A vaccination for depression

Van Voorhees, who is chief of general pediatrics at Children's Hospital University of Illinois, and his team are working on an approach that they hope will reduce the risk of mental illness for a diverse group of young people, from teens struggling with issues of sexuality to those living in neighborhoods mired in violence.

The goal is to identify kids at risk and then use a combination of traditional counseling and Internet-based learning to stave off mental disorders and their accompanying medicines.

Van Voorhees said he wants to change the way doctors, especially pediatricians, deal with mental illness by moving the focus, which is now so heavily trained on treatment, to prevention.

"Right now most (medical professionals) only treat mental illness," he said. "We're trying to develop a type of behavioral vaccine that functions the same way vaccines work in fighting infections. You stop it before it starts. We hope this approach will be simple, culturally acceptable, universally deployable - and inexpensive."

He said that initial depressive episodes tend to strike between the ages of 13 and 17. Once an adolescent tumbles into severe depression, episodes can recur across his or her lifetime.

Van Voorhees said young people establish patterns of coping in adolescence and young adulthood.

"There's a period of plasticity in the brain during which it's developing the capacity for learning new coping skills," he said. "You want to make (youths) resilient against mental disorders, and you try to give them ways to cope so that they don't fall into substance abuse."

Van Voorhees said it takes about a year to relearn coping skills. His research has been testing the effectiveness of Internet use and other techniques to hone such skills.

Project CATCH-IT, begun in 2002, is a multimillion-dollar study that has been funded by the National Institute of Mental Health and the Robert Wood Johnson Foundation, among others.

CATCH-IT includes an initial motivational interview with a physician to get the young person to understand the importance of the program. It also has a self-contained learning component on the Internet that focuses on changing behavior and improving cognitive thinking and social skills.

The website, which has evolved over time, teaches resiliency skills in part by allowing patients to read stories about other teens to learn how they overcame adversity and became more successful in school, their relationships or on the job.

Van Voorhees said the website is designed to be visually appealing.

"The colors, the graphics, the art, the videos are there to illustrate the main points: It's important to be optimistic, socially connected and behaviorally active," he said.

"The individuals chosen for the study find it difficult to engage the world in activities that bring them pleasure and meaning. They might go home if they feel down and channel-surf. We're saying, 'You have to get off the couch and do something that lifts you.'"

He said that over the years CATCH-IT has shown some evidence of being effective. But in February a new study, called PATH, was begun to determine whether CATCH-IT does a better job of preventing depression than routine mental health care and health education that teens can find online.

"With CATCH-IT alone, we saw depression dropping over the years, but we didn't have anything to compare it to," said Monika Marko-Holguin, PATH's project manager.

During the PATH study, subjects will get repeated mental health evaluations and be referred for treatment as needed. The study includes a nationally representative sample of patients. (For information about enrolling, call Marko-Holguin at 312-996-0407.)

Earlier, I mentioned that Van Voorhees wanted to construct a prevention model that worked for a diverse group of young people. From its inception, the stories on CATCH-IT's website were designed for a multiracial group of youths dealing with stresses that didn't often involve such things as violence or homelessness.

But a new study called CURB, for Chicago Urban Resiliency Building, is set to begin soon and has a website designed specifically for black and Hispanic kids who live in tougher, more violent Chicago neighborhoods. Marya Corden is CURB's project manager.

Corden said CURB is a derivative of CATCH-IT, but culturally and ethnically adapted with a hip-hop vibe.

"A lot of kids were gathered in advisory groups to look at old and new website designs, as well as the stories to say whether the look and feel of the design, and the stories, were applicable to their community," said Corden. (You can learn more about CURB by calling Corden at 312-996-6713.)

Van Voorhees said the goal is to reach as many young people as possible.

"We want to develop a model that will be embedded in primary care with pediatricians screening kids who are at risk for mental disorders and trying to prevent them ahead of time," he said. "We hope it will save money and lives."

(c)2012 the Chicago Tribune
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