Randomized Clinical Trial of Primary Care Based Online Depression Prevention Intervention: Impact on Adolescent Modifiable Factors and Behaviors

Round 1

Reviewer 1 Report

First, I would like to congratulate the authors for their excellent research. There are some suggestions and considerations to make as a contribution to the manuscript.

Abstract - I would like to suggest a review of the first sentence ("The developmental period of adolescence can pose a risk for the onset of depressive disorders, but it is also a time when potentially modifiable factors and behaviors related to depressive episode onset can develop"), mainly regarding "modifiabe factors and behaviors" . Examples would help to clarify the authors´s explanation.

I would also like to suggest a brief explanation about HE and each  outcomes in the introduction (describe, justify its use in the study) for a better understanding of the method and results. HE was mentioned in the introduction,but there was no previous explanation; the outcomes were explained in the method, but there was no introduction and justification about them in the article.

There is a need for a detailed description of the selected population. What were the participant inclusion and exclusion criteria?
Demographic informations were cited. Why were they considered? How have these variables been observed? If the CATCH-IT is in English, how was the selection of participants carried out in relation to the language? Would  Hispanic participants have English as their first language? 

In the results,  there are  terms such as "Unadjusted means" and "Within-group slopes" (Table 2). These terms could be explained in the data analysis for a better understanding of the reader.

Author Response

Reviewer 1

First, I would like to congratulate the authors for their excellent research. There are some suggestions and considerations to make as a contribution to the manuscript.

Thank you for reviewing the manuscript.

Abstract - I would like to suggest a review of the first sentence ("The developmental period of adolescence can pose a risk for the onset of depressive disorders, but it is also a time when potentially modifiable factors and behaviors related to depressive episode onset can develop"), mainly regarding "modifiabe factors and behaviors" . Examples would help to clarify the authors´s explanation.

We agree and added an example in the sentence and changed wording throughout the abstract to make it clear it is a technology-based health preventative intervention that targets these factors and behaviors.

I would also like to suggest a brief explanation about HE and each  outcomes in the introduction (describe, justify its use in the study) for a better understanding of the method and results. HE was mentioned in the introduction,but there was no previous explanation; the outcomes were explained in the method, but there was no introduction and justification about them in the article.

We agree regarding HE and added a brief qualifier for HE in the introduction. Regarding the outcomes, there are many, and instead of describing and justifying each one in the introduction, we proposed justifying them as a group. We proposed adding an explanation that our group and others have identified these factors and behaviors and assessed instruments to measure their outcomes prior to this study.

There is a need for a detailed description of the selected population. What were the participant inclusion and exclusion criteria?
Demographic informations were cited. Why were they considered? How have these variables been observed? If the CATCH-IT is in English, how was the selection of participants carried out in relation to the language? Would  Hispanic participants have English as their first language? 

We agree regarding the sample selection and concern of which Hispanic participants could join. Under study design and setting, made clear the inclusion criteria of understanding English and subthreshold depression symptoms or history of depression. We made clear the exclusion criteria of not understanding English and current depression diagnosis or receiving treatment for depression. We agree there is a need for clarity on how the demographic information was used and under demographics, add wording to clarify this information was used as part of the statistical analysis of the outcomes.

In the results, there are terms such as "Unadjusted means" and "Within-group slopes" (Table 2). These terms could be explained in the data analysis for a better understanding of the reader.

Unadjusted means are just the raw arithmetic means, without any statistical adjustments.  – correction from the first e mail

Within-group slopes are the estimated slopes (change over time) for CATCH-IT and HE, from the growth curve models.

Reviewer 2 Report

This RCT examined how the CATCH-IT intervention affects modifiable risk factors and behaviors related to depressive episode onset in adolescents. The findings of the study will be of interest to clinicians and clinical researchers in the field of adolescent psychiatry. I have several suggestions for minor modifications:

• In the Analysis subsection, please explain whether the data were normally distributed and indicate the name of the used software.
• Was there a statistically significant difference in the incidence of depressive episodes at two years of follow-up?
• Please indicate whether informed consent was obtained from the participants
• In the Conclusions, I suggest mentioning whether there are any subsets of at-risk adolescents who should not receive a CATCH-IT intervention.

Author Response

Reviewer 2

This RCT examined how the CATCH-IT intervention affects modifiable risk factors and behaviors related to depressive episode onset in adolescents. The findings of the study will be of interest to clinicians and clinical researchers in the field of adolescent psychiatry. I have several suggestions for minor modifications:

Thank you for reviewing the manuscript.

In the Analysis subsection, please explain whether the data were normally distributed and indicate the name of the used software.

"Monte Carlo simulations have shown that Gaussian models are robust to non-normality under a wide range of conditions." https://link.springer.com/article/10.3758/s13428-021-01587-5. The software we used was SAS v 9.4

Was there a statistically significant difference in the incidence of depressive episodes at two years of follow-up?

There was no difference between groups at 2 years follow-up. We agree it was not stated in the paper and we added this to sample description.

Please indicate whether informed consent was obtained from the participants

We agree it was not stated in the paper. Under the study design and setting, we added an explanation of informed assent for adolescents and informed consent by the parents for the teen and themselves.

In the Conclusions, I suggest mentioning whether there are any subsets of at-risk adolescents who should not receive a CATCH-IT intervention.

 Based on the data, we added to the conclusion, there was no subset of participants where CATCH-IT appears contraindicated.