Randomized controlled trial of primary care physician motivational interviewing versus brief advice to engage adolescents with an Internet-based depression prevention intervention: 6-month outcomes and predictors of improvement

Abstract

We believe that primary care physicians could play a key role in engaging youth with a depression prevention intervention. We developed CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral and Interpersonal Training), an adolescent Internet-based behavior change model. We conducted a randomized comparison of two approaches in engaging adolescents with the Internet intervention: primary care physician (PCP) motivational interview + CATCH-IT Internet program (MI) versus PCP brief advice + CATCH-IT Internet program (BA). Participants (N=84) were recruited by screening for risk of depression in 13 primary care practices. We compared depressive disorder outcomes between groups and within groups over 6 months and examined potential predictors and moderators of outcomes across both study arms. Depressive symptom scores declined from baseline to 6 weeks with these statistically significant reductions sustained at the 6 months follow-up in both groups. No significant interactions with treatment condition were found. However, by 6 months, the MI group demonstrated significantly fewer depressive episodes and reported less hopelessness as compared to the BA group. Hierarchical linear modeling regressions showed higher ratings of ease of use of the Internet program predicting lower depressive symptom levels over 6 months. In conclusion, a primary care/Internet-based intervention model among adolescents demonstrated reductions in depressed mood over 6 months and may result in fewer depressive episodes.

Web-Based Interventions for Youth Internalizing Problems: A Systematic Review

“…Adverse events were reported for only 1 program involving participants with a prior history of self-harm and psychiatric hospitalization who did not endorse suicidal ideation during the initial assessment. 26,27 The potential for adverse events such as suicide or self-harm highlights the importance of frequent screening of mood symptoms even in programs designed to be preventive.…”

“…A trend toward greater participation on the CATCH-IT site was found for the MI group. 6 Three follow-up studies evaluated outcomes from this RCT and found that reduction in depressed mood was sustained at 6 weeks and 12 weeks, 26 at 6 months, 27 and at 1-year follow-up. 28 It should be noted that 1 participant attempted suicide 1 week after enrollment in the MI group, and there was 1 completed suicide 5 months after enrollment in the BA group.…”

“…Both individuals had prior histories of self-harm behaviors and psychiatric hospitalizations. [26][27][28] Although the use of an RCT design and the amount of follow-up data on CATCH-IT are strengths, the current research compares only the MI and BA versions of the same treatment, making it impossible to determine whether the intervention itself led to symptom improvements rather than just the passage of time or nonspecific elements of any psychosocial intervention. In addition, adolescent and clinician ratings and full scales should be used to assess outcomes, as some constructs were measured using single items (e.g., self-harm).…”

Cultural considerations for the adaptation of an Internet-based intervention for depression prevention in Mainland China

“…The intervention consists of a number of components including cognitive behavioral therapy (CBT), interpersonal therapy (IPT), behavioral activation (BA), and resiliency theory. Two previous studies of the intervention in the US showed high levels of user engagement and favorable outcomes on lowering depressed moods and strengthening protective factors for depression (15,16). Although this intervention and its application of psychotherapies were developed with a Western cultural perspective, we believe that, with appropriate cultural adaptation, it can be used with Chinese adolescents and young adults.…”

Computer-Facilitated Substance Use Screening and Brief Advice for Teens in Primary Care: An International Trial

“…25,26 Existing studies suggest that primary care screening and brief interventions can positively impact adolescent health issues, such as tobacco use, [27][28][29][30] nutrition and physical activity, 31,32 and depression. 33,34 A large longitudinal study of 14-year-old primary care patients 26 found that screening and brief provider counseling significantly increased helmet use but did not reduce adolescent alcohol or drug use, suggesting the need to explore supplemental strategies to enhance effectiveness, such as the computerized education component that occurs before the provider visit in the cSBA system.…”