Pilot Study of Implementation of an Internet-Based Depression Prevention Intervention (CATCH-IT) for Adolescents in 12 US Primary Care Practices: Clinical and Management/Organizational Behavioral Perspectives.

OBJECTIVE: To explore the implementation of CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training), an Internet-based depression intervention program in 12 primary care sites, occurring as part of a randomized clinical trial comparing 2 versions of the intervention (motivational interview + Internet program versus brief advice + Internet program) in 83 adolescents aged 14 to 21 years recruited from February 1, 2007, to November 31, 2007. METHOD: The CATCH-IT intervention model consists of primary care screening to assess risk, a primary care physician interview to encourage participation, and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders. Specifically, we evaluated this program from both a management/organizational behavioral perspective (provider attitudes and demonstrated competence) and a clinical outcomes perspective (depressed mood scores) using the RE-AIM model (Reach, Efficacy, Adoption, Implementation, and Maintenance of the intervention). RESULTS: While results varied by clinic, overall, clinics demonstrated satisfactory reach, efficacy, adoption, implementation, and maintenance of the CATCH-IT depression prevention program. Measures of program implementation and management predicted clinical outcomes at practices in exploratory analyses. CONCLUSION: Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community settings. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care settings. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT00152529 and NCT00145912.

Randomized controlled trial of primary care physician motivational interviewing versus brief advice to engage adolescents with an Internet-based depression prevention intervention: 6-month outcomes and predictors of improvement.

We believe that primary care physicians could play a key role in engaging youth with a depression prevention intervention. We developed CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral and Interpersonal Training), which is an adolescent Internet-based behavior change model. We conducted a randomized comparison of two approaches in engaging adolescents with the Internet intervention: primary care physician (PCP) motivational interview + CATCH-IT Internet program (MI) vs PCP brief advice + CATCH-IT Internet program (BA). The participants (N = 84) were recruited by screening for risk of depression in 13 primary care practices. We compared depressive disorder outcomes between groups and within groups over 6 months and examined the potential predictors and moderators of outcomes across both study arms. Depressive symptom scores declined from baseline to 6 weeks with these statistically significant reductions sustained at the 6 months follow-up in both groups. No significant interactions with treatment condition were found. However, by 6 months, the MI group demonstrated significantly fewer depressive episodes and reported less hopelessness as compared with the BA group. Hierarchical linear modeling regressions showed higher ratings of ease of use of the Internet program predicting lower depressive symptom levels over 6 months. In conclusion, a primary care/Internet-based intervention model among adolescents demonstrated reductions in depressed mood over 6 months and may result in fewer depressive episodes.

From prototype to product: development of a primary care/internet based depression prevention intervention for adolescents (CATCH-IT).

We describe the prototype to product development process of a low cost, socio-culturally relevant, easily implemented Internet-based depression prevention intervention for adolescents in primary care. The intervention named "Project CATCH-IT" (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training) includes an initial motivational interview in primary care to engage the adolescent, fourteen Web-based modules based on behavioral activation, cognitive behavioral and interpersonal psychotherapy which target known risk factors, and a follow-up motivational interview in primary care. This was successfully fielded in a pilot study with 25 adolescents. We know of no other similar interventions developed for the prevention of depression in youth that is potentially universally available at low cost and that utilizes existing systems of healthcare providers.

Overweight and obesity in children and adolescents.

Obesity is becoming a leading threat to the health of children and adolescents. Many causes, modifiable and nonmodifiable, have been determined and include, but are not limited to, genetic factors, medical conditions, medications, and environmental factors. Obesity also leads to medical conditions, some of which are specific to obesity in childhood. Treatment begins with diet and exercise but may extend to medical management and, in severe cases, surgical management.

Randomized clinical trial of an Internet-based depression prevention program for adolescents (Project CATCH-IT) in primary care: 12-week outcomes.

OBJECTIVE: The authors sought to evaluate 2 approaches with varying time and complexity in engaging adolescents with an Internet-based preventive intervention for depression in primary care. The authors conducted a randomized controlled trial comparing primary care physician motivational interview (MI, 5-10 minutes) + Internet program versus brief advice (BA, 1-2 minutes) + Internet program. SETTING: Adolescent primary care patients in the United States, aged 14 to 21 years. PARTICIPANTS: Eighty-four individuals (40% non-white) at increased risk for depressive disorders (subthreshold depressed mood >3-4 weeks) were randomly assigned to either the MI group (n = 43) or the BA group (n = 40). MAIN OUTCOME MEASURES: Patient Health Questionnaire-Adolescent and Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Both groups substantially engaged the Internet site (MI, 90.7% vs BA 77.5%). For both groups, CES-D-10 scores declined (MI, 24.0 to 17.0, p < .001; BA, 25.2 to 15.5, p < .001). The percentage of those with clinically significant depression symptoms based on CES-D-10 scores declined in both groups from baseline to 12 weeks, (MI, 52% to 12%, p < .001; BA, 50% to 15%, p < .001). The MI group demonstrated declines in self-harm thoughts and hopelessness and was significantly less likely than the BA group to experience a depressive episode (4.65% vs 22.5%, p = .023) or to report hopelessness (MI group of 2% vs 15% for the BA group, p = .044) by 12 weeks. CONCLUSIONS: An Internet-based prevention program in primary care is associated with declines in depressed mood and the likelihood of having clinical depression symptom levels in both groups. Motivational interviewing in combination with an Internet behavior change program may reduce the likelihood of experiencing a depressive episode and hopelessness.

