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 Fitzgibbon; Linda Schiffer; Nina Liu; Monika Marko-Holguin; Benjamin W Van Voorhees

doi:10.1001/jamanetworkopen.2018.4278

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

JAMA Netw Open. 2018 Nov;1(7):e184278. doi: 10.1001/jamanetworkopen.2018.4278.

Authors

Tracy Gladstone¹, Daniela Terrizzi², Allison Stinson³, Jennifer Nidetz², Jason Canel⁴, Eumene Ching⁵, Anita Berry⁶, James Cantorna⁷, Joshua Fogel^{2

8}, Milton Eder⁹, Megan Bolotin², Lauren O Thomann¹, Kathy Griffith¹⁰, Patrick Ip¹¹, David A Aaby¹², C Hendricks Brown¹³, William Beardslee¹⁴, Carl Bell^{15

16

17}, Theodore J Crawford¹⁸, Marian Fitzgibbon^{2

19

20}, Linda Schiffer¹⁹, Nina Liu⁴, Monika Marko-Holguin², Benjamin W Van Voorhees²

Affiliations

¹ The Robert S. and Grace W. Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts, USA.
² Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
³ School of Social Service Administration, University of Chicago, Chicago, Illinois, USA.
⁴ NorthShore University HealthSystem, Evanston, Illinois, USA.
⁵ Harvard Vanguard, Boston, Massachusetts, USA.
⁶ Advocate Children's Hospital, Downers Grove, Illinois, USA.
⁷ Franciscan Medical Specialists, Munster, Indiana, USA.
⁸ Department of Business Management, Brooklyn College, Brooklyn, New York, USA.
⁹ Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
¹⁰ Research School of Psychology, College of Health & Medicine, The Australian National University, Canberra, Australia.
¹¹ Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
¹² Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹³ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁴ Judge Baker Center, Harvard Medical School, Boston, Massachusetts, USA.
¹⁵ Jackson Park Hospital, Chicago, Illinois, USA.
¹⁶ Department of Psychiatry, School of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
¹⁷ Windsor University, St. Kitts, Saint Kitts and Nevis.
¹⁸ Graduate School of Social Work, Chicago State University and Positive Influence, Inc., Chicago, Illinois, USA.
¹⁹ Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA.
²⁰ University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois, USA.

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.

Abstract

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