***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: Background : Depression is undertreated in primary care setting s. Little research investigates the impact of patient involvement in decisions on guideline -concordant treatment and depression outcomes . Objective : The objective of this study was to determine whether patient involvement in decision-making is associated with guideline -concordant care and improvement in depression symptoms . Design : Prospect i ve cohort study . Setting : Multisite , nationwide r and omized clinical trial of quality improvement strategies for depression in primary care . Subjects : Primary care patients with current symptoms and probable depressive disorder . Measurements : Patients rated their  involvement in decision-making ( IDM )  about their care on a 5-point scale from poor to excellent 6 months after entry into the study . Depressive symptoms were measured every 6 months for 2 years using a modified version of theCenter for Epidemiologic Studies –Depression ( CES-D ) scale . We examined probabilities ( Pr ) of receipt of guideline -concordant care and resolution of depression across IDM groups using multivariate logistic regression models controlling for patient and provider factors . Results : For each 1-point increase in IDM ratings , the probability of patients ’ report of receiving guideline -concordant care increased 4 % to 5 % ( adjusted Pr 0.31 vs. 0.50 for the lowest and highest IDM ratings , respectively , P < 0.001 ) . Similarly , for each 1-point increase in IDM ratings , the probability of depression resolution increased 2 % to 3 % ( adjusted Pr 0.10 vs. 0.19 for the lowest and highest IDM ratings respectively , P = 0.004 ) . Conclusions : Depressed patients with higher ratings of involvement in medical decisions have a higher probability of receiving guideline -concordant care and improving their symptoms over an 18-month period . Interventions to increase patient involvement in decision-making may be an important means of improving care for and outcomes of depression Background The biggest barrier to treatment of common mental disorders in primary care setting s is low recognition among health care providers . This study attempts to explore the explanatory models of common mental disorders ( CMD ) with the goal of identifying how they could help in improving the recognition , leading to effective treatment in primary care . Results The paper describes findings of a cross sectional qualitative study nested within a large r and omized controlled trial ( the Manas trial ) . Semi structured interviews were conducted with 117 primary health care attendees ( 30 males and 87 females ) suffering from CMD . Main findings of the study are that somatic phenomena were by far the most frequent presenting problems ; however , psychological phenomena were relatively easily elicited on probing . Somatic phenomena were located within a biopsychosocial framework , and a substantial proportion of informants used the psychological construct of ‘ tension ’ or ‘ worry ’ to label their illness , but did not consider themselves as suffering from a ‘ mental disorder ’ . Very few gender differences were observed in the descriptions of symptoms but at the same time the pattern of adverse life events and social difficulties varied across gender . Conclusion Our study demonstrates how people present their illness through somatic complaints but clearly link their illness to their psychosocial world . However they do not associate their illness to a ‘ mental disorder ’ and this is an important phenomenon that needs to be recognized in management of CMD in primary setting s. Our study also elicits important gender differences in the experience of CMD Background In the UK , 8–15 % of women suffer from postnatal depression with long term consequences for maternal mood and child development . Current guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression . Previous literature suggests that women are reluctant to disclose symptoms of postnatal depression . This study aim ed to explore general practitioners ' ( GPs ) , health visitors ' and women 's views on the disclosure of symptoms which may indicate postnatal depression in primary care . Methods In-depth interviews with GPs , health visitors and women who were participating in a r and omised controlled trial of anti-depressants versus health visitor delivered non-directive counselling for the treatment of postnatal depression . Interviews were audio-taped and fully transcribed . Thematic analysis with an iterative approach was used , allowing the views of practitioners and patients to be explored and then compared . Results Nineteen GPs , 14 health visitors and 28 women were interviewed . A number of common themes were identified across all three data sets : underst and ing and negotiating the diagnosis of postnatal depression , hindering and facilitating disclosure , and the system of care . Both women and health professionals described postnatal depression in psychosocial terms : an adjustment reaction to change in life circumstances and the reality of motherhood not meeting personal expectations . Women described making a conscious decision about whether or not to disclose their feelings to their GP or health visitor . Health professionals described strategies used to hinder disclosure and described a reluctance to make a diagnosis of postnatal depression , as they had few personal re sources to manage women with postnatal depression themselves , and no services to which to refer women for further treatment . Conclusion To improve disclosure of symptoms in primary care , there should be a move away from question ing why health professionals do not make the diagnosis of depression and in response suggesting that education and training will improve skills and thus improve detection of depression . Improving the detection and management of postnatal depression in primary care requires recognition of the context in which women consult , and system changes that ensure health professionals work