Dr. Van Voorhees'long-term research objective is to reduce the morbidity of depression during the adolescence through early, preventive intervention in primary care. Primary care physicians (PCP) currently lack a defined, efficacious behavioral intervention for adolescents with sub-threshold depressive symptoms who are at risk for progressing to major depression. The proposed training program will provide him with knowledge/skills to develop/evaluate preventive interventions. Dr. Van Voorhees (Principal Investigator) has already completed a pilot study of a prototype primary care/Web-based depression prevention intervention with late adolescents (age 18-24) that demonstrated favorable trends in three risk factors. This K-08 application proposes a three-step process to systematically redesign and evaluate the potential efficacy of each component of the intervention for younger adolescents age 14-18 in preparation for an anticipated efficacy study (RO-1). Results of a stakeholder marketing survey (Study I) will inform (motivation and feasibility factors) intervention redesign for younger adolescents (Study II) leading to a pilot randomized pilot efficacy evaluation of each component. Study I will identify the key motivation (attitudes, social norms and behavioral factors) and process (dose and socio-cultural relevance) factors that will influence feasibility and efficacy in the target age group. Informed by the survey results, Study II will revise the intervention to include a comprehensive approach to reducing modifiable risk factors including parent education/engagement and behavioral activation approaches (more suited to younger adolescents). Study will evaluate the potential efficacy of each of the components of the intervention. We will recruit and randomize the 100 participants into one of two study groups: (1) control group that will be given only the address of the Internet site and receive follow-up phone call to evaluate safety, and (2) full intervention (motivational program, Ml before and after internet components and 4 motivational phone calls). We will conduct intention to treat and completer analyses of three outcomes: 1) process (dose, time on site, exercise completion), 2) post-intervention mood (CES-D score) and post-intervention risk factor/resiliency measures. These results will lead directly to an RO-1 application.
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