Creating a Preventative Mental Health System: Engagement Among Chicago Youth

Introduction: Currently there is a lack of preventative mental health care to address depression in teens. CATCH-IT was developed as a primary care internet-based depression prevention which teaches CBT and IPT techniques in a self-guided manner to teens at risk for depression with the primary outcome of preventing major depressive episodes and offers a partnering site for parents to gain similar information. Researchers are conducting a randomized clinical trial comparing CATCH-IT to a general health education Internet intervention which includes an evaluation of participant engagement.

Methods: 13-18 year-olds are recruited from primary care clinics (N=14) in Boston and Chicago.   All adolescents visiting the clinics are screened for depressive symptoms. If at-risk, they are contacted by research staff to confirm eligibility. If eligible, they participate in a semi-structured clinical interview and then offered enrollment into the trial. Follow up data points are collected at two, six, twelve, eighteen, and twenty-four months after baseline. Engagement is defined as completion of self-assessments and semi-structured interviews at each time point.  

Results: Adolescents were recruited from a total of N=14 clinics in N=4 health systems. Of N=1295 Chicago teens that completed the two-question screener, N=416 (32%) endorsed depressive symptoms. N=291(70%) completed an eligibility assessment by phone where N=218 (75%) were ineligible based on exclusion criteria. N=73 (25%) adolescents were enrolled. The study has been able to successfully oversample ethnic and racial minorities: 70% are African American, multiracial, or Hispanic.

In terms of follow up, 79% of enrolled participants completed the phone portion of the 2-month time point compared with 44% for the online questionnaires. For the 6-month time point, 62% completed the phone portion and 18% filled out the questionnaires. For 12-month, 63% and 53% completed phone and online portions respectively.

Conclusions: Our current study design incorporates a variety of activities to reach out to teens that include efforts to consistently promote clinic involvement, offer multiple forms of communication to participants, and decrease their practical barriers such as transportation and scheduling. Maximizing engagement from screening through follow up is critical for treatment adherence. A preliminary review suggests engagement also appears to vary across follow-up modalities. Because of this, we have modified the follow up protocol to reflect this aspect which has aided in gathering self assessment data. This implies that a voice element might be an important factor in preventative intervention development to keep teens engaged.