***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES No longitudinal studies have concurrently evaluated predictors of anxiety , depression , and fatigue  in people with multiple sclerosis ( PwMS ) . This study determined factors that best predicted anxiety , depression , and fatigue  in MS patients from a large pool of disease , cognitive , life-event stressor ( LES ) , psychosocial , life-style , and demographic factors . DESIGN A 2-year prospect i ve longitudinal study evaluated predictors of psychological distress and fatigue in PwMS . METHODS One hundred and one consecutive participants with MS were recruited from two MS clinics in Sydney , Australia .  LES , anxiety , depression , and fatigue were assessed at baseline and at 3-monthly intervals for 2-years . Disease , cognitive , demographic , psychosocial , and life-style factors were assessed at baseline . Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria . RESULTS Depression strongly predicted anxiety and fatigue , and anxiety and fatigue strongly predicted later depression . Psychological distress ( i.e. anxiety , depression ) was also predicted by a combination of unhealthy behaviours ( e.g. drug use , smoking , no exercise , or relaxation ) and psychological factors ( e.g. low optimism , avoidance coping ) , similar to the results of community-based studies . However , state-anxiety and fatigue were also predicted by immunotherapy status , and fatigue was also predicted by LES and demographics . CONCLUSIONS These results suggest that similar factors might underpin psychological distress and fatigue  in MS patients and community-well sample s , although MS treatment factors may also be important . These results might assist clinicians in determining which MS patients are at greatest risk of developing anxiety , depression , or fatigue OBJECTIVE The aim of this study was to design a trial that could evaluate the effect of acceptance and commitment therapy as a group-intervention for multiple sclerosis patients with psychological distress .  DESIGN R and omized controlled trial with assessment at pretreatment , end of treatment , and at 3-month follow-up . SUBJECTS Multiple sclerosis out patients with elevated symptoms of anxiety and /or depression ( n = 21 ) . METHODS Patients were r and omly assigned to acceptance and commitment therapy or relaxation training . Both treatments consisted of 5 sessions over 15 weeks containing didactic sessions , group discussion s , and exercises . Outcome was assessed by self-rated symptoms of anxiety , depression , and a measure of acceptance . RESULTS At 3-month follow-up , the relaxation training group had a significant decline in anxiety symptoms whereas the acceptance and commitment therapy group showed a maintained improvement in rated acceptance at follow-up . CONCLUSION The results reflect the different emphases of the therapies . Acceptance and commitment therapy is aim ed at living an active , valued life and increasing acceptance , while relaxation training focuses directly on coping strategies to h and le emotional symptoms . The results are preliminary , but supportive of further study of brief group interventions for reducing psychological distress in patients with multiple sclerosis Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Disability status , depression and anxiety are important determinants of quality of life ( Q oL ) in patients with multiple sclerosis ( MS ) . We investigated whether anxiety and depression influence the relation between disability status and Q oL in our cohort of recently diagnosed patients .  Disability status [ Exp and ed Disability Status Scale ( EDSS ) ] , anxiety and depression [ Hospital A nxiety and Depression Scale ( HADS ) ] , and  Q oL ( SF-36 ) were prospect ively obtained in 101 MS patients . The relation between EDSS and SF-36 scales was examined using regression analyses , without and with adjustment for anxiety and depression . Interaction effects were investigated by comparing the relation between EDSS and Q oL in patients with high and low anxiety and depression . In the unadjusted analyses , EDSS was significantly related to all SF-36 physical and mental health scales . A fter adjustment for anxiety and depression , EDSS was significantly related only to the SF-36 physical functioning , role-physical functioning and bodily pain scales . The relation between EDSS and these SF-36 scales was consistently higher in patients with more symptoms of anxiety or depression , suggesting that anxiety and depression strengthened the association of EDSS in these SF-36 physical health scales . A fter adjustment for anxiety and depression , EDSS was not significantly related to the SF-36 mental health scales and the general health scale . This finding is compatible with the hypothesis that anxiety and depression are intermediate factors in the association of EDSS with these SF-36 