Internet-Based Depression Prevention over the Life Course: A Call for Behavioral Vaccines

Abstract

Background SignificanceMajor depression is the number one cause of disability worldwide. 1 The lifetime prevalence of major depression in the United States is 16.6%, but is as high as 19.8% for those in more recent birth cohorts. 2 Depression, known as a "life course" disorder, usually has its first onset in mid-adolescence, and recurs every five to seven years in 80% of individuals.3 Most people with major depression do not obtain treatment4; of those who do obtain evidencebased treatments, approximately one-third do not improve.5 -6 Depression is associated with substantial impairment both during and after the episode. Many who suffer from depression © 2010 Elsevier Inc. All rights reserved.Corresponding Author: Benjamin Van Voorhees, MD, MPH, Section of General Internal Medicine, Department of Medicine, The University of Chicago, 5841 South Maryland Blvd, Chicago, IL 60637, bvanvoor@medicine.bsd.uchicago.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Disclosures: Benjamin W. Van Voorhees has served as a consultant to Prevail Health Solutions, Inc, Mevident Inc, San Francisco and Social Kinetics, Palo Alto, CA, and the Hong Kong University to develop Internet-based interventions. In order to facilitate dissemination, the University of Chicago recently agreed to grant a no-cost license to Mevident Incorporated (3/5/2010) to develop a school-based version. Neither Dr. Van Voorhees nor the university will receive any royalties or equity. Dr. Van Voorhees has agreed to assist the company in adapting the intervention at the rate of $1,000/day for 5.5 days. The CATCH-IT Internet site and all materials remain open for public use and made freely available to healthcare providers at http://catchit-public.bsd.uchicago.edu/. NIH Public Access Value of Technology-Based Approaches in Preventing DepressionThe Institute of Medicine (IOM) has published two major reports on the prevention of mental, emotional, and behavioral disorders18 -19 and has called for the development and rigorous evaluation of new technology based on new prevention strategies. Technologybased delivery offers considerable benefits including easy access (time and space), patient autonomy, and "non-consumable" services that are autonomous from traditional (face-toface) interventions.13 , 20 In the IOM model ( Figure 1, interventions are deployed to prevent the onset of illness in individuals who do not already meet diagnostic criteria for these disorders. Such interventions can be universal (applied to the entire population), selected (applied to those with a risk factor for disorder), and indicated (applied ...

Prevención, detección, tratamiento o seguimiento en salud mental de adolescentes a través del uso de Internet: una revisión sistemática cualitativa

“…El artículo de Benjamin Van Voorhees y cols (2011) aborda intervenciones para la prevención de depresión 10 , el artículo de Alison Calear y Helen Christensen (2010) revisa programas para la prevención de ansiedad y depresión 11 ; y por último en artículo de Christopher Siemer y cols (2011) aborda programas de promoción de salud mental, intervenciones de prevención y tratamiento de diferentes problemas de salud mental 12 .…”

“…Principalmente los artículos se centran en tratamientos para la depresión (Ej., proyecto CATCH-IT, programa Mood GYM), ansiedad (ej., programa BRAVE Online), trastornos de alimentación (ej., programa My Body, My Life, The Student Bodiesprogram) y abuso de sustancias (ej., The Climate Schools program, entre otros) [10][11][12] . Es importante mencionar que la minoría de los programas señalados que se encontraron en las revisiones sistemáticas cuentan con ECC.…”

“…Otros programas realizan la primera entrevista y evaluación en establecimientos educacionales, y se imparten en éstos mismos. Una minoría de los programas se ofrece a través de un acceso abierto en sitio web desde su inicio (evaluación se realiza a través de Internet también) [10][11][12] . En la mayoría de los estudios se presta apoyo en línea a los usuarios de las intervenciones, pero los métodos varían considerablemente.…”

“…Por úl-timo en algunos no existe este soporte adicional. El apoyo adicional sirve para varios propósitos: monitorea el progreso del usuario en el sitio, revisa tareas y actividades de los programas, ofrece clases semanales presenciales, determina si existe riesgo en los participantes (aumento significativo de sintomatología, ideación suicida), velando así por la seguridad emocional de los usuarios; y por último, motiva la permanencia de los adolescentes en los programas [10][11][12] . Los programas que se mencionan en estas revisiones se basan principalmente en la terapia cognitivo conductual (TCC), sólo uno de ellos señala incluir además la activación conductual y la terapia interpersonal.…”

Pilot study of Internet-based early intervention for combat-related mental distress

“…The VETS PREVAIL intervention encompasses five online elements thought to promote behavior change for mental health problems within a framework of "behavioral vaccines" that include (1) effective components (1 element), (2) a motivational framework (2 elements), and (3) an implementation structure (2 elements) [18].…”