Effect of Internet-Based Cognitive Behavioral Humanistic and Interpersonal Training vs Internet-Based General Health Education on Adolescent Depression in Primary Care
Authors: Tracy R. G. Gladstone, Daniela A. Terrizzi, Allison Paulson, Jennifer Nidetz, Jason Canel, Eumene Ching, Anita D. Berry, James Cantorna, Joshua Fogel, Milton Eder, Megan Bolotin, Lauren O. Thomann, Kathy Griffiths, Patrick Ip, David A. Aaby, C. Hendricks Brown, William Beardslee, Carl Bell, Theodore J. Crawford, Marian Fitzgibbon, Linda Schiffer, Nina Liu, Monika Marko-Holguin, Benjamin W. Van Voorhees
Journal: JAMA Network Open (2018)

<h3>Importance</h3> Although 13% to 20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available. <h3>Objective</h3> 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. <h3>Design, Setting, and Participants</h3> This multicenter, randomized clinical trial, a phase 3 single-blind 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). <h3>Interventions</h3> 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. <h3>Main Outcomes and Measures</h3> Time to event for depressive episode; depressive symptoms at 6 months. <h3>Results</h3> 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;<i>P</i> = .18; adjusted HR, 0.53; 95% CI, 0.23-1.23;<i>P</i> = .14). Adolescents with higher baseline Center for Epidemiologic Studies Depression scale (CES-D<sub>10</sub>) 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;<i>P</i> = .04). For example, the hazard ratio for a CES-D<sub>10</sub>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<sub>10</sub>score of 5. In both CATCH-IT and HE groups, depression symptoms declined and functional scores increased. <h3>Conclusions and Relevance</h3> For preventing depressive episodes CATCH-IT may be better than HE for at-risk adolescents with subsyndromal depression. Also CATCH-IT may be a scalable approach to prevent depressive episodes in adolescents in primary care. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier: NCT01893749