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

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00145912 NCT00152529.

Figure 1:. CATCH-IT Intervention

This diagram represents the CATCH-IT intervention including the primary care and Internet components. Prior to visiting the Internet site, the adolescents are first engaged by the primary care physician by the means of either a motivational interview or a brief advice interview. Each adolescent regardless of the group (motivational interview or brief advice interview) receives the same Internet-based treatment. The treatment consists of modules that are tailored to focus on certain behavioral areas such as individual coping skills, school and peer relationships, community and social factors and family factors. For simplicity we did not include the post interview in the diagram, but participants received the same type of interview post-Internet as they did at pre-Internet.

Figure 2:. Consort Diagram

This diagram describes the flow of participants through the study from initial eligibility assessment, followed by randomization of the eligible participants into either motivational interview group or brief advice group, excluding the ones that did not meet the criteria. The remaining diagram shows the flow of analysis for each of the two groups separately as they were receiving treatment (same for each group).