meanings of power locally and in Australia, the 2nd Co-I’s home country. A short-term goal is to increase awareness of embedded power relations within teacher-student relationships that will lead to the promotion of active learning and student-centred teaching. A long-term goal is to make students aware of power issues in the nurse-patient relationship after they have graduated and become registered nurses.

An Evaluation of the Effectiveness of a Mindfulness-based Illness Management Program for Chinese People with Schizophrenia: A Randomised Controlled Trial

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Prof. Sally W.C. CHAN, Prof. Thanos KARATZIAS, Ms Shuk Yi CHAN, Ms Jolene H.C. MUI, Ms Lai King YIP

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $653,270

Commencement Date: 1-Jul-15

Objectives:This controlled trial is to test the effects of a Mindfulness-based Care for Schizophrenia Program(MBCSP) on a variety of patient outcomes over a 12-month follow-up.

Hypotheses: When compared with those in a psychoeducation group and routine psychiatric outpatient care, the MPCSP participants will indicate significant greater reduction in patients' re-hospitalization and remission rates, improvements in levels of recovery, functioning, symptom severity, and insights into illness/treatment at 2-week, 6-month and/or 12-month after completed the interventions.

Design and subjects: A randomized controlled trial with repeated-measures, three-group design on the community-based MBCSP will be conducted with outcome (and cost-effectiveness) and process(formative) evaluation. Instruments: Questionnaire of Process of Recovery, Positive and Negative Syndrome Scale(for severity and remission), frequency and length of hospitalization, InsightlTreatment Attitude Questionnaire, and Specific Level of Functioning Scale.

Interventions: Two treatment groups (MBCSP and psychoeducation group) and routine psychiatric outpatient care(control).

Main outcome measures: Primary outcomes include frequency and length of re-hospitalization, level of recovery and symptom remission; secondary outcomes are patients' functioning, symptom severity and insight into illness/treatments. Four focus group interviews for formative evaluation of two treatment programs will be conducted.

Data analysis: Patient outcomes will be compared over 12-month follow-up(pretest and 3 posttests) using multivariate ANOVA or Mixed Model technique. Focus group interview data will be content analyzed and cost-effectiveness analysis of the MBCSP will also be conducted.

Expected results: The findings provide evidence of the effectiveness(cost-effectiveness) of the integrated MBCSP on improving schizophrenia sufferers' psychosocial and mental conditions over 12-month follow-up, thus reducinQ relapses and medical costs.

A Randomized Controlled Trial of Problem-solving Based Bibliotherapy Program for Family Caregivers of People with Schizophrenia Spectrum Disorders

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Prof. Dan I. LUBMAN, Prof. David Robert THOMPSON, Prof. Eric F.C. CHEUNG, Prof. Terence V. McCANN, Ms Lai King YIP

Funding Scheme/ Source of Funding: General Research Fund

Total Grant: HK $537,662

Commencement Date: 1-Jan-15

Family caregivers of people with schizophrenia-spectrum disorders are confronted by a various physical, psychosocial and financial hardships. This can adversely affect family members’ caregiving experiences, psychological distress, general well-being, and family relationships or emotional involvement, which in turn may contribute to a greater risk of patient relapse and non-recovery. While family psycho-education and mutual support groups are effective in reducing caregivers’ burden of care, these approaches usually require regular meetings and encounter difficulties in extensive training of group leaders/facilitators and engaging participants to actively share their caregiving experiences due to time inconvenience and fear/inability of expression of feelings. By virtue of the above, an alternate model of self-help program in book form named bibliotherapy, which is a guided reading and self-practice program with problem-solving training facilitated by a psychiatric nurse, has recently demonstrated evidences in clinical trials for families of depressive and psychotic patients by the research team, and other researchers. This proposed randomized controlled trial will test the effectiveness of a problemsolving based bibliotherapy program (PSBBP) for Chinese family caregivers in schizophrenia spectrum disorders. A repeated-measures, three-group design will be used to evaluate and compare the effects between two treatment groups(PSBBP and psychoeducation group) and routine outpatient service and family support(controls with a selfhelp booklet) for 129 randomly selected family caregivers of outpatients with schizophrenia-spectrum disorders over a 12-month follow-up. Primary outcomes include caregivers’ burden of care, caregiving experiences and coping and social problem-solving skills using validated instruments. Secondary outcomes are patients’ mental state, functioning, perceived expressed emotion, and re-hospitalization rate. They will be measured at recruitment, one week, and 6 and 12 months following the interventions. Kaplan-Meier survival analysis will be used to analyze the relative risks of rehospitalizations amongst the treatment and control groups over 12-month follow-up. It is hypothesized that the PSBBP participants will produce significantly better improvements in caregivers’ perceived burden, caregiving experience and coping and problem-solving skills than those in psycho-education and control groups over 12-month follow-up. Focus group interviews will be conducted after the first post-test with 20 caregivers (10 participants per group) in both treatment groups. Their data will be content analyzed to identify their perceived benefits, limitations and difficulties encountered and therapeutic ingredients of the two programs. With significant positive outcomes found in the PSBBP, this program will be adopted by community mental healthcare services in Hong Kong, and replicated in other Asian countries, to improve family-based care in schizophreniaspectrum disorders.

