PATH: Promoting Adolescent Health through Internet-Based Primary Care Intervention

Background: Internet-based interventions for preventing youth depression hold promise, but further research is needed to explore the efficacy of these approaches and ways of integrating emerging technologies for behavioral health into the primary care system.

Methods: We developed a primary care Internet-based depression prevention intervention, CATCH-IT, to evaluate a self-guided, online approach to depression prevention and are conducting a randomized clinical trial comparing CATCH-IT to a general health education Internet intervention.  CATCH-IT was developed utilizing the media theory of “Synchronization of the Senses” to incorporate character stories, peer videos and design/picture elements to create a unified experience meeting today’s social media standards. CATCH-IT combines several therapeutic modalities including cognitive-behavioral and interpersonal/family-based interventions in an ecological model. The intervention also includes an Internet-based parent program incorporating psycho-educational material about youth depression and role-playing video vignettes. Three primary care physician motivational interviews are used to engage youth with the CATCH-IT program. Parents randomized to CATCH-IT also participate in motivational interviews with the project manager. The Health Education (HE) model was developed based on the current well-child curriculum used for primary care visits.

Results: We enrolled N=234 adolescents/expected 400 and N=186 parents/expected 400 in the PATH study, from N=6 major health systems. Adolescents were diverse in race and ethnicity: N=30 identified as Hispanic and N=65 identified as African American. The mean number of modules started or completed for those enrolled in HE is greater than those in CATCH-IT:  M=3.73 (SD = 4.30) for teens, M=2.37 (SD = 2.06) for parents; HE:  M=6.76 (SD=6.34) for teens, M=2.18 (SD = 1.92) for parents. The mean number of minutes spent on line, however is significantly higher for the CATCH-IT teens (M=80.41, SD=108.24) than for the HE teens (M=19.31, SD=6.29). In addition, CATCH-IT teens typed an average of 3927.17 (SD=4043.94) characters. N=8 participants developed MDD or probable MDD (DSR 4 or 5), and no significant differences were found between groups.

Conclusions: Embedding technology within the primary care setting may have increased access to hard-to-reach populations and decreased stigma in addressing mental health concerns. It may also provide a platform for parents and teens to improve communication and offer teens a way of connecting with trusted healthcare providers regarding depression. Additional efforts are needed to evaluate the importance of the semi-structured interview and staff interaction with families in conjunction with self-directed online prevention. Future projects should include intervention platforms on smartphones, tablets, and individualization of the program to best suit each teen’s preferences and needs.