Depression Prevention Intervention Research Articles

Undertaking specific stress-reducing activities are associated with reduced fatigue and depression, and increased mastery, in people with multiple sclerosis

BackgroundMultiple sclerosis is a demyelinating autoimmune disease, presenting with heterogenous symptoms that impact daily living. Undertaking stress-reducing activities may reduce symptoms including depression and fatigue, and enhance mastery, the sense of control of one's life. We assessed cross-sectional associations of undertaking stress-reducing activities or meditation on depression, fatigue, and mastery, and 5-year prospective relationships between meditation and these outcomes. MethodsData were extracted from the longitudinal Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) study. Stress-reducing activities were categorised to relaxation, physical, mind-body, and spiritual. Meditation was analysed as a dichotomous term, and for duration and frequency of practice. Depression, fatigue, and mastery were assessed by Patient's Health Questionnaire-9, Fatigue Severity Scale, and Pearlin Mastery Scale, respectively. Associations with depression, fatigue and mastery were assessed by log-binomial regression. Models were adjusted for age, sex, symptoms due to relapse, socioeconomic status, employment status, and antidepressant and anti-fatigue medication use, as appropriate. ResultsCross-sectionally, physical and relaxation activities were associated with 40% and 33% lower frequencies of depression, respectively. Physical activities were additionally associated with 19% lower frequency of fatigue. Meditation was associated with 30% lower frequency of depression and 17% higher mastery. Prospectively, meditation was associated with 28% decreased depression, and 48% reduction of developing depression at 5-year follow-up. ConclusionPotential benefits of undertaking stress-reducing activities, or meditation, on depression, fatigue, and mastery are promising and should be further assessed prospectively. Meditation practice should be encouraged as a safe and inexpensive intervention for prevention of depression.

A psychological intervention by community pharmacies to prevent depression in adults with subthreshold depression and long-term conditions: the CHEMIST pilot RCT

Background Depression is common in people with long-term health conditions, and this combination can lead to worsened health outcomes and increased health-care costs. Subthreshold depression, a risk factor for major depression, is prevalent in this population, but many people remain untreated due to the demand on services. The community pharmacy may be an alternative setting to offer mental health support; however, insufficient evidence exists to support implementation. Objectives To conduct a feasibility study and pilot randomised controlled trial of a community pharmacy-delivered psychological intervention aimed at preventing depression in adults with long-term health conditions. Design A feasibility study with nested qualitative evaluation and an external pilot, two-arm, 1 : 1 individually randomised controlled trial with nested process and economic evaluations. Setting Community pharmacies in the north of England. Participants Adults aged ≥ 18 years with subthreshold depression and at least one long-term health condition. Intervention A bespoke enhanced support intervention (behavioural activation within a collaborative care framework) involving up to six sessions delivered by trained community pharmacy staff (intervention facilitators) compared with usual care. Main outcome measures Recruitment and retention rates, completeness of outcome measures and intervention engagement. The intended primary outcome was depression severity at 4 months, assessed by the Patient Health Questionnaire-9. Results In the feasibility study, 24 participants were recruited. Outcome measure completeness was 95–100%. Retention at 4 months was 83%. Seventeen participants (71%) commenced intervention sessions and all completed two or more sessions. Depression symptoms reduced slightly at 4 months. The process evaluation suggested that the intervention was acceptable to participants and intervention facilitators. In the pilot randomised controlled trial, 44 participants (target of 100 participants) were randomised (intervention, n = 24; usual care, n = 20). Outcome measure completeness was 100%. Retention at 4 months was 93%. Eighteen participants (75%) commenced intervention sessions and 16 completed two or more sessions. Depression symptoms reduced slightly at 4 months, with a slightly larger reduction in the usual-care arm, although the small sample size limits any conclusions. The process evaluation reported good acceptability of the intervention and identified barriers associated with study implementation and its impact on core pharmacy functions. The economic analysis revealed some indication of reduced resource use/costs associated with the intervention, but this is limited by the small sample size. Intervention costs were low. Limitations The main limitation is the small sample size due to difficulties with recruitment and barriers to implementing the study within existing pharmacy practices. Conclusions The community pharmacy represents a new setting to deliver a depression prevention intervention. Recruitment was a challenge and pharmacy staff encountered barriers to effective implementation of the study within busy pharmacy practice. Despite these challenges, good retention rates and intervention engagement were demonstrated, and process evaluation suggested that the intervention was acceptable in this setting. To the best of our knowledge, this is the first study to demonstrate that community pharmacy staff can be trained to deliver a depression prevention intervention. Future work Further work is needed to address barriers to recruitment, intervention delivery and implementation of psychological interventions in the community pharmacy setting. Trial registration This trial is registered as ISRCTN11290592. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 5. See the NIHR Journals Library website for further project information.

