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

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.

Inclusion Criteria:

Adolescents:

(A) Youth ages 13 through 18 who are English speaking. (B) Youth must be experiencing
elevated level of depressive symptoms on the Center for Epidemiologic Studies Depression
(CES-D) scale (score >/= 16). (C) Youth will be included if they have a past history of
depression, anxiety, externalizing symptoms, or substance abuse. Youth presenting in
partial remission from a major depressive episode at Baseline will be rescreened after 2
months utilizing the phone screen to ensure episode is fully remitted prior to
randomization or access to study intervention. Those who do not fully remit after two
months will be excluded.

Parents:

*Parent of eligible adolescents

Physicians (PCP) or NP:

*Physician in any of the study sites

Healthcare Professionals:

*Primary care practice for a minimum of 6 months

Exclusion Criteria:

Adolescents:

- Current DSM-IV diagnosis of Major Depressive Disorder

- Current therapy for depression, or be taking antidepressants (e.g., SSRIs, TCAs,
MAOIs, bupropion, nefazodone, mirtazapine, venlafaxine);

- Current CES-D score >35;

- DSM-IV diagnosis of schizophrenia (current or past) or bipolar affective disorder;

- Current serious medical illness that causes significant disability or dysfunction;

- Significant reading impairment (a minimum sixth-grade reading level based on parental
report), mental retardation, or developmental disabilities;

- Serious imminent suicidal risk (as determined by endorsement of current suicide on
CES-D or in KSADS interview) or other conditions that may require immediate
psychiatric hospitalization

- Psychotic features or disorders, or currently be receiving psychotropic medication

- Extreme, current drug/alcohol abuse (greater than or equal to 2 on the CRAFFT).

Parents:

- Ineligible child

- Non-English speaking

Physicians:

*None

Healthcare Professionals:

*None