Gloria Hoi Yan Wong

Background: Network analysis has increasingly been adopted over the past decade to study the structure of depressive symptoms in middle-aged to older populations, with ‘central’ symptoms often taken to suggest potential intervention targets. However, questions have been raised regarding the stability and clinical significance of centrality metrics. This systematic review aimed to examine the centrality of depressive symptoms among adults aged 50 years and older across network studies, with a focus on identifying its influencing factors. Methods: We conducted systematic searches via PubMed, PsycINFO, and Web of Science from database inception to February 15, 2025, with one additional study identified during peer review. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was adapted to assess the quality of included studies. Symptoms were ranked according to their centrality. Factors associated with the presence of any DSM-based depressive symptom, non-DSM depressive symptom, and comorbid symptom/associated factor as among the top three central nodes, were examined using Firth penalised multivariable logistic regression. Results: Fifty-seven studies comprising 176 networks were reviewed, with 17 different depression scales adopted. Six of them were ‘strong’ in terms of their quality. ‘ Depressed mood ’ was the most central DSM-based depressive symptom, although its rate of being among the most central nodes dropped from 80.6% in depressive symptoms-only networks to 59% in comorbidity and extended networks. ‘Lack of happiness’ was among the most central non-DSM depressive symptoms. Meanwhile, comorbid symptoms and risk/protective factors were among the most central nodes in comorbidity and extended networks, with anxiety symptoms of ‘ uncontrollable worry’, ‘ trouble relaxing ’, and ‘ nervousness ’ showing the highest node and bridge centrality. ‘Tired in the morning’ , ‘lack companionship’ , ‘alone’ , and ‘isolated’ were other commonly identified bridge symptoms. Networks constructed during the COVID-19 pandemic was associated with a lower odds of DSM-based depressive symptoms (aOR=0.22, CI = 0.07–0.64) and a higher odds of comorbid symptoms/associated factors (aOR=3.41, CI = 1.31–9.45) being most central, while networks constructed among clinical/subclinical samples were associated with a lower odds of comorbid symptoms/associated factors being most central (aOR=0.22, CI = 0.08–0.56). Those adopting DSM-based depression scales showed a trend of DSM-based depressive symptoms being most central across networks (aOR=3.10, CI = 0.97–11.20). Conclusion: Substantial heterogeneity was observed in the centrality of symptoms in networks of depressive symptoms, with network types, environmental changes during time of data collection, and the choice of depression scales being influencing factors. Clinical implications and future directions in the context of these findings are discussed.

Background and Objectives: Depression is a modifiable predictor of dementia, but the effects of addressing depression to improve cognition, especially psychosocial interventions, are understudied. The underlying relationships between depressive symptoms (DS) and cognitive function (CF) are also unclear. Most prior research has been observational, lacking insight into their interactions during interventions. This study examined the longitudinal relationships between DS and CF across psychosocial interventions in older adults, modeling changes as latent variables for more accurate estimations. Research Design and Methods: The study drew on participant data from JC JoyAge, a community stepped-care program for late-life mental health. Participants (≥60 years) with mild to moderate DS (N = 4,412) completed DS and CF assessments (e.g., attention, language, orientation, memory domains) before and after the program. Latent change score models were computed to examine changes in DS and CF as well as their interaction. Results: On average, participants’ DS and CF improved following intervention. A greater reduction in DS was associated with greater improvement in CF. Higher baseline CF predicted a greater reduction in DS, while a lower baseline DS predicted a greater improvement in global CF, attention, and memory. Discussion and Implications: The findings demonstrated the bidirectional relationships between DS and CF and showed their shared improvements during psychosocial intervention. Treating depression is expected to benefit cognition, potentially preventing cognitive decline and dementia. Combining depression and cognition components in integrated intervention approaches may enhance their reciprocal response. Early intervention at a lower depression level may achieve greater cognitive benefits.

