24-Month Outcomes of Primary Care Web-Based Depression Prevention Intervention in Adolescents: Randomized Clinical Trial (Preprint)

Abstract

BACKGROUND Although adolescent depression carries a high burden of disease worldwide, few scalable depression interventions target adolescents in primary care. OBJECTIVE This study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education (HE) “attention control” on depression onset in adolescents. METHODS We conducted a two-site, single-blind randomized trial comparing CATCH-IT to HE to prevent depressive episodes in 369 adolescents (ages 13-18, 43.1% identified as non-Hispanic white) with sub-threshold depressive symptoms and/or prior depressive episode. The primary outcome was the occurrence of first episode, determined by the Depression Symptom Rating (DSR). Secondary symptom outcomes include the Center for Epidemiologic Studies – Depression (CES-D10) and Global Assessment Scale (GAS). RESULTS Between March 23, 2012 – June 22, 2016, 193 youths were randomly assigned to CATCH-IT and 176 to HE. In intention-to-treat (ITT) analyses, the adjusted hazard ratio favoring CATCH-IT for first depressive episode was not statistically significant at 12 (HR = 0.77, 95% CI, 0.42, 1.40, p = 0.39) and 24 months (HR = 0.87, 95% CI, 0.52, 1.47, p = 0.61). In analyses restricted to adolescents enrolled with elevated depression symptoms (N=321), baseline CES-D10 score was a marginally significant moderator at 12 months, with CATCH-IT providing greater benefit in adolescents with higher CES-D10 scores (0.15 decline in HR for each CES-D10 point increase, p = 0.054). CATCH-IT provided preventive benefit for first depressive episode for those with mild hopelessness or at least moderate paternal monitoring at baseline. GAS and CES-D10 scores declined comparably in both groups (ITT). CONCLUSIONS A technology-based intervention for prevention implemented in primary care may be beneficial up to 24 months for adolescents with elevated depressed mood, or with lower levels of hopelessness and higher levels of paternal monitoring. CLINICALTRIAL NCT01893749, www.clinicaltrials.gov