scales . Screening for symptoms of anxiety and depression is recommended in studies that use Q oL as an outcome measure of treatment or intervention efficacy Objective : To evaluate the cost effectiveness of a psychological adjustment group shown to be clinical ly effective in comparison with usual care for people with multiple sclerosis . Design : R and omized controlled trial with comparison of costs and calculation of incremental cost effectiveness ratio . Setting : Community . Participants : People with multiple sclerosis were screened on the General Health Question naire 12 and Hospital Anxiety and Depression Scale , and those with low mood were recruited . Interventions : Participants r and omly allocated to the adjustment group received six group treatment sessions . The control group received usual care , which did not include psychological interventions . Main measures : Outcomes were assessed four and eight months after r and omization , blind to group allocation . The costs were assessed from a service use question naire and information provided on medication . Quality of life was assessed using the EQ-5D . Results : Of the 311 patients identified , 221 ( 71 % ) met the criteria for having low mood . Of these , 72 were r and omly allocated to receive treatment and 79 to usual care . Over eight months follow-up there was a decrease in the combined average costs of £ 378 per intervention respondent and an increase in the costs of £ 297 per patient in the control group , which was a significant difference ( p=0.03 ) . The incremental cost-effectiveness ratio indicated that the cost per point reduction on the Beck depression inventory – II was £ 118 . Conclusion : In the short term , the adjustment group programme was cost effective when compared with usual care , for people with multiple sclerosis presenting with low mood .  The longer-term costs need to be assessed Anxiety and phobia frequently prevent patients with multiple sclerosis ( MS ) from self-injecting their injectable disease-modifying medications . This small , r and omized , controlled trial tested the efficacy of a six-session nurse-administered programme to teach self-injection to patients with MS , who , due to anxiety or phobia , were unable to self-inject their injectable medications . Participants were 30 patients with MS who were prescribed interferon beta-1a ( IFNβ-1a ) administered via weekly intramuscular injection . All patients were unable to self-inject due to anxiety or phobia . Patients were r and omized to either the six-session Self-Injection Anxiety Therapy ( SIAT ) or a control telephone support condition modelled on the support programme offered by the manufacturer of IFNβ-1a . Four patients dropped out of SIATwhile three dropped out of the control condition . Eight patients receiving SIAT , compared to three control patients , were able to self-inject after six weeks of treatment . SIAT patients were significantly more likely to achieve self-injection at treatment cessation , compared to telephone control patients , in completer analyses ( p=0.022 ) , however , this only reached a trend in intent-to-treat analyses ( p=0.058 ) . These findings suggest that SIAT is a potentially valuable intervention to teach self-injection skills to injection phobic and anxious patients , and should be investigated more thoroughly in a larger clinical trial Objective : There has long been a belief that depression contributes to fatigue in multiple sclerosis ( MS ) although supporting data are minimal at best . Clinical guidelines for the treatment of fatigue include recommendations for the treatment of depression in the absence of clear empirical support . The goal of this study was to examine the effects of treatment for depression on fatigue in MS . Methods : Sixty patients with a relapsing form of MS and moderate to severe depression were r and omly assigned to one of three vali date d 16‐week treatments for depression : individual cognitive behavioral therapy , group psychotherapy , or sertraline . Assessment s at baseline and treatment cessation included the primary outcome measure , fatigue assessment instrument ( FAI ) , and Beck depression inventory ( BDI ) . Results : The total FAI and the global fatigue severity subscale were significantly reduced over the course of treatment ( p values < .02 ) . Other subscales did not change significantly . Secondary analyses showed change in global fatigue severity was associated with change in BDI ( p = .03 ) but change in total FAI was only marginally related to change in BDI ( p = .05 ) . These relationships were due entirely to change in mood ( p values < .02 ) and not to change in cognitive or vegetative symptoms ( p values > .17 ) . Conclusions : These findings suggest that treatment for depression is associated with reductions in the severity of fatigue symptoms , and that this relationship is due