Prevention of Adolescent Depression in Primary Care

Abstract

Background and Purpose: Depression affects millions of adolescents in the United States each year. This population may benefit from targeted preventive interventions. We sought to understand the internal factors that affect the ability of healthcare organizations to implement an intervention that involves mental health screening and depression prevention treatment of at-risk adolescents in primary care settings. Methods: From November 2011 to July 2016 we conducted a study of the implementation of a multisite (N=30) phase 3 randomized clinical trial of an Internet-based depression prevention intervention program (CATCH-IT). We describe the prevalence of internal barriers on the screening and enrollment process by reporting REACH (the proportion of target audience exposed to the intervention). Results: A total of 369 adolescents were randomized into the intervention or control program. Mean REACH values for the study clinics were 0.216 for screening and 0.181 for enrollment to CATCH-IT. Mean REACH enrollment lost due to internal barriers was 0.233. This translated to 4,691 adolescents lost at screening and 2,443 adolescents lost at enrollment due to internal barriers. Conclusion: We propose a model of the implementation process that emphasizes the importance of positive relational work that assists in overcoming internal barriers to REACH. We also provide implications for policy and practice.

Effect of Internet-Based Cognitive Behavioral Humanistic and Interpersonal Training vs Internet-Based General Health Education on Adolescent Depression in Primary Care

“… 52 , 53 The implementation of our study at 2 sites and 8 health systems has rarely been accomplished in studies of child psychiatric conditions. 20 This study fits the model by Curran et al 19 of hybrid efficacy and implementation studies and substantially enhances generalizability. The attention control condition, which included guidelines for adolescent depression in primary care and chronic care model elements, no doubt reduced between-group differences.…”

“…Institutional review board approval was received from the central site, University of Illinois at Chicago, and local institutional review boards (IRB of Record, Wellesley College, Advocate Healthcare, Franciscan Alliance, Northshore University Health Systems, Northwestern, and Access Healthcare). 20 Participants were recruited from 2012 to 2016 through a description of the study during doctor visits, recruitment letters, and posted flyers. Adolescents were screened for risk in-person or by phone.…”

“…Institutional review board (IRB) approval was received from the central site (UIC) and local IRBs. 20 This study followed the Consolidated Standard of Reporting Trials (CONSORT) reporting guidelines. The protocol, implementation process, and methods have been described in Supplement 1 and elsewhere.…”

Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes

“…This trial was implemented in eight major US Health Systems ( N = 31 primary care sites, 42,310 adolescents) in a population health approach (screen all youth, offer intervention, assessment, refer those in need of treatment) with over 1200 primary care staff consented and trained. This process has been previously described in further detail [ 43 , 50 ]. Data were collected from urban and suburban clinics located in Chicago, Illinois, and surrounding areas including northern Indiana, and Boston, Massachusetts and surrounding areas.…”

“…Data were collected from urban and suburban clinics located in Chicago, Illinois, and surrounding areas including northern Indiana, and Boston, Massachusetts and surrounding areas. The protocol, CONSORT statement, and a description of the implementation process have been described previously [ 43 , 50 ]. Institutional review board (IRB) approval was received from the University of Chicago IRB (protocol # 2011-0505), the IRB of record, on 15 December 2011, and also by local review boards.…”