EHealth Interventions for Treatment and Prevention of Depression, Anxiety, and Insomnia During Pregnancy: Systematic Review and Meta-analysis.

BackgroundPregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions.ObjectiveThe objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness.MethodsA total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators.ResultsIn total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected.ConclusionseHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population.Trial RegistrationPROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954

Cultural Adaptation of the Mothers and Babies Intervention for Use in Tribal Communities.

ObjectiveWhile one in five women may experience mood and anxiety disorders during pregnancy and postpartum, Indigenous identity increases that risk by 62%, especially among younger Indigenous women. The need for evidence-based perinatal mental health interventions that provide culturally relevant well-being perspectives and practices is critical to improving maternal, child, and community outcomes for Indigenous peoples, and reducing health inequities.MethodsThrough a collaboration between community maternal and child health professionals, intervention researchers, and a cultural consultant, our workgroup developed cultural adaptations to Mothers and Babies, an evidence-based perinatal depression prevention intervention. Applying a cultural interface model, the workgroup identified existing intervention content for surface adaptations, as well as deep, conceptual adaptations to incorporate traditional teachings into this evidence-based intervention.ResultsThis collaboration developed a culturally adapted facilitator manual for intervention providers, including guidance for implementation and further adaptation to represent local tribal culture, and a culturally adapted participant workbook for Indigenous perinatal women that reflects cultural teachings and traditional practices to promote well-being for mother and baby.ImplicationsCommitting to a culturally respectful process to adapt Mothers and Babies is likely to increase the reach of the intervention into Indigenous communities, reengage communities with cultural practice, improve health outcomes among parents, children, and the next generation's elders, and reduce disparities among Indigenous groups. Replication of this community-engaged process can further the science and understanding of cultural adaptations to evidence-based interventions, while also further reducing health inequities. Future steps include evaluating implementation of the culturally adapted intervention among tribal home visiting organizations.

A potential syndemic effect associated with symptoms of depression among men who have sex with men.

Introduction:Globally, depression rates are high among men who have sex with men (MSM). Multiple factors may interact synergistically to increase this risk. This analysis assessed the prevalence of symptoms of depression among MSM in Brazil and synergistic effects of several factors.Methods:Cross-sectional study conducted in 12 cities using respondent-driven sampling. Sociodemographic and behavioral characteristics were collected. The PHQ-9 was used to screen for depression. Having moderate-severe depressive symptoms was compared to none-mild using logistic regression. The syndemic factor was a composite of hazardous alcohol use, sexual violence, and discrimination due to sexual orientation. Those with one to three of these factors were compared to those with none.Results:The weighted prevalence of moderate-severe depressive symptoms was 24.9% (95%CI = 21.8-28.8) and 16.2%, 22.9%, 46.0% and 51.0% when none, one, two, or three syndemic factors were present, respectively, indicating a dose-response effect. Perception of HIV risk, high level of HIV knowledge, known HIV infection, and health self-rated as poor or very poor were also associated with depressive symptoms.Conclusion:The prevalence of moderate-severe depressive symptoms among MSM in Brazil is high, and selected factors act synergistically in increasing their prevalence. Public health policies should consider holistic depression prevention and treatment interventions for this population.

Understanding ADHD in Black Adolescents in Urban Schools: A Qualitative Examination of Factors that Influence ADHD Presentation, Coping Strategies, and Access to Care

