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，结合“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。预防精神障碍已成为NIMH的优先事项，它强调开发“新的和更好的干预措施”的重要性，以“……预防疾病的发生。”这些干预措施必须：(1)在多种多样的环境中发挥作用（例如初级保健）；(2)适合在传统精神卫生系统之外提供服务；(3)使用新技术；(4)以以往临床试验为基础；(5)减少已发现的疾病/增强功能结局；(6)包括家庭；(7)针对个人。尽管有这些NIMH指南，初级保健医生仍然是高危青少年的第一线提供者，但在初级保健机构中，没有广泛可用、低成本和文化上可接受的针对抑郁症的预防方法。为了解决这一差距并明确NIMH的优先事项，Van Voorhees博士开发并进行了一项基于初级保健网络的抑郁症预防干预的2期临床试验（CATCH-IT，胜任成人过渡与认知行为人文主义和人际关系训练）。在这项研究中，与低强度组（网站转诊+医生简短建议）相比，高强度组（即动机性访谈+网站）在12个月内显著减少了抑郁情绪，增加了保护因素（社会支持、动机），抑郁发作的发生率较低（7%对28%）。我们现在提出下一步研究，一项3期疗效研究。在这项为期5年的双中心随机临床试验中，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岁中至高危青少年抑郁发作方面的效果。我们计划(a)根据PHQ-A（一种抑郁症状的筛查方法）得分的升高来识别高风险青少年；(b)招募400名（每个站点200名）这些有风险的青少年，随机分为CATCH-IT组或AMPE组；(c)在摄入后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，以及教育中的角色损害、生活质量、实现教育里程碑和家庭功能的测量结果；(d)进行探索性分析，以检验该干预计划的有效性，保护的调节因素，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.