Adolescent Dose and Ratings of an Internet-Based Depression Prevention Program: A Randomized Trial of Primary Care Physician Brief Advice versus a Motivational Interview.

BACKGROUND: Internet-based interventions for education and behavior change have proliferated, but most adolescents may not be sufficiently motivated to engage in Internet-based behavior change interventions. We sought to determine how two different forms of primary care physician engagement, brief advice (BA) versus motivational interview (MI), could enhance participation outcomes in an Internet-based depression prevention intervention. METHODS: Eighty-three adolescents at risk for developing major depression were recruited by screening in primary care and randomized to two groups: BA (1-2 minutes) + Internet program versus MI (10-15 minutes) + Internet program. We compared measures of participation and satisfaction for the two groups for a minimum of 12 months after enrollment. RESULTS: Both groups engaged the site actively (MI: 90% versus BA: 78%, p=0.12). MI had significantly higher levels of engagement than BA for measures including total time on site (143.7 minutes versus 100.2 minutes, p=0.03), number of sessions (8.16 versus 6.00, p=0.04), longer duration of session activity on Internet site (46.2 days versus 29.34 days, p=0.04), and with more characters typed into exercises (3532 versus 2004, p=0.01). Adolescents in the MI group reported higher trust in their physician (4.18 versus 3.74, p=0.05) and greater satisfaction with the Internet-based component (7.92 versus 6.66, p=0.01). CONCLUSIONS: Primary care engagement, particularly using motivational interviewing, may increase Internet use dose, and some elements enhance and intensify adolescent use of an Internet-based intervention over a one to two month period. Primary care engagement may be a useful method to facilitate adolescent involvement in preventive mental health interventions.

Integrative internet-based depression prevention for adolescents: a randomized clinical trial in primary care for vulnerability and protective factors.

BACKGROUND: Adolescent depression is both a major public health and clinical problem, yet primary care physicians have limited intervention options. We developed two versions of an Internet-based behavioral intervention to prevent the onset of major depression and compared them in a randomized clinical trial in 13 US primary care practices. METHODS: We enrolled 84 adolescents at risk for developing major depression and randomly assigned them to two groups: brief advice (BA; 1-2 minutes) + Internet program versus motivational interview (MI; 5-15 minutes) + Internet program. We compared pre/post changes and between group differences for protective and vulnerability factors (individual, family, school and peer). RESULTS: Compared with pre-study values, both groups demonstrated declines in depressed mood; [MI: 21.2 to 16.74 (p < 0.01), BA: 23.34 to 16.92 (p < 0.001)]. Similarly, both groups demonstrated increases in social support by peers [MI: 8.6 to 12.1 (p = 0.002), BA: 7.10 to 12.5 (p < 0.001)] and reductions in depression related impairment in school [MI: 2.26 to 1.76 (p = 0.06), BA: 2.16 to 1.93 (p = 0.07)]. CONCLUSIONS: Two forms of a primary care/Internet-based behavioral intervention to prevent adolescent depression may lower depressed mood and strengthen some protective factors for depression.

Development of a submerged-liquid sporulation medium for the johnsongrass bioherbicide Gloeocercospora sorghi.

Submerged culture experiments were conducted in three phases to determine the optimal medium for rapidly producing conidia of the fungal bioherbicide Gloeocercospora sorghi. In phase I, 18 crude carbon sources were evaluated to determine which would support sporulation. Under the conditions tested, butter bean and lima bean brines (1.5-4.6 mS/cm) provided best conidiation. In phase II, a fractional-factorial design was utilized to screen 76 different medium adjuncts in combination with butter bean brine for improved sporulation. d-Mannitol and carboxymethylcellulose (CMC) were the only acceptable factors that resulted in a significant improvement. In phase III, a central composite design with response surface methodology was used to optimize concentrations of these critical factors. The model predicted optimal sporulation in a medium composed of 2.69 mS/cm butter bean brine +0.043 M d-mannitol +0.37% w/v CMC with an expected titer of 1.51x10(7) conidia/ml. Actual mean titer attained with the model-derived medium was 1.91x10(7) conidia/ml. Optimal sporulation occurred at 25.5 degrees C in this medium and conidia remained viable up to 2.71 days when stored at 12 degrees C. No significant difference was observed in virulence of conidia produced on agar vs washed conidia produced in the model-derived (liquid) medium.