ABSTRACT The high school years are a challenging developmental period for adolescents with attention- deficit/hyperactivity disorder (ADHD), their families, and those who work with them in the school system. Moreover, racially minoritized families and schools in low-resource, urban settings often experience additional adverse experiences that can make access to evidence-based mental health care particularly difficult. This qualitative investigation into the experiences of Black high school students with ADHD, their caregivers, teachers, and school mental health providers (SMHPs) aimed to understand this community’s experiences with ADHD across development and to explore the barriers/facilitators to adequate services. Through focus group interviews with stakeholders (i.e., 6 adolescents with a diagnosis of ADHD, 5 caregivers of adolescents with ADHD, 6 teachers, 5 school mental health providers), themes emerged related to (1) developmental changes observed in ADHD presentation in high school students and (2) contextual factors (including barriers/facilitators to optimal school and home functioning). These themes led to the development of an ecological model that show various contextual factors influencing the experiences of Black adolescents with ADHD in under-resourced urban public high schools (e.g., adolescents’ coping strategies, caregiver involvement, teacher burden or lack of ADHD-knowledge, socio-economic status, access to care). This qualitative study represents the first step of a treatment development project assessing the implementation of a depression prevention intervention for Black adolescents with ADHD in urban public-school settings. Clinical implications (e.g., coordination of care between home and schools, increasing attention to social determinants of health, ensuring culturally competent discussion of ADHD and its treatment) are discussed.

Adaptation of an Evidence-Based Online Depression Prevention Intervention for College Students: Intervention Development and Pilot Study Results

College and university students across the United States are experiencing increases in depressive symptoms and risk for clinical depression. As college counseling centers strive to address the problem through wellness outreach and psychoeducation, limited resources make it difficult to reach students who would most benefit. Technology-based prevention programs have the potential to increase reach and address barriers to access encountered by students in need of mental health support. Part 1 of this manuscript describes the development of the Willow intervention, an adaptation of the technology-based CATCH-IT depression prevention intervention using a community participatory approach, for use by students at a women’s liberal arts college. Part 2 presents data from a pilot study of Willow with N = 34 (mean age = 19.82, SD = 1.19) students. Twenty-nine participants (85%) logged onto Willow at least once, and eight (24%) completed the full intervention. Participants positively rated the acceptability, appropriateness, and feasibility of Willow. After eight weeks of use, results suggested decreases in depressive symptoms (95% CI (0.46–3.59)), anxiety symptoms (95% CI (0.41–3.04)), and rumination (95% CI (0.45–8.18)). This internet-based prevention intervention was found to be acceptable, feasible to implement, and may be associated with decreased internalizing symptoms.

Randomized Clinical Trial of Primary Care Based Online Depression Prevention Intervention: Impact on Adolescent Modifiable Factors and Behaviors

The developmental period of adolescence can pose a risk for the onset of depressive disorders, but is also a time when potentially modifiable factors and behaviors related to depressive episode onset can develop. An online health intervention can provide an opportunity to reach at-risk adolescents in between primary care visits and could impact these modifiable factors and behaviors to support healthy development. We explore the Competent Adulthood Transition with Cognitive-Behavioral, Humanistic, and Interpersonal Therapy (CATCH-IT), a self-directed online cognitive behavioral therapy prevention intervention, and its impact on modifiable factors and behaviors related to: (1) program completion, (2) normative adolescent development, (3) coping, (4) family relations, (5) general health behaviors, and (6) externalizing behaviors, in a primary care sample of adolescents at intermediate to high risk of developing depression. Adolescents were enrolled into either CATCH-IT or Health Education (HE) control group and followed for 24 months. CATCH-IT improved some factors related to program completion (e.g., motivation, recommendation to peers for depression prevention, and physician positive relationship), coping (e.g., perceived behavior change), and family relations (e.g., parental psychological control, sibling relative status) as compared to HE. HE improved normative adolescent development (e.g., health and loss life events) as compared to CATCH-IT. CATCH-IT utilized in primary care may benefit some at-risk adolescents in selective factors and behaviors.

Leading the charge toward a world without depression: perinatal depression can be prevented.

This manuscript is based on a keynote address presented at the 2020 Marcé Society's Conference celebrating the Society's 40th anniversary. The address described a 50-year perspective on prevention research, current evidence that perinatal depression can be prevented, and how digital tools could be used to disseminate perinatal depression prevention interventions throughout the world. We utilized the Mothers and Babies Course as a case study to illustrate these goals. The article reviews the gradual progress of depression prevention research, from the time when the state of the science was such that it was believed that the onset of major depressive episodes could not be prevented until the present day. In addition, the article recounts the three consensus reports on prevention of mental disorders published by the National Academies of Science, Engineering, and Medicine, culminating in the 2019 report, which calls on the field to implement known interventions for the prevention of depression and other mental disorders, and to scale up their administration to reduce the prevalence of these disorders in the general population. The paper presents the 2019 recommendations of the US Preventive Services Task Force, which instructs the health system to provide routine referrals to perinatal depression prevention interventions (e.g., the Mothers and Babies Course) to perinatal persons at risk for depression. We now have the knowledge to prevent approximately half of episodes of perinatal depression. It is time to implement this knowledge and begin to do research on how to prevent the remaining half.