primarily to treatment related changes in mood Background People with multiple sclerosis ( MS ) are at high risk of depression . We undertook a pilot trial of computerised cognitive behavioural therapy ( CCBT ) for the treatment of depression in people with MS to test the feasibility of undertaking a full trial . Methods Participants with a diagnosis of MS and clinical levels of depression were recruited through out-patient clinics and postal screening question naires at two UK centres and r and omised to CCBT or usual care . Clinical outcomes included the Beck Depression Inventory ( BDI-II ) and Multiple Sclerosis Impact Scale ( MSIS-29 ) at baseline , 8 and 21 weeks . Feasibility outcomes included : recruitment rate ; reasons for refusal , withdrawal and dropout ; feasibility and acceptability of the proposed outcome measures ; sample size estimation and variation in and preferences for service delivery . Results Twenty-four participants were recruited . The recruitment rate , calculated as the proportion of those invited to fill in a screening question naire who were consented into the trial , was 4.1 % . Recruitment through out-patient clinics was somewhat slower than through screening question naire mail-out but the overall recruitment yield was similar . Of the 12 patients in the CCBT arm , 9 ( 75 % ) completed at least four , and 6 completed all 8 CCBT sessions . For completers , the median time ( IQR ) to complete all eight CCBT sessions was 15 ( 13 to 20 ) weeks . Participants expressed concern about the face validity of the Beck Depression Inventory II for the measurement of self-reported depression in people with MS . The MSIS-29 was the patient-reported outcome measure which participants felt best reflected their concerns . The estimated sample size for a full trial is between 180 and 390 participants . NHS partners were not delivering CCBT in community facilities and participants preferred to access CCBT at home , with no one expressing a preference for use of CCBT in an alternative location . Conclusions A definitive trial , with a recruitment window of one year , would require the participation of around 13 MS centres . This number of centres could be reduced by exp and ing the eligibility criteria to include either other neurological conditions or people with more severe depression . The MSIS-29 should be used as a patient-important outcome measurement . Trial registration IS RCT N : IS RCT In a double-blind clinical trial involving 28 patients with multiple sclerosis and major depressive disorder , 14 patients were r and omly assigned to a 5-week trial of desipramine and individual psychotherapy and 14 to placebo plus psychotherapy .  Clinical judgments indicated that patients treated with desipramine improved significantly more than the placebo group . This was confirmed by scores on the Hamilton Rating Scale for Depression but not by Beck Depression Inventory scores . Side effects limited desipramine dosage in half of the treated patients . The authors conclude that desipramine has a modest beneficial effect in serious depression associated with multiple sclerosis but that side effects may be more of a limiting factor than in patients without medical or neurologic disease BACKGROUND Several studies have shown that telephone-administered cognitive-behavioral therapy ( T-CBT ) is superior to forms of no treatment controls . No study has examined if the skills-training component to T-CBT provides any benefit beyond that provided by nonspecific factors . OBJECTIVE To test the efficacy of a 16-week T-CBT against a strong control for attention and nonspecific therapy effects . DESIGN R and omized controlled trial including 12-month follow-up . SETTING Telephone administration of psychotherapy with patients in their homes . PARTICIPANTS Participants had depression and functional impairments due to multiple sclerosis . INTERVENTIONS A 16-week T-CBT program was compared with 16 weeks of telephone-administered supportive emotion-focused therapy . MAIN OUTCOME MEASURES Hamilton Depression Rating Scale score , Structured Clinical Interview for DSM-IV diagnosis of major depressive disorder , Beck Depression Inventory score , and Positive Affect scale score of the Positive and Negative Affect Scale . RESULTS Of the 127 participants r and omized , 7 ( 5.5 % ) dropped out of treatment . There were significant improvement during treatment on all outcome measures ( P<.01 for all ) and an increase in Positive Affect Scale score . Improvements over 16 weeks of treatment were significantly greater for T-CBT , compared with telephone-administered supportive emotion-focused therapy , for major depressive disorder frequency ( P = 
    Output:
    
Pharmacological and psychological treatments for depression were effective in reducing depressive symptoms in MS .
The data are insufficient to determine the effectiveness of treatments for anxiety