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

Tracy Gladstone, Daniela Terrizzi, Allison Stinson, Jennifer Nidetz, Jason Canel, Eumene Ching, Anita Berry, James Cantorna, Joshua Fogel, Milton Eder, Megan Bolotin, Lauren O. Thomann, Kathy Griffith, Patrick Ip, David A. Aaby, C. Hendricks Brown, William Beardslee, Carl Bell, Theodore J. Crawford, Marian FitzgibbonLinda Schiffer, Nina Liu, Monika Marko-Holguin, Benjamin W. Van Voorhees

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Importance: Although 13-20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available. Objective: To study whether 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). Design: 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. Setting: Primary care. Participants: 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). Interventions: 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. Main Outcomes and Measures: Time-to-event for depressive episode; depressive symptoms at 6 months. Results: 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; unadjusted HR=0.59; 95% CI 0.27, 1.29; p=0.18; adjusted HR=0.53; 95% CI 0.23, 1.23, p=0.14). Adolescents with higher baseline CES-D10 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-D10 score of 15 (significant sub-syndromal depression), HR=0.20 (95% CI 0.05, 0.77), compared to CES-D10 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. Conclusions and Relevance: 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.

Original languageEnglish (US)
JournalJAMA network open
Volume1
Issue number7
DOIs
StatePublished - Nov 1 2018

ASJC Scopus subject areas

  • Medicine(all)

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