Primary Care Internet-Based Depression Prevention for Adolescents (CATCH-IT)

描述(由申请人提供)：开发新的干预措施，纳入“精神疾病患者的不同需求和情况”，特别是在初级保健和社区环境中，是NIMH的一个关键战略目标。预防精神障碍已经成为NIMH的优先事项，它强调了开发“新的和更好的干预措施”的重要性，以“……抢占疾病的发生”。这些干预措施必须(1)在多种不同的环境中发挥作用(例如初级保健)；(2)适合在传统精神卫生系统之外提供；(3)使用新技术；(4)以以前的临床试验为基础；(5)减少已发现的疾病/增强功能结果；(6)包括家庭；(7)针对个人量身定制。尽管有这些NIMH指南，尽管初级保健医生仍然是高危青少年的第一线提供者，但没有广泛可用的、低成本和文化上可接受的预防方法来针对初级保健环境中的抑郁症。为了解决这一差距和明确的NIMH优先事项，Van Voorhees博士开发并进行了一项基于互联网的初级保健抑郁症预防干预(CATCH-IT，通过认知行为人文主义和人际培训进行合格的成年过渡)的第二阶段临床试验。在这项研究中，与低强度ARM(网站推荐+医生简短建议)相比，高强度ARM(即激励性访谈+互联网网站)在12个月内显示出抑郁情绪的显著减少和保护性因素(社会支持、动机)的增加，并降低了抑郁发作的发生率(7%对28%)。我们现在建议进行下一步研究，即第三阶段疗效研究。在这项为期5年的两点随机临床试验中，我们建议测试Catch-IT初级保健/基于互联网的抑郁症预防干预与注意监测心理教育(AMPE)在预防13-17岁中高危青少年抑郁发作方面的有效性。我们计划(A)根据抑郁症状的筛查指标PHQ-A的高分来识别高危青少年；(B)招募400名高危青少年(每个地点200人)，随机分为Catch-IT组或AMPE组；(C)在服药后2、8、12、18和24个月评估抑郁症状、抑郁诊断、其他精神障碍的测量结果，以及在教育、生活质量、教育里程碑的实现和家庭功能方面的角色障碍测量；以及(D)进行探索性分析，以检查这一干预计划的有效性、保护的调解人以及干预反应中潜在的种族和文化差异。

DESCRIPTION (provided by applicant): Developing new interventions that incorporate the "diverse needs and circumstances of people with mental illness," particularly in primary care and community settings, is a key NIMH strategic objective. Prevention of mental disorders has become a priority for the NIMH, which emphasizes the importance of developing "new and better interventions" to "...preempt the occurrence of disease." These interventions must (1) work in multiple and diverse settings (e.g. primary care); (2) be suitable for delivery outside of traditional mental health systems (3) use new technologies; (4) build on previous clinical trials; (5) reduce identified disorders/enhance functional 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. To address this gap and specified NIMH priority, Dr. Van Voorhees developed and conducted a phase 2 clinical trial of a primary care Internet-based depression prevention intervention (CATCH-IT, Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training). In this study, the high intensity arm (i.e., motivational interview + internet site) demonstrated significant reductions in depressed mood and increases in protective factors (social support, motivation) and lower incidence of depressive episodes over 12 months (7% versus 28%), compared to the low intensity arm (internet site referral + only physician brief advice). We now propose the next step study, a phase 3 efficacy study. In this 5-year, two-site randomized clinical trial, we propose to test the efficacy of the CATCH-IT primary care/Internet based depression prevention intervention against Attention Monitoring Psychoeducation (AMPE) in preventing the onset of depressive episodes in an intermediate to high risk group of adolescents aged 13-17. We plan to (a) identify high risk adolescents based on elevated scores on the PHQ-A, a screening measure of depressive symptoms; (b) recruit 400 (200 per site) of these at-risk adolescents to be randomized into either the CATCH-IT or the AMPE group; (c) assess outcomes at 2, 8, 12, 18, and 24 months post intake on measures of depressive symptoms, depressive diagnoses, other mental disorders, and on measures of role impairment in education, quality of life, attainment of educational milestones, and family functioning; and (d) conduct exploratory analyses to examine the effectiveness of this intervention program, moderators of protection, and potential ethnic and cultural differences in intervention response.