November 02, 2018
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Internet-based program may prevent depression in adolescents

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An internet-based cognitive behavioral humanistic and interpersonal training intervention helps lower depressive symptoms among adolescents in primary care, according to research published in JAMA Network Open.

“Although 13% to 20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available,” Tracy R. Gladstone, PhD, from Robert S. and Grace W. Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College, and colleagues wrote.

Gladstone and colleagues conducted a multicenter, randomized clinical trial, a phase 3 single-blind study to determine if the hazard for depression in at-risk adolescents identified in primary care is lowered more with cognitive behavioral humanistic and interpersonal training (CATCH-IT) vs. a general health education (HE) attention control.

CATCH-IT was described as an internet-based intervention including an online psychoeducation course with 20 modules, 15 for the adolescents and five for the parents, a parent program and three motivational interviews with physicians. The HE intervention consisted of 14 modules that provided instruction on general health topics, with the last module discussing mood, mental health treatment and mental disorder stigma.

The researchers enrolled 369 adolescents aged 13 to 18 years (mean age, 15.4 years; 68% women) with subsyndromal depression and/or history of depression and no current depression diagnosis or treatment and randomly assigned 193 to CATCH-IT and 176 to HE. They measured time to event for each depressive episode and depressive symptoms at 6 months. Participants’ level of depression was based on scores from the Center for Epidemiologic Studies Depression scale (CES-D10).

Overall, 28% of participants had both a past episode of depression and subsyndromal depression, while 12% had a past episode only, 59% had subsyndromal depression only and 1% had borderline subsyndromal depression.

CATCH-IT indicated better time to event for depression compared with ED, but intention-to-treat analyses showed no significance in the outcome (unadjusted HR = 0.59; 95% CI, 0.27-1.29; adjusted HR = 0.53; 95% CI, 0.23-1.23).

CATCH-IT had a significantly stronger effect on time to event among participants with a higher baseline CES-D10 score, compared with those with lower baseline scores (HR = 0.82; 95% CI, 0.67-0.99). The HR was 0.2 (95% CI, 0.05-0.77) for participants with a CES-D10 score of 15 and 1.44 (95% CI, 0.41-5.03) for those with a CES-D10 score of 5.

Both groups showed declines in depression symptoms and increases in functional scores.

“For preventing depressive episodes, CATCH-IT may be better than HE for at-risk adolescents with subsyndromal depression,” Gladstone and colleagues concluded. “Also CATCH-IT may be a scalable approach to prevent depressive episodes in adolescents in primary care.” – by Alaina Tedesco

 

Disclosure: Gladstone reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.