Background: Older adults face a substantial burden of common mental disorders, yet they are less likely to seek professional help compared to younger adults. In Chinese contexts, collectivist values and stigma may further deter help-seeking. Social norms are central to the theory of planned behavior (TPB) and nudge theory, suggesting that norm-based messages, especially those that are visually engaging, could strengthen perceived social approval and subsequent help-seeking intentions. Objective: This study aims to evaluate the effectiveness of co-designed norm-based nudges, delivered in descriptive (descriptive norm nudge) or pictorial forms (pictorial norm nudge), in improving subjective norms and intentions to seek mental health help among older adults, compared to an information-only control. Methods: This 3-arm randomized controlled trial (1:1:1) recruits adults aged ≥60 years via community partners in Hong Kong. Participants receive daily texting for 14 days and are allocated to the pictorial norm nudge (descriptive text combined with pictorial cultural games that evoke social support), the descriptive norm nudge (descriptive text only), or the control (mental health service information) groups. Assessments are conducted at baseline (T0), after intervention (T1), and at a 3-month follow-up (T2). Primary outcomes are subjective norms and help-seeking intentions, measured using the Chinese version of the TPB questionnaire. Secondary outcomes include perceived behavioral control, help-seeking attitudes, perceived barriers, depression, anxiety, and loneliness. A 2-level linear mixed model will be used in intention-to-treat analyses to examine the intervention’s effectiveness. Results: The study grant was awarded in June 2023, with recruitment of participants to the randomized controlled trial starting in December 2024 and concluding in June 2026. As of June 30, 2026, a total of 532 eligible participants had completed the baseline assessment. Among them, 470 (88.34%) completed the postintervention, and 408 (76.69%) completed the 3-month follow-up assessment assessments. Data collection and follow-ups are ongoing. A full report of the findings is expected by October 2026, with publication anticipated in early 2027. Conclusions: This study will provide critical insights into the feasibility and effectiveness of brief, co-designed nudges for promoting mental health help-seeking intentions. If effective, this approach will offer a scalable, culturally adaptive, and low-intensity strategy to improve mental health service use among older adults.

Objectives: Aligned with the World Health Organization's call for enhanced dementia research to inform national strategies, this systematic mapping review identifies critical gaps in the evidence base for Chinese populations. Representing over 20% of people living with dementia globally, this group remains underrepresented in the Western‐centric research that currently guides best practices. This is the first study that comprehensively reviews evidence on dementia‐related interventions trialled among participants identified as Chinese worldwide across both Chinese and English literature. It addresses critical gaps in previous Anglo‐centric reviews by capturing culturally specific interventions and assessing the evolving evidence landscape for Chinese population. Methods: Following PRISMA guidelines, we systematically searched two widely used Chinese databases (China National Knowledge Infrastructure, Wanfang Data) and 12 English bibliographical databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit, Cochrane Database of Systematic Reviews) to identify randomised controlled trials (RCTs) published between 2008 and 2020 (registered on PROSPERO: CRD42019134135). Dual‐language teams employed culturally sensitive strategies to maximise coverage of regionally prevalent interventions. Risk of bias was assessed using version two of the Cochrane risk‐of‐bias tool for randomised trials. A narrative approach was used to review and assess the current landscape of dementia intervention research in Chinese communities. Results: We identified 183,277 records across Chinese and English databases and included 525 unique RCTs for synthesis (93% published in Chinese). The most commonly studied interventions were multicomponent interventions (35.2%), followed by pharmacological (29.5%), non‐pharmacological (18.3%), and traditional Chinese medicine (TCM; 14.5%) interventions. 62.7% of multicomponent RCTs were those combining TCM with Western drugs. Cognitive outcomes were measured in 86.9% of RCTs and functional outcomes in 60.2%, while only 3% evaluated quality of life (QoL) and 1% carer‐related outcomes. Most trials (91.8%) were hospital‐based. Over 80% of included RCTs were assessed as having overall ‘some concerns’. Conclusions: Despite rapid growth of dementia intervention research in Chinese communities, evidence remains skewed towards hospital‐based trials conducted predominantly in mainland China, with a focus on cognitive and functional outcome. High‐quality evidence is urgently needed to rebalance research priorities and address critical knowledge gaps in improving QoL, carer support, and community‐based interventions. Our finding that most trials were published in Chinese involving TCM illustrates the value of integrating non‐English literature in global evidence synthesis, especially for identifying culturally specific interventions common in lower‐ and middle‐income countries.

Background and Objectives: While participatory arts are thought to benefit older adults’ well-being, evidence has focused on dementia. This umbrella review synthesizes evidence from systematic reviews (SRs) and meta-analyses (MAs) on the impacts of participatory arts for older adults without dementia, and conceptually organizes findings using the proposed “Aesthetic–Engagement–Creativity” (AEC) framework. Research Design and Methods: Following PRIOR guidelines, we searched MEDLINE, PubMed, PsycINFO, The Cochrane Library of Systematic Reviews and gray literature to September 2023, with an update in June 2025. Study characteristics and well-being outcomes were extracted. We used the AEC framework for conceptual categorization, assessed primary study overlap using the corrected covered area (CCA) and the methodological quality with the AMSTAR 2. Results: Eighteen reviews were included, with minimal study overlap (CCA = 1.96%). However, the evidence base was weak; 12 reviews were of low or critically low quality. A synthesis of the six moderate-to-high quality reviews revealed that dance was the most studied modality, associated with improved physical well-being. The benefits for other well-being domains and art modalities were mixed, and significant heterogeneity in study designs and measures complicated comparisons. Our retrospective application of the AEC framework suggests that considering participants’ aesthetic preferences and optimizing engagement and creativity levels may be important, but this link is speculative. Discussion and Implications: Participatory arts show potential for promoting well-being of older adults, but robust conclusions are constrained by the poor quality, underrepresented art modalities, and heterogeneity of the existing evidence. The AEC framework is offered as a conceptual tool requiring future empirical validation.

