Effect of Internet-based Cognitive Behavioral Humanistic and Interpersonal Training vs. Internet-based General Health Education on Adolescent Depression in Primary Care: A Randomized Clinical Trial

• Published in: JAMA network open Vol. 1; no. 7; p. e184278
• Main Authors: Gladstone, Tracy, Terrizzi, Daniela, Stinson, Allison, Nidetz, Jennifer, Canel, Jason, Ching, Eumene, Berry, Anita, Cantorna, James, Fogel, Joshua, Eder, Milton, Bolotin, Megan, Thomann, Lauren O, Griffith, Kathy, Ip, Patrick, Aaby, David A, Brown, C Hendricks, Beardslee, William, Bell, Carl, Crawford, Theodore J, Fitzgibbon, Marian, Schiffer, Linda, Liu, Nina, Marko-Holguin, Monika, Van Voorhees, Benjamin W
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01.11.2018
• Subjects: Clinical trials; Health education; Internet; Mental depression; Online Only; Original Investigation; Primary care; Psychiatry; Teenagers
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2018.4278

Although 13-20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available. To study whether CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training) reduces the hazard for depression in at-risk adolescents identified in primary care, as compared to a general health education attention control (HE). The Promoting AdolescenT Health (PATH) study compares CATCH-IT and HE in a phase 3 single-blind multicenter randomized attention control trial. Participants were enrolled from 2012 to 2016 and assessed at 2, 6, 12, 18, and 24 months post-randomization. Primary care. Eligible adolescents were 13-18 years with subsyndromal depression and/or history of depression and no current depression diagnosis or treatment. Of 2,250 adolescents screened for eligibility, 446 participants completed the baseline interview and 369 were randomized into CATCH-IT (n=193) and HE (n=176). CATCH-IT is a 20-module (15 adolescent modules, 5 parent modules) online psychoeducation course that includes a parent program, supported by three motivational interviews. Time-to-event for depressive episode; depressive symptoms at 6 months. Mean age was 15.4 years, and 68% were female; 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 (N=369; HR=0.59; 95% CI 0.27, 1.29; p=0.18; HR=0.53; 95% CI 0.23, 1.23, p=0.14). Adolescents with higher baseline CES-D scores showed a significantly stronger effect of CATCH-IT on time-to-event relative to those with lower baseline scores (p=0.04). For example, for a CES-D score of 15 (significant sub-syndromal depression), HR=0.20 (95% CI 0.05, 0.77), compared to CES-D of 5 (no sub-syndromal depression), HR=1.44 (95% CI, 0.41, 5.03). In both CATCH-IT and HE groups, depression symptoms declined and functional scores increased. CATCH-IT may be better than HE for preventing depressive episodes for at-risk adolescents with sub-syndromal depression. CATCH-IT may be a scalable approach to prevent depressive episodes in adolescents in primary care.