The Effects of a Community-Based, Multicomponent, Depression Prevention Intervention in Mothers At-Risk.

The purpose of this study was to develop a 12-week multicomponent, depression prevention pilot intervention and evaluate its feasibility and preliminary effects on improving levels and correlates of depressive symptoms, including anger, self-esteem perceived stress, social support, and racism. A quasi-experimental, mixed-methods design and a community-based participatory research (CBPR) approach was employed. University faculty, students and community residents collaborated at a low-income housing complex in a low-resourced, urban community. Fifteen low-income, ethnic minority mothers ages 23-46 years completed the intervention and evaluation surveys. Eight mothers participated in a focus group. The intervention included social group-dance, health education, and socialization. t-Tests, sign-tests, and thematic analysis was employed. Mothers identified barriers and facilitators of program engagement. Depressive symptoms were significantly reduced (t(14) = 2.41, p = .030). Self-esteem (t(14) = 2.28, p = .039) and social support levels (M = 4.5, p = .035) were significantly increased. This multicomponent intervention is feasible. Preliminary efficacy evidence was mixed.

Testing the effects of a prenatal depression preventive intervention on parenting and young children\u2019s self-regulation and functioning (EPIC): protocol for a longitudinal observational study

BackgroundPerinatal depression is a pervasive public health concern that disproportionately affects low-income women and can have negative impacts on parenting and child developmental outcomes. Few interventions focus on preventing perinatal depression. Previous studies suggest that Mothers and Babies is efficacious in preventing the worsening of depressive symptoms and the onset of postpartum depression. This manuscript presents the protocol of the EPIC study (Effects of a Prenatal Depression Preventive Intervention on parenting and young children’s Self-Regulation and Functioning) to test the effects of Mothers and Babies on parenting and child developmental outcomes through 54 months postpartum. EPIC is an observational study that builds on a completed cluster-randomized trial (CRT). Innovations of this study are direct observations of a subsample of mother-child dyads and the inclusion of fathers/caregivers’ variables as moderators of maternal mental health.MethodsFor this study, we plan to enroll 738 women with children under 30 months old, ≥18 years old, and who speak English or Spanish. Additionally, 429 fathers, partners, or other adult caregivers will be recruited through women participating in the study. Women will be recruited through the parent study (intervention and control participants) or through one of 10 home visiting programs in Illinois (control participants). Data collection will take place through maternal self-report at five time points (when the child is 30, 36, 42, 48, and 54 months), paternal self-report at three time points (when the child is 30, 42, and 54 months), and through mother-child observations at three time points (when the child is 36, 42, and 48 months). Outcome domains include maternal mental health, cognitive-behavioral and parenting skills, and child self-regulation and functioning. Moderators include the contributions of fathers/caregivers, race-ethnicity, and socioeconomic disadvantage. Power and sample size were calculated assuming a two-sided 5% type I error rate and assumed analyses on the individual level.DiscussionThis study has several key strengths and innovations, as well as great potential significance to influence the long-term trajectories of parenting and child development via prenatal intervention.Trial registrationThe study was retrospectively registered at ClinicalTrials.gov (Identifier: NCT04296734) on March 5, 2020.

Preliminary investigation of the feasibility of a long-term but low-frequency preventive intervention for depression in Japanese high schools.

We explored the feasibility of a long-term but low-frequency psychological preventive intervention in a high school setting. High school students may experience depression; psychological interventions to improve social and cognitive skills may be useful to decrease such depression. A long-term but low-frequency intervention may be feasible in this setting because of its minimal time demands and lack of need for specialist human resources DESIGN: We conducted a single-arm longitudinal descriptive study with an intervention applied six times over 2years in one high school. We conducted a psychological preventive intervention with 94 high school students in one school for 2 years (April 2014 to March 2016). This intervention aimed to improve social and cognitive skills. We measured social skills, cognitive distortion, and depression five times during the 2-year period, through a self-report scale. Scores for maintaining relationship skills tended to increase over the 2years. However, depression did not decrease over the intervention period. Although our research did not include control conditions and the intervention did not decrease depression, the six-session programme for high school adolescents improved an aspect of social skills that is a preventive factor against depression.

