Developing new interventions that incorporate the 'diverse needs and circumstances of people with mentalillness,' particularly in primary care and community settings, is a key NIMH strategic objective. Prevention ofmental disorders has become a priority for the NIMH, which emphasizes the importance of developing 'newand better interventions' to '...preempt the occurrence of disease.' These interventions must (1) work inmultiple and diverse settings (e.g. primary care); (2) be suitable for delivery outside of traditional mental healthsystems (3) use new technologies; (4) build on previous clinical trials; (5) reduce identified disorders/enhancefunctional outcomes; (6) include families and (7) be tailored to the individual. Despite these NIMH guidelines,while primary care physicians remain the first line providers for at-risk adolescents, there is no widely available,low cost and culturally acceptable preventive approach that targets depression in primary care settings. Toaddress this gap and specified NIMH priority, Dr. Van Voorhees developed and conducted a phase 2 clinicaltrial of a primary care Internet-based depression prevention intervention (CATCH-IT, Competent AdulthoodTransition with Cognitive Behavioral Humanistic and Interpersonal Training). In this study, the high intensityarm (i.e., motivational interview + internet site) demonstrated significant reductions in depressed mood andincreases in protective factors (social support, motivation) and lower incidence of depressive episodes over 12months (7% versus 28%), compared to the low intensity arm (internet site referral + only physician briefadvice). We now propose the next step study, a phase 3 efficacy study. In this 4-year, two-site randomizedclinical trial, we propose to test the efficacy of the CATCH-IT primary care/Internet based depressionprevention intervention against treatment as usual (TAU) in preventing the onset of depressive episodes in anintermediate to high risk group of adolescents aged 13-18. We plan to (a) identify high risk adolescents basedon elevated scores on the PHQ-A, a screening measure of depressive symptoms; (b) recruit 320 (160 per site)of these at-risk adolescents to be randomized into either the CATCH-IT or the TAU group; (c) assessoutcomes at 2, 8, 12, 18, and 24 months post intake on measures of depressive symptoms, depressivediagnoses, other mental disorders, and on measures of role impairment in education, quality of life, attainmentof educational milestones, and family functioning; and (d) conduct exploratory analyses to examine theeffectiveness of this intervention program, moderators of protection, and potential ethnic and culturaldifferences in intervention response. This application builds on a K-08 funded research program (VanVoorhees) that has resulted in the development, preliminary testing, and revision of this intervention, which isnow ready for an efficacy trial.
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