Randomized clinical trial of an internet-based intervention to prevent adolescent depression in a primary care setting (CATCH-IT): 2.5-year outcomes

IntroductionThe lifetime prevalence of major depressive disorder (MDD) in adolescence is about 11% (Kessler et al., 2005). Adolescents with depressive disorders have an increased risk of suicidal events, future depressive episodes and a more chronic disease course of MDD that continues into adulthood (Lewinsohn et al., 1994; Lewinsohn, Rohde, Klein, & Seeley, 1999). They also have higher rates of school dropout, somatic complaints, obesity, chronic medical conditions and co-morbid psychiatric disorders such as anxiety (Keenan-Miller, Hammen, & Brennan, 2007).A 2- to 4-year window may exist between initial presentation of symptoms and the development of a disorder, suggesting an opportunity to intervene before these problems become more serious in adolescents (O'Connell, Boat, & Warner, 2009; Weitzman et al., 2015). However, these adverse consequences can occur even if the depression is subsyndromal (Compas, Ey, & Grant, 1993), thus underscoring the need for the development of robust prevention and treatment modalities.There is increasing interest in developing preventive interventions in mental health in primary care settings. The National Academy of Medicine posits that primary care clinicians should not consider mental health separate from physical health, and that a key function of the primary care clinician is to open opportunities for disease prevention (Donaldson, 1996). The disease burden in children and adolescents has shifted significantly from one defined by acute (typically infectious) illness to one in which chronic illnesses, such as depression, are increasingly prominent (Wise, 2004). Having experienced considerable success in ameliorating infectious threats, the clarion now sounds for health systems to tackle the increasingly prominent mental and behavioral health burdens of our population (Coreil, 2010). Consequently, there is a need for lowcost interventions that can be implemented in the primary care setting. Internet interventions meet that need and are beneficial for treating depression and anxiety in adults (Cuijpers & Schuurmans, 2007; Cuijpers, Smit, Bohlmeijer, Hollon, & Andersson, 2010; Cuijpers, van Straten, & Andersson, 2008) and adolescents (Siemer, Fogel, & Van Voorhees, 2011).We combined theoretical models (stress diathesis, cognitive vulnerability) to target vulnerability factors identified in epidemiologic studies on preventing depression in primary care environments (Booth, Paunesku, Msall, Fogel, & Van Voorhees, 2008; Compas, Hinden, & Gerhardt, 1995; Garber, 2006; Garber et al., 2009; Hankin, 2006; Lewinsohn et al., 1994; Reinecke & Simons, 2005; Van Voorhees, Paunesku, Gollan, et al., 2008). Similarly, families are a substantial source of vulnerability and protection with regard to the future incidence of depression (Booth et al., 2008; Evans & Annenberg Foundation Trust at Sunnylands., 2005; Liu, 2002; Paunesku et al., 2008; Procidano & Heller, 1983; Van Voorhees, Paunesku, Gollan, et al., 2008; Van Voorhees, Paunesku, Kuwabara, et al., 2008).We developed CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral and Interpersonal Training) with a pilot study in 2004 ("CATCH-IT 1") phase 1 clinical trial and later phase 2 clinical trials 2007-2011. It was designed as an Internet-based intervention with which primary care clinicians could engage adolescents at risk for MDD. Based on face-to-face manual-based interventions (Beardslee, Gladstone, Wright, & Cooper, 2003; G. N. Clarke, 1994; Jacobson, Martell, & Dimidjian, 2001; Laura Mufson, Dorta, Moreau, & Weissman, 2004; Stuart & Robertson, 2003) of demonstrated efficacy (G. N. Clarke et al., 2001; Garber et al., 2009; Jacobson et al., 2001; L. Mufson et al., 2004) the CATCH-IT (Beardslee et al., 2003; Bell et al., 2008; G. N. Clarke et al., 2001; L. Mufson, Weissman, Moreau, & Garfinkel, 1999) intervention represented a paradigm shiftfor establishing a primary care prevention mode (Clarke et al. …