Preventing Recurrence of Depression: Long-Term Effects of a Randomized Controlled Trial on Cognitive Control Training for Remitted Depressed Patients

Previous studies suggest that cognitive control training (CCT) shows potential as a preventive intervention for depression. In this study, the first to examine long-term preventive effects of CCT, we examined effects on (a) task-specific cognitive transfer at 1-year follow-up, (b) recurrence of depression, and (c) functioning over the course of a year. Each of 92 remitted depressed patients were randomly assigned to a CCT condition or an active control condition (ACT). Effects of training were monitored using weekly assessments of emotion regulation, cognitive complaints, depressive symptoms, and resilience (brief weekly questionnaire). At 1-year follow-up, participants completed a structured clinical interview, cognitive transfer task, and questionnaires. We observed task-specific cognitive transfer ( p < .001, d = 1.23) and lower recurrence rates in the CCT condition ( p = .04; odds ratio = 0.38). However, no long-term beneficial effects of training were observed on the weekly ratings of functioning, and groups did not differ in performance on the self-report questionnaires at 1-year follow-up.

Comparing the effectiveness of home visiting paraprofessionals and mental health professionals delivering a postpartum depression preventive intervention: a cluster-randomized non-inferiority clinical trial.

To determine whether pregnant women receiving the Mothers and Babies group-based intervention exhibited greater depressive symptom reductions and fewer new cases of major depression than women receiving usual community-based services, and to examine whether groups run by paraprofessional home visitors and mental health professionals yielded similar depressive symptom reductions and prevention of major depression. Using a cluster-randomized design, 37 home visiting programs were randomized to usual home visiting, Mothers and Babies delivered via home visiting paraprofessionals, or Mothers and Babies delivered via mental health professionals. Baseline assessments were conducted prenatally with follow-up extending to 24weeks postpartum. Eligibility criteria were ≥ 16years old, ≤ 33 gestation upon referral, and Spanish/English speaking. Depressive symptoms at 24weeks postpartum was the primary outcome. Eight hundred seventy-four women were enrolled. Neither intervention arm was superior to usual care in decreasing depressive symptoms across the sample (p = 0.401 home visiting paraprofessional vs. control; p = 0.430 mental health professional vs. control). Post hoc analyses suggest a positive intervention effect for women exhibiting mild depressive symptoms at baseline. We have evidence of non-inferiority, as the model-estimated mean difference in depressive symptoms between intervention arms (0.01 points, 95% CI: -0.79, 0.78) did not surpass our pre-specified margin of non-inferiority of two points. Although we did not find statistically significant differences between intervention and control arms, non-inferiority analyses found paraprofessional home visitors generated similar reductions in depressive symptoms as mental health professionals. Additionally, Mothers and Babies appears to reduce depressive symptoms among women with mild depressive symptoms when delivered by mental health professionals. This trial is registered on ClinicalTrials.gov (initial post: December 1, 2016; identifier: NCT02979444).

Effect of a multicomponent depression prevention intervention on depressive symptoms, anxiety and well-being among adolescents with risk for depression: A pilot study

Effect of a multicomponent depression prevention intervention on depressive symptoms, anxiety and well-being among adolescents with risk for depression: A pilot study

Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study

IntroductionProcess evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a...

Who comes to a self-help depression prevention website? Characteristics of Spanish- and English-speaking visitors

ObjectiveTo describe demographic and clinical characteristics of Spanish- and English-speaking visitors to a “Healthy Mood” website. MethodsAn online study intended to prevent depression by teaching users mood management skills recruited participants globally using primarily Google Ads. Those who consented responded to the Patient Health Questionnaire (PHQ-9) and the MDE Screener (Muñoz, 1998) upon entry into the study. Results1423 participants consented, 437 English speakers and 986 Spanish speakers. Of the 1271 participants with sufficient depression symptom data, 65% screened positive for a current major depressive episode, 30% were at high risk for onset of a major depressive episode, and 5% were in the low-risk category. ConclusionWebsites intended to be preventive appear to attract primarily individuals who are currently experiencing enough symptoms to screen positive for a major depressive episode. Only 30% of participants were appropriate for a depression prevention intervention. Therefore, such sites must be ready to encourage those with current depression to obtain professional help as well as ensure that the online self-help interventions are appropriate for participants who could benefit from both preventive and treatment interventions.

