Primary Care Internet Based Depression Prevention for Adolescents (CATCH-IT) Also Known as Promoting AdolescenT Health

• The Center for Epidemiological Studies of Depression(CES-D)Scale [ Time Frame: 0, 2, 6, 12, 18 and 24 months ] [ Designated as safety issue: Yes ]
  Change in CES-D score from baseline Change in CES-D score between groups (CATCH-IT & HEALTHED)across the duration of the study and for each assessment point
  
  

• Kiddie Schedule of Affective Disorders Scale(KSADS) [ Time Frame: 0, 2, 6, 12, 24 months ] [ Designated as safety issue: Yes ]
  Screening for current and past psychiatric diagnosis at each time point to ensure eligibility is consistent throughout the study (certain psychiatric diagnosis might render a subject ineligible for the study, therefore a KSADS interview is conducted at each major assessment point)
  
  
• Vulnerability Factors [ Time Frame: 0, 2, 6, 12, 18, 24 months ] [ Designated as safety issue: No ]
  Change in scales of SCARED, Disruptive Behavior Disorder Scale (DBD - teen and parent), CRAFFT, Sibling Relationship Questionnaire (SRQ - teen and parent), Sibling Inventory of Differential Experience, (SIDE), Child/Parent Report of Parental Behavior Inventory (CRPBI - teen and parent), Conflict Behavior Questionnaire (CBQ - teen and parent), Physician Relationship Scale, Pediatric Quality of Life and Enjoyment and Satisfaction Questionnaire (teen and parent), Masten's Status Questionnaire, Theory of Planned Behavior Scale, Trans-Theoretical Model Scale, Beck Hopelessness Scale (BHS), Teen Behavior Questionnaire (TBS), Social Adjustment Scare (SAS-SR), Adolescent Life Events Questionnaire (ALEQ). Not all measures are used at all timepoints. As needed based on suicidal presentation at a given timepoint, safety measures are also obtained (Suicide Ideation Scale, Suicide Intent Scale, Lethality Scale).
  
  

• Adherence to Internet Use [ Time Frame: continous measure ] [ Designated as safety issue: No ]
  Counting the number of logs/subject (over 2 years), number of characters typed, number of clicks in each page, time spent on each session and total time spent online.
  
  
• Implementation [ Time Frame: 0, 2, 24 months ] [ Designated as safety issue: No ]
  Changes in perceived feasibility and implementation of the study from the healthcare professionals (physicians, nurse and leaders)from baseline to the completion of the study at 24 months.
  
  
• Motivational Interview Pre-Measure [ Time Frame: 0,2,12 months ] [ Designated as safety issue: No ]
  This measure is administered to adolescents prior to meeting with the physician for a motivational interview. It contains items asking adolescents to identify goals for the intervention, consider how they are feeling and their degree of motivation to change their feelings, and their willingness to engage in the present intervention. This is an optional measure
  
  
• Demographic Information [ Time Frame: 0,2,6,12,24 months ] [ Designated as safety issue: No ]
  assesses age, height, weight, contact information, race, ethnicity, home demographics, educational level of parents.
  
  

Additional aims and hypothesis are provided below:

-Aim 1: To determine whether the CATCH-IT depression prevention intervention prevents or delays major depressive episodes, as well as non-affective disorder episodes, compared to HEALTH EDUCATION.

Hypothesis 1: Compared to youth in the HEALTH EDUCATION condition, youth assigned to CATCH-IT will have a lower hazard ratio of major depressive episodes and non-affective disorder episodes over 2 years.

-Aim 2: To determine if participants in the CATCH-IT group exhibit more rapid favorable changes of depressive symptoms/and or vulnerability/protective factors compared to the HEALTH EDUCATION group.

Hypothesis 2: Compared to youth in the HEALTH EDUCATION condition, youth in the CATCH-IT program will demonstrate a steeper slope of improved symptoms and fewer depressed days over 2 years.

-Aim 3: To determine if participants in the CATCH-IT program report lower perceived educational impairment, greater quality of life, greater health-related quality of life, and lower incidence of other mental disorders (anxiety, substance/alcohol use) as compared to participants in HEALTH EDUCATION.

Hypothesis 3: Compared to youth in the HEALTH EDUCATION group, youth in the CATCH-IT program will demonstrate more rapid benefits in reduced educational impairment, improved quality of life, and fewer disorders over 2 years.

-Aim 4: To determine for whom (moderators)among 13-18 year old (inclusive) and how (mediators) the CATCH-IT program works.

Hypothesis 4.1: CATCH-IT effects will be moderated by six domains: (1) demographic/cultural factors, (2) vulnerability factors/adverse events,(3) motivation,(4) physician relationship, (5) parent/child co-morbid psychopathology, and (6) treatment.

Hypothesis 4.2: The relation between CATCH-IT participation and reduction in depressive episodes will be mediated by adherence to the Internet, motivational interview fidelity as they alter vulnerability factors (e.g. motivation, cognition and social support) and responses to adverse events, which in turn impact the likelihood of episodes.

Exploratory Aim 1: To determine the implementation feasibility of the intervention from the physician/nurse practitioner and office nurse/medical assistant perspective as well as to describe the practices in relationship to the medical home model.

Exploratory Aim 2: To determine whether CATCH-IT has a favorable cost-benefit ratio and/or cost effectiveness of <$50,000/disability adjusted life year compared to the HEALTH EDUCATION group.