in an environment that can facilitate disclosure and that the necessary re sources for management are available . Trail Registration IS RCT N OBJECTIVE Research has shown that people are reluctant to seek professional help for depression , especially from mental health professionals . This may be because of the impact of stigma which can involve people 's own responses to depression and help-seeking ( self stigma ) as well as their perceptions of others ' negative responses ( perceived stigma ) . The aim of this article was to examine community help-seeking intentions and stigmatizing beliefs associated with depression . METHOD A total of 1,312 adults r and omly sample d from the Australian community completed a question naire providing a depression vignette and measures of self- and perceived-stigmatizing responses , source -specific help-seeking intentions , current depressive symptoms and depression experience , and demographics . RESULTS Many people reported they would feel embarrassed about seeking help from professionals , and believed that other people would have a negative reaction to them if they sought such help . Some expected professionals to respond negatively to them . Responses varied according to the sources of professional help . Self-embarrassment and expectations that others would respond negatively predicted the likelihood of help-seeking from professional sources . CONCLUSION Self- and perceived-stigmatizing responses to help-seeking for depression are prevalent in the community and are associated with reluctance to seek professional help . Interventions should focus on minimizing expectations of negative responses from others and negative self-responses to help-seeking , and should target younger people BACKGROUND In the UK , 8 - 15 % of women suffer from postnatal depression , with long-term consequences for maternal mood and child development . Previous literature suggests that health visitors struggle with their conflicting roles with respect to mother and infant . Current policy is redirecting the emphasis and organisation of health visitor work , but guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression . AIM To explore the views of GPs and health visitors on the diagnosis and management of postnatal depression . DESIGN OF STUDY A qualitative study nested within a multicentre r and omised controlled trial . SETTING Nine primary care trusts in Bristol , Manchester , and London . METHOD In-depth interviews with GPs and health visitors from primary care trusts participating in a r and omised controlled trial of antidepressants versus health visitor-delivered non-directive counselling .  Interviews were audiotaped and fully transcribed . Thematic analysis with an iterative approach was used to develop conceptual categories from the transcripts . RESULTS Nineteen GPs and 14 health visitors were interviewed . GPs and health visitors described their work in making and negotiating the diagnosis of postnatal depression , the value of a long-term relationship with the woman , and how labelling affects management of women with postnatal depression . Responders described how they viewed others ' roles in the management of postnatal depression , and how national policy and local organisational changes had an impact on patient care , so that no one health professional was assuming overall responsibility for the care of women with postnatal depression . CONCLUSION Ongoing organisational changes within primary care , such as the implementation of corporate working by health visitors , affect care provided to women after birth , which in turn has an impact on the diagnosis and management of postnatal depression Abstract Objective : To evaluate the efficacy of emotional support and counselling combined with placebo or antidepressants with single or dual mechanism of action in the treatment of depression in primary care . Design : R and omised double blind study . Setting : Several locations in Norway . Subjects : 372 patients with depression . Main outcome measures : Improvement ( clinical remission ) reported both by the patient ( Montgomery Åsberg depression rating scale ) and the physician ( clinical global improvement and impression scales ) . Results : Intention to treat analyses showed 47 % remission in patients r and omised to placebo compared with 61 % remission in patients r and omised to sertraline ( odds ratio 0.56 , 95 % confidence interval 0.33 to 0.96 ) and 54 % in patients r and omised to mianserin ( 0.75 , 0.44 to 1.27 ) . Women responded  better than men ( 1.86 , 1.17 to 2.96 ) . Subgroup analyses showed that subjects with recurrent depression ( n=273 ) responded more frequently to sertraline than to placebo ( 0.43 , 0.23 to 0.82 ) than those having their first episode of depression ( 1.18 , 0.39 to 3.61 ) . Statistically significant interactions between type of drug treatment and history of depression were not shown by logistic regression . Conclusion : The combination of active drug and simple psychological treatment ( counselling , emotional support , and close follow up over a 24 week period ) was more effective than simple psychological treatment alone , in particular for those with recurrent depression . Overall , women may benefit more than men . If confirmed in future studies , the findings should lead to more differentiated treatment guidelines for depression in primary care 
    Output:
    
Three facilitative themes were : ( v ) a human connection improves identification of emotional concerns and is therapeutic ; ( vi ) exploring , explaining and negotiating a shared underst and ing or guiding patients towards new underst and ings and ( vii ) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment .
CONCLUSION The findings suggest that treatment guidelines should acknowledge : the therapeutic value of a positive GP-patient relationship ; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor 's domain of expertise ; and the value of exploring and shaping new underst and ings about patients ' emotional concerns and their management