Usability, Acceptability, and Adherence Rates of Mobile Application Interventions for Prevention or Treatment of Depression: A Systematic Review.

Mobile health applications (apps) have been growing as a new frontier in mental health care delivery. The objective of the current systematic review was to summarize the evidence regarding usability, acceptability, and adherence rates of mobile app interventions for prevention or treatment of depression. A literature search was conducted in relevant databases, including PubMed, PsycINFO, and Embase, for articles published between January 1, 2009, and August 1, 2019. Key terms used for searching included depression AND smartphone OR mobile AND application AND acceptability OR feasibility. Based on a full-text examination, seven studies were included for review. All studies were conducted in developed countries and five studies were developing a mobile app for depression treatment. The current study highlights the need for developers of mobile apps for individuals with mental health care needs to consider user acceptability and adherence rates. Innovation in designing a mobile app for individuals with depression is needed to improve the adherence rates of users. [Journal of Psychosocial Nursing and Mental Health Services, 59(2), 41-47.].

24-Month Outcomes of Primary Care Web-Based Depression Prevention Intervention in Adolescents: Randomized Clinical Trial.

BackgroundAdolescent depression carries a high burden of disease worldwide, but access to care for this population is limited. Prevention is one solution to curtail the negative consequences of adolescent depression. Internet interventions to prevent adolescent depression can overcome barriers to access, but few studies examine long-term outcomes.ObjectiveThis study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education active control for depression onset at 12 and 24 months in adolescents presenting to primary care settings.MethodsA 2-site randomized trial, blinded to the principal investigators and assessors, was conducted comparing Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training to health education to prevent depressive episodes in 369 adolescents (193 youths were randomly assigned to Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training and 176 to health education) with subthreshold depressive symptoms or prior depressive episodes. Participants were recruited from primary care settings in the United States. The primary outcome was the occurrence of a depressive episode, determined by the Depression Symptom Rating. The secondary outcome was functioning, measured by the Global Assessment Scale.ResultsIn intention-to-treat analyses, the adjusted hazard ratio favoring Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training for first depressive episode was not statistically significant at 12 months (hazard ratio 0.77, 95% CI 0.42-1.40, P=.39) and 24 months (hazard ratio 0.87, 95% CI 0.52-1.47, P=.61). Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training provided preventive benefit for first depressive episode for those with mild hopelessness or at least moderate paternal monitoring at baseline. Global Assessment Scale scores improved comparably in both groups (intention-to-treat).ConclusionsA technology-based intervention for adolescent depression prevention implemented in primary care did not have additional benefit at 12 or 24 months. Further research is necessary to determine whether internet interventions have long-term benefit.Trial RegistrationClinicalTrials.gov NCT01893749; http://clinicaltrials.gov/ct2/show/NCT01893749.

Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes.

Approximately 20% of people will experience a depressive episode by adulthood, making adolescence an important developmental target for prevention. CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic, and Interpersonal Training), an online depression prevention intervention, has demonstrated efficacy in preventing depressive episodes among adolescents reporting elevated symptoms. Our study examines the effects of CATCH-IT compared to online health education (HE) on internalizing symptoms in adolescents at risk for depression. Participants, ages 13–18, were recruited across eight US health systems and were randomly assigned to CATCH-IT or HE. Assessments were completed at baseline, 2, 6, 12, 18, and 24 months. There were no significant differences between groups in change in depressive symptoms (b = −0.31 for CATCH-IT, b = −0.27 for HE, p = 0.80) or anxiety (b = −0.13 for CATCH-IT, b = −0.11 for HE, p = 0.79). Improvement in depressive symptoms was statistically significant (p < 0.05) for both groups (p = 0.004 for CATCH-IT, p = 0.009 for HE); improvement in anxiety was significant for CATCH-IT (p = 0.04) but not HE (p = 0.07). Parental depression and positive relationships with primary care physicians (PRPC) moderated the anxiety findings, and adolescents’ externalizing symptoms and PRPC moderated the depression findings. This study demonstrates the long-term positive effects of both online programs on depressive symptoms and suggests that CATCH-IT demonstrates cross-over effects for anxiety as well.