Introduction: While loneliness has been recognised as a global public health concern, there are still knowledge gaps about how to prevent or reduce loneliness. The Social Relationship Expectations (SRE) Framework (Akhter-Khan et al, 2023 ) has been developed to enhance mechanism-based interventions targeting individuals’ expectations for social relationships. However, no scale has yet been developed to measure these expectations. We aim to measure SRE across the six interdependent dimensions identified in the theoretical framework, across diverse settings. This protocol outlines the methodology for developing the SRE scale. Methods and analysis: The scale will be developed using both inductive and deductive techniques in a multicountry observational study. First, items will be extracted from published qualitative studies on loneliness and SRE across 15 lower-middle-income countries and from a qualitative focus group study with older Myanmar and Thai adults. Second, using a Delphi process for item development, experts across five world regions (Africa, the Americas, Asia, Europe and Oceania) will be involved in the item selection and scale creation process. A preliminary item pool will be administered in English, German and Chinese. Classical test theory as well as network analysis will be used to assess the dimensionality of the scale, understand item relationships and clusters, and select the final items for the SRE scale. Ethics and dissemination: Ethics approval for the scale development has been obtained from King’s College London (reference number: MRSP-24/25-46512). Informed consent will be obtained from all participants prior to completing the cognitive interviews and online surveys. Results will be disseminated in peer-reviewed journals in collaboration with coauthors across different countries and disciplines.

Background and objectives: Most people with dementia are undiagnosed and rely heavily on long-term care. Little is known about the relationship between dementia diagnosis and care costs, and inconsistent evidence exists on the cost implications of cognitive impairment severity. We examined how formal and informal care costs are associated with a dementia diagnosis and cognitive impairment levels across care settings. Research design and methods: We used representative data from publicly funded long-term care recipients in residential care settings and community care settings in Hong Kong (n = 1,603). Staff time measurement was used to capture service utilization of both formal and informal care. Generalized linear model (log-link and gamma distribution) was used to estimate long-term care costs, controlling for covariates. Results: A dementia diagnosis is associated with an additional 13% and 23% care costs in residential and community care settings, respectively. People with more severe cognitive impairment incur greater long-term care costs; the highest difference (a 189% increase) was found in informal care costs in community care settings among those with moderate-to-severe cognitive impairment. In community care settings, formal care costs were insensitive to cognition status but were consistently higher with a dementia diagnosis; in contrast, informal care costs were less associated with a diagnosis but increased with cognitive impairment severity. Discussion and Implications: Having a diagnosis of dementia and poorer cognition are associated with higher long-term care costs in both residential and community care settings. A dementia diagnosis is potentially a more important driver of formal care costs than cognitive impairment levels within the current care system, in contrast to what is observed with informal care costs. Practitioners and policymakers need to ensure that individuals with cognitive impairment without a dementia diagnosis receive the appropriate level of care.

Background: Chronic pain and depression are common in older people, and creative activities may lower the perceived impact and distress related to the symptoms. Aims: This study describes the co-development of a creative arts and crafts protocol for older people with chronic pain and depressive symptoms, and investigates its feasibility and potential effects. Method: This study had two phases. In phase 1, a multidisciplinary expert panel (n = 10), consisting of professionals, patients and researchers, underwent iterative rounds to co-develop the protocol. In phase 2, a pilot study was conducted among 12 older adults (mean age 71.4 years). Mixed methods were used, including questionnaires at baseline, post-intervention and 3-month follow-up, assessing pain intensity and interference, depressive symptoms and quality of life; observational notes and focus groups. Descriptive and Wilcoxon signed-rank tests were applied to analyse quantitative data, and thematic analysis was used for qualitative data. Results: Qualitative findings supported the programme’s feasibility. Participants reflected that the process was engaging and empowering and brought them a sense of achievement and recognition. The quantitative findings evidenced the programme’s potential effects in reducing depressive symptoms (Z = −2.60, P < 0.01) and improving mental health-related quality of life (Z = −2.67, P < 0.01) at 3-month follow-up. Conclusions: Our results support the feasibility of a creative arts and crafts programme and provide preliminary evidence of its impact on reducing depressive symptoms and improving mental health-related quality of life. Given the promising results, a definitive trial is needed to reveal the effectiveness of creative activities in pain management.