Testing the Psychometric Properties of a Chinese Version of Dementia Management Strategies Scale among Family Caregivers in Hong Kong

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Ms Lai King YIP, Prof. Richard GRAY, Prof. Sally W.C. CHAN

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: HK $79,992

Commencement Date: 2-Jan-14

Objectives: This study aims at validating a Chinese version of Dementia Management Strategies Scale (DMSS) that is useful for assessing the educational needs of family caregivers in dementia care. Hypothesis to be tested: It is hypothesized that family caregivers who adopted adaptive management strategies in dementia care (e.g., giving encouragement, using home modification, etc.) can alleviate the caregiver's distresses and the progression of neuropsychiatric symptoms among people with dementia. Design and subjects: A cross-sectional design will be used to test the psychometric properties of DMSS. A 6·month prospective cohort, nested in the cross-sectional design, will be used to examine the prognostic factors affecting the progression of illness among people with dementia. Subjects will include 200 dyads of family caregivers and their elderly relatives with dementia. Study instruments: Mainly include DMSS, Task Management Strategies Index (TMSI), and Neuropsychiatric Inventory (NPI). Main outcome measures: Subscale scores of DMSS and total scores of TMSI and NPI. Data analysis: The factor structure of DMSS will be extracted by principal component analysis with varimax rotation. The internal consistency (Cronbach's alpha), test-retest reliability (ICC), reproducibility (ICC), and responsiveness to change will be examined. Expected results: Subscales in DMSS that measure frequencies of adaptive strategies in dementia care will be convergent with the total score in TMSI, and vice versa for the subscales that measure non-adaptive strategies (e.g. criticism). The changes in the subscale scores of DMSS and TMSI will predict the improvement! deterioration of neuropsychiatric symptoms among people with dementia across the 6-month interval.

An Evaluation of the Effectiveness of Adherence Therapy for Patients with Schizophrenia: A Randomized Controlled Trial

Investigators Name:
PI: Prof. Wai Tong CHIEN
Co-I: Dr Eric F.C. CHEUNG, Ms Glendy IP, Ms Jolene H.C. MUI, Prof. Richard GRAY

Funding Scheme/ Source of Funding: Health and Medical Research Fund (HMRF)

Total Grant: $611,120

Commencement Date: 1-Mar-13

Background: Despite the advent of newer antipsychotic medication with less severe side-effects, there is little progress has been made in medication adherence. Poor adherence with anti psychotics is associated with a substantial increase in illness relapse and poor psychosocial outcomes such as poor functioning. Motivational interviewing(+cognitive approach) suggested by Kemp and colleagues(1998) have demonstrated sustained gains in medication adherence and insights into treatment. Design:A randomized controlled trial, using a repeated-measures control group design. Sample and settings:134 people with psychotic disorders served by the CPNS in the NT and Kowloon regions(n=67 each setting) will be randomly selected from the patient lists. After baseline measurement, they will be randomly assigned either to the treatment (n=67;6-session Adherence Therapy) or control group(n=67;usual care). They will be assessed on levels of adherence, insight and attitude to treatment, mental state, functioning, and re-hospitalization rates at recruitment, one week and 6 and 15 months after intervention. Field observation and semi-structured interviews with 22 patients and six nurses will be conducted to identify their perceived benefits and difficulties in the intervention. Data analysis:On an intention-to-treat basis, multivariate repeated-measures analyses of co-variance will be used to assess the outcome changes between two groups/settings over 15-month follow-up. Content analysis will be used to identify therapeutic components and limitations of the Adherence Therapy from interview data. Conclusion: lf significant outcome improvements are found in the treatment group, the Adherence Therapy can be adopted by other community care teams in Hong Kong to increase medication adherence rates in psychotic patients, thus reducing their relapse rates.


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