OBJECTIVE(S): The primary objective is to conduct a randomized controlled trial to evaluate a behavioral health intervention aimed at reducing health risk behaviors and improving health among adolescents with major depressive disorder (MDD). The intervention targets four areas of health risk behavior common among depressed adolescents: tobacco use; alcohol and drug use; sexual activity; and obesity (nutrition, exercise, excess calorie intake, hereafter referred to as obesity). Although the intervention emphasizes health risk behaviors (our primary outcome), we also evaluate the prediction that the intervention will be associated with a reduction in depression severity (a secondary outcome measure). We also will examine whether the intervention has independent effects on health risk behavior and depression, whether improvements in health risk behavior mediate any observed intervention effects on depression, or whether depression operates as a mediator of intervention effects on health risk behaviors. In addition, we will examine potential moderators (e.g. age, gender, ethnicity, income, family status, comorbidity) of intervention response.

METHODS: We will enroll 300 adolescents with MDD identified through screening at the time of a primary care visit. Adolescents will be randomized to either 1) the health behavior intervention, or 2) usual care. The intervention targets four major areas of health risk behavior: tobacco use; alcohol and drug use; sexual activity; and obesity. Based on our prior HIV preventive interventions and our work integrating behavioral interventions for adolescent depression within primary health care services, the intervention employs a collaborative care model, with a Care Manager supporting the primary care provider and delivering a 10-session cognitive-behavioral health education intervention aimed at reducing health risk behaviors and promoting and maintaining positive health behaviors. Like successful HIV prevention programs, the intervention addresses multiple risk factors simultaneously, intervenes at multiple system levels (individual, family, organization), and emphasizes linking youth to care. Outcomes are monitored at baseline and at 6 and 12-month follow-ups.

STATUS: Funding pending.

IMPACT: Depression is a common mental disorder in adolescents and associated with health risk behaviors, negative health and mental health outcomes, and significant health expenditures. Results will provide critical guidance to the field regarding strategies for improving health and reducing health risk behaviors in adolescents with MDD.

Principal Investigator:
Joan R. Asarnow, Ph.D.

Sponsored by:
Kaiser Permanente Los Angeles Medical Center