Effect of Internet-Based Cognitive Behavioral Humanistic and Interpersonal Training vs Internet-Based General Health Education on Adolescent Depression in Primary Care

Abstract

IMPORTANCE Although 13% to 20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available.OBJECTIVE To study whether competent adulthood transition with cognitive behavioral humanistic and interpersonal training (CATCH-IT) lowers the hazard for depression in at-risk adolescents identified in primary care, as compared with a general health education (HE) attention control. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, randomized clinical trial, a phase 3 singleblind study, compares CATCH-IT with HE. Participants were enrolled from 2012 to 2016 and assessed at 2, 6, 12, 18, and 24 months postrandomization in a primary care setting. Eligible adolescents were aged 13 to 18 years with subsyndromal depression and/or history of depression and no current depression diagnosis or treatment. Of 2250 adolescents screened for eligibility, 446 participants completed the baseline interview, and 369 were randomized into CATCH-IT (n = 193) and HE (n = 176). INTERVENTIONS The internet-based intervention, CATCH-IT, is a 20-module (15 adolescent modules and 5 parent modules) online psychoeducation course that includes a parent program, supported by 3 motivational interviews. MAIN OUTCOMES AND MEASURES Time to event for depressive episode; depressive symptoms at 6 months. RESULTS Of 369 participants (mean [SD] age, 15.4 [1.5] years; 251 women [68%]) included in this trial, 193 were randomized into CATCH-IT and 176 into HE. Among these participants, 28% had both a past episode and subsyndromal depression; 12% had a past episode only, 59% had subsyndromal depression only, and 1% had borderline subsyndromal depression. The outcome of time to event favored CATCH-IT but was not significant with intention-to-treat analyses (unadjusted hazard ratio [HR], 0.59; 95% CI, 0.27-1.29; P = .18; adjusted HR, 0.53; 95% CI, 0.23-1.23; P = .14). Adolescents with higher baseline Center for Epidemiologic Studies Depression scale (CES-D 10 ) scores showed a significantly stronger effect of CATCH-IT on time to event relative to those with lower baseline scores (HR 0.82; 95% CI, 0.67-0.99; P = .04). For example, the hazard ratio for a CES-D 10 score of 15 was 0.20 (95% CI, 0.05-0.77), compared with a hazard ratio of 1.44 (95% CI, 0.41-5.03) for a CES-D 10 (continued) Key Points Questions Does an internet-based depression prevention program (competent adulthood transition with cognitive behavioral humanistic and interpersonal training) lower the hazard for depression in at-risk adolescents relative to health education attention control? Findings In this randomized clinical trial of adolescents with subsyndromal depression or history of depression randomized to receive internet-based behavioral humanistic interpersonal training or an internet-based general health education control, those who received the CATCH-IT intervention did not evidence fewer episodes of depression in the full intention-to-treat sample, but adolescents with subsyndromal depression may...

Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes

“…This study utilized a hybrid type I efficacy-implementation design to evaluate the effectiveness of CATCH-IT in a scalable setting [ 49 ]. The efficacy of CATCH-IT was evaluated while simultaneously gathering information on CATCH-IT’s implementation to prepare for scaling up [ 12 ]. This trial was implemented in eight major US Health Systems ( N = 31 primary care sites, 42,310 adolescents) in a population health approach (screen all youth, offer intervention, assessment, refer those in need of treatment) with over 1200 primary care staff consented and trained.…”

“…Parents were also invited to complete four online modules to support their child’s skills development, as well as an optional module for parents who worry they may themselves be depressed. Parent modules have been described in detail in previous publications [ 12 , 43 , 54 ].…”

“…A recent Cochrane review revealed that depression prevention programs for adolescents are associated with a moderate reduction in depressive episodes (risk difference = −0.03) across one-year follow-up [ 10 ], and a meta-analysis of 19 randomized preventive trials revealed that, for adolescents with elevated symptoms of depression, preventive interventions are associated with benefits across a two-year follow-up [ 11 ]. Several trials of specific depression prevention approaches for adolescents at risk for depression also have been found to be effective for certain subsets of teens [ 12 , 13 , 14 , 15 , 16 , 17 ]. The majority of these interventions involve in-person groups that rely on training therapists and recruiting participants who can attend regular sessions; these approaches are limited by lack of access due to barriers related to seeking in-person interventions [ 14 , 15 , 16 , 17 ].…”

“…Early pilot studies demonstrated that participants who used CATCH-IT reported decreases in symptoms of depression at 6, 12, and 30 months, relative to baseline [ 13 , 44 , 45 ]. A more recent randomized clinical trial found CATCH-IT to be efficacious in preventing depressive episodes at six months, relative to an attention-control condition that combined usual care with monitoring and an online general health education program (HE) in adolescents who were experiencing elevated symptoms of depression, though not in the full intention to treat analysis [ 12 ]. These initial findings suggest that CATCH-IT may have great potential as a public health intervention for adolescents at risk of developing Major Depressive Disorder (MDD).…”

“…The current study uses data from the randomized clinical trial comparing CATCH-IT to HE, an online program providing general health education, in a sample that was composed of adolescents with an intermediate to high risk of depression recruited from primary care settings [ 43 ]. As mentioned above, at six months, CATCH-IT, compared to HE, prevented depressive episodes in high-risk adolescents with significant subthreshold depressive symptoms at baseline [ 12 ], and additionally, depressive symptoms significantly decreased in both conditions. Moreover, preventive effects for CATCH-IT were found for up to 24 months for those with low levels of hopelessness or adequate levels of paternal monitoring [ 48 ].…”