***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 Lesbian , gay , and bisexual ( LGB ) men and women represent one of the highest-risk population s for depressive symptomatology and disorders , with young LGB adults being at greatest risk . To date , there have been no r and omized controlled trials ( RCT ) to specifically target depressive symptoms in young LGB adults . This is despite research highlighting unique predictors of depressive symptomatology in this population . Here we outline a protocol for an RCT that will test the preliminary efficacy of a tailored compassion-focused therapy ( CFT ) intervention for young LGB adults compared with a self-directed cognitive behavioral therapy ( CBT ) program with no specific tailoring for LGB individuals . Methods The CFT intervention consists of 8 units with self-directed reading and activities tailored to LGB young adults , and 8 x weekly 1-hour consultations with a therapist . The CBT intervention consists of 8 units with self-guided reading and activities , with 1 x 1-hour session with a therapist at the mid-point of therapy . Fifty LGB individuals with scores of 13 or above on the Beck Depression Inventory-II will be r and omized to either the CFT or CBT condition . The primary outcome measure is depressive symptomatology . Secondary outcome measures are symptoms of anxiety , suicidal ideation , internalized homophobia , self-compassion , and shame and guilt proneness . Assessment s will occur at pre-intervention , post-intervention , and at 3-month post-intervention . Discussion This study is an RCT to test the preliminary efficacy of an LGB-tailored compassion-focused intervention for young LGB adults with depressive symptomatology . If this intervention is efficacious , this could begin to address the substantial mental health disparities amongst sexual minorities . Trial registration ACTRN12616001018404 . Prospect i ve registration , registered 02/08/2016 OBJECTIVE We examined whether a shortened form of dialectical behavior therapy , dialectical behavior therapy for adolescents ( DBT-A ) is more effective than enhanced usual care ( EUC ) to reduce self-harm in adolescents . METHOD This was a r and omized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were r and omly allocated to either DBT-A or EUC .  Assessment s of self-harm , suicidal ideation , depression , hopelessness , and symptoms of borderline personality disorder were made at baseline and after 9 , 15 , and 19 weeks ( end of trial period ) , and frequency of hospitalizations and emergency department visits over the trial period were recorded . RESULTS Treatment retention was generally good in both treatment conditions , and the use of emergency services was low . DBT-A was superior to EUC in reducing self-harm , suicidal ideation , and depressive symptoms . Effect sizes were large for treatment outcomes in patients who received DBT-A , whereas effect sizes were small for outcomes in patients receiving EUC . Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation , whereas no mediation effects were found on the other outcomes or for total treatment time . CONCLUSION DBT-A may be an effective intervention to reduce self-harm , suicidal ideation , and depression in adolescents with repetitive self-harming behavior . Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm ; http:// Clinical Trials.gov/ ; NCT00675129 OBJECTIVE To identify the independent and differential diagnostic and symptom correlates of  suicidal ideation and suicide attempts  and determine whether there are gender- and age-specific diagnostic profiles . METHOD The relationships between suicidal ideation , suicide attempts , and psychiatric disorders were examined among 1,285 r and omly selected children and adolescents , aged 9 to 17 years , of whom 42 had attempted suicide and 67 had expressed suicidal ideation only . Youths and their parents were interviewed as part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders ( MECA ) Study , using the Diagnostic Interview Schedule for Children Version 2.3 ( DISC-2.3 ) . RESULTS Logistic regression analyses indicated that mood , anxiety , and substance abuse/dependence disorders independently increased the risk of suicide attempts , after controlling for sociodