Internet-Based Cognitive Behavioral Therapy for Depressive Symptoms in Adolescents With Type 1 Diabetes Mellitus

Adolescents with diabetes have a higher incidence of subclinical and clinical depression
compared to healthy adolescents. Patients with diabetes who are clinically or subclinically
depressed are at high risk for poor glycemic control.

Studies evaluating prevention and treatment strategies for depression in patients with type 1
diabetes have shown that group cognitive-behavioral therapy (CBT) and individual
interpersonal psychotherapy (IPT) can reduce the risk of depressive illness in adolescents
with diabetes. Computerized interventions show evidence of being efficacious, and have been
recommended as the "first line" intervention.

The Competent Adulthood Transition with Cognitive Humanistic and Interpersonal Teaching
(CATCH-IT) internet program has shown positive results with adolescents at risk for
depression, but has not been used in patients with a chronic illness like diabetes. CATCH-IT
is based on established CBT and IPT treatment models. It includes a) an innovative and
effective brief practitioner-provided motivation enhancement component (in person at
enrollment and through phone calls) and b) self-directed modules for the adolescent that can
be accessed on the internet.

Inclusion Criteria:

- Age 13-17 receiving ongoing medical care in the Diabetes Clinic at Children's Medical
Center Dallas.

- Patients must be fluent in English (the materials on the site have not been validated
in any other language), be in at least the 8th grade, report/demonstrate comfort with
use of a computer, and regular, convenient and discreet access to the internet.

- Patients must experience at least sub-threshold depression (CES-D score > 15).

- Patients must have had the diagnosis of type 1 diabetes for at least 12 months.

Exclusion Criteria:

- Patients who are medically unstable during their diabetes clinic visit will be
excluded (i.e. diabetes ketoacidosis, symptomatic hypoglycemia).

- Patients who are too severely depressed for this form of intervention (i.e. meet
criteria for MDD, endorse suicidal intent, PHQ-A score ≥ 20), those with a diagnosis
or symptoms of severe mental illness (schizophrenia, bipolar disorder), prior
psychiatric hospitalization, prior self-harm attempt.

- Patients receiving ongoing counseling or therapy services within the last year, by a
licensed professional (counselor, psychologist or psychiatrist).

- Patients who are currently taking or begin taking psychotropic medications during
study participation will be excluded/withdrawn.