青少年基于初级保健的网络抑郁预防干预的 24 个月结果：随机临床试验。

24-Month Outcomes of Primary Care Web-Based Depression Prevention Intervention in Adolescents: Randomized Clinical Trial.

机构信息

Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States.

The Robert S and Grace W Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College, Boston, MA, United States.

出版信息

J Med Internet Res. 2020 Oct 28;22(10):e16802. doi: 10.2196/16802.

DOI:10.2196/16802

PMID:33112254

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7657722/

Abstract

BACKGROUND

Adolescent depression carries a high burden of disease worldwide, but access to care for this population is limited. Prevention is one solution to curtail the negative consequences of adolescent depression. Internet interventions to prevent adolescent depression can overcome barriers to access, but few studies examine long-term outcomes.

OBJECTIVE

This study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education active control for depression onset at 12 and 24 months in adolescents presenting to primary care settings.

METHODS

A 2-site randomized trial, blinded to the principal investigators and assessors, was conducted comparing Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training to health education to prevent depressive episodes in 369 adolescents (193 youths were randomly assigned to Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training and 176 to health education) with subthreshold depressive symptoms or prior depressive episodes. Participants were recruited from primary care settings in the United States. The primary outcome was the occurrence of a depressive episode, determined by the Depression Symptom Rating. The secondary outcome was functioning, measured by the Global Assessment Scale.

RESULTS

In intention-to-treat analyses, the adjusted hazard ratio favoring Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training for first depressive episode was not statistically significant at 12 months (hazard ratio 0.77, 95% CI 0.42-1.40, P=.39) and 24 months (hazard ratio 0.87, 95% CI 0.52-1.47, P=.61). Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training provided preventive benefit for first depressive episode for those with mild hopelessness or at least moderate paternal monitoring at baseline. Global Assessment Scale scores improved comparably in both groups (intention-to-treat).

CONCLUSIONS

A technology-based intervention for adolescent depression prevention implemented in primary care did not have additional benefit at 12 or 24 months. Further research is necessary to determine whether internet interventions have long-term benefit.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01893749; http://clinicaltrials.gov/ct2/show/NCT01893749.

摘要

背景

青少年抑郁症在全球范围内带来了沉重的疾病负担，但该人群获得治疗的机会有限。预防是遏制青少年抑郁症负面影响的一种解决方案。针对青少年抑郁症的互联网干预措施可以克服获取障碍，但很少有研究关注长期结果。

目的

本研究比较了基于互联网的干预措施 CATCH-IT（认知行为人文和人际培训促进成人过渡期）与一般健康教育主动控制，以在出现青少年初级保健环境中，在 12 个月和 24 个月时预防青少年抑郁发作。

方法

在一项双盲、主要研究者和评估者盲法的 2 地点随机试验中，比较了认知行为人文和人际培训促进成人过渡期与健康教育，以预防有阈下抑郁症状或既往抑郁发作的 369 名青少年（193 名青少年被随机分配到认知行为人文和人际培训促进成人过渡期，176 名青少年分配到健康教育）发生抑郁发作。参与者从美国的初级保健环境中招募。主要结局是抑郁发作的发生，通过抑郁症状评定量表确定。次要结局是功能，通过总体评估量表测量。

结果

在意向治疗分析中，在 12 个月（危险比 0.77，95%CI 0.42-1.40，P=.39）和 24 个月（危险比 0.87，95%CI 0.52-1.47，P=.61）时，有利于认知行为人文和人际培训促进成人过渡期的调整后危险比在统计学上对首次抑郁发作无显著意义。对于基线时有轻度绝望感或至少中度父亲监护的患者，认知行为人文和人际培训促进成人过渡期提供了首次抑郁发作的预防益处。两组的总体评估量表评分均有相当改善（意向治疗）。