Abstract: Two Year Outcomes of a Randomized Control Trial of an Internet-Base Adolescent Depression Prevention Intervention in Primary Care (Society for Prevention Research 27th Annual Meeting)

457 Two Year Outcomes of a Randomized Control Trial of an Internet-Base Adolescent Depression Prevention Intervention in Primary Care

Thursday, May 30, 2019
Pacific D/L (Hyatt Regency San Francisco)
* noted as presenting author
Emily Sykes, MA, Research Associate, University of Illinois at Chicago, Chicago, IL
Miae Lee, MD, Research Assistant, University of Illinois at Chicago, Chicago, IL
Linda Schiffer, MS, MPH, Research Data Analyst, University of Illinois at Chicago, Chicago, IL
Tracy RG Gladstone, PhD, Associate Director/Senior Research Scientist, Wellesley College, Wellesley, MA
Benjamin Van Voorhees, MD, MPH, Professor of Pediatrics Head, Department of Pediatrics Physician-in-Chief, Childrens Hospital University of Illinois, University of Illinois at Chicago, Chicago, IL
Introduction: Depression is a leading cause of illness and disability in adolescents worldwide, and scalable interventions with long term follow-up in primary care settings remain limited. Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Psychotherapy (CATCH-IT) is an internet-based teen depression prevention intervention that has been found to reduce the risk of developing a depressive episode among symptomatic teens in primary care. We explore the long-term effects of CATCH-IT compared to a general health education (HE) program in a multicenter randomized controlled trial with 24 month follow-up.

Methods: We screened 8499 teens (ages 13-18) from 2012 to 2016. We randomized 369 eligible teens (Mean [SD] age=15.4 [1.5]) with sub-syndromal and/or history of depression with a prior DSR≥3 (62%) and DSR≥4 (40%). The cohort self-identified as moderately depressed (Mean [SD] CES-D10=9.4 [4.6]) and functionally impaired (Mean [SD] GAS=78.1 [9.4]) with moderate anxiety (Mean [SD] SCARED=25.3 [12.3]). Participants were assessed at 2, 6, 12, 18, and 24 months.

Results: In intention-to-treat (ITT) analyses, there was not a statistically significant effect for CATCH-IT at 24 months (adjusted HR=0.86, 95% CI, 0.51, 1.47, p=0.59). Per protocol 2 (2 modules completed) analysis favored CATCH-IT over HE at 6 months (unadjusted HR=0.41; 95% CI, 0.17, 0.99, p=0.047), but results attenuated at 12 months (HR=0.65, 95% CI, 0.34, 1.21, p-value=0.17) and similarly at 24 months (HR=0.71, 95% CI, 0.41, 1.23, p=0.22). At 6 months, adolescents with higher baseline CES-D10 scores showed a stronger effect of CATCH-IT on time to event, but this effect was not seen at 24 months. Demographics, vulnerability factors, adverse life events, motivation, and parent/child comorbid psychopathology did not moderate outcome. The overall annual incidence of major depressive episodes remained low in both arms, 5.4% in HE and 4.6% in CATCH-IT. Relative to baseline, at 24 months adolescents in the CATCH-IT group reported fewer symptoms of depression (adjusted mean change=-1.6, p=.006) and anxiety (-3.2, p=.03), while symptom reductions were only marginally significant for adolescents in the HE group (-0.9, p=.07 for depression; -2.5, p=.08 for anxiety). Across groups, GAS scores improved over time (9.7, 9.6; p<.001).

Discussion: The incidence of depressive episodes was lower than expected for a high risk sample in CATCH-IT and HE, suggesting protective elements common to both interventions. These findings suggest several benefits to investing in internet based tele-health systems for at-risk adolescents. This is the first long-term, population-based trial of a scalable intervention to prevent teen depression in the primary care setting.