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

BACKGROUND: Internet-based interventions for preventing youth depression hold promise, but research is needed to explore the efficacy of these approaches and methods of integrating emerging technologies for behavioral health into the primary care system. We hypothesize that adolescents and parents assigned to the CATCH-IT intervention, in comparison to those assigned to Health Education, will complete more modules, spend more time on the intervention, and engage in the intervention more actively.

METHODS: We developed an Internet-based intervention, CATCH-IT, as a self-guided approach to depression prevention. We conducted a randomized clinical trial comparing CATCH-IT to a general health education Internet intervention (HE). CATCH-IT combines several therapeutic modalities, including cognitive-behavioral and interpersonal/family-based interventions, in an ecological model. The intervention included 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 participated in motivational interviews with the project manager. The HE model was based on the current well-child curriculum used for primary care visits.

RESULTS: We randomized N=369 adolescents and N=322 parents from N=6 major health systems in the PATH study. Adolescents were diverse in race and ethnicity: N=77 identified as Hispanic, N=94 identified as African American, N=159 identified as white, and N=37 identified as multiracial/other. The mean number of modules started or completed is greater for those enrolled in HE than those in CATCH-IT [HE: M=7.04 (SD=6.42) for teens, M=2.30 (SD=1.93) for parents; compared to CATCH-IT: M=3.80 (SD=4.58) for teens, M=2.50 (SD=2.12) for parents]. The mean number of minutes spent online is higher for the CATCH-IT teens (M=75.98, SD=91.54) than for the HE teens (M=42.48, SD=38.59), and higher for the CATCH-IT parents (M=50, SD=42.35) than for the HE parents (M=13.82, SD=11.57). CATCH-IT teens typed an average of 4,563.31 (SD=4907.09) characters, and CATCH-IT parents typed an average of 1,291.85 (SD=949.22) characters.

CONCLUSIONS: Website usage data suggest that teens and parents are engaging with CATCH-IT actively and more often than with HE. Embedding technology within the primary care setting may help access hard-to-reach populations and decrease 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 healthcare providers regarding depression. Future projects should include platforms on more devices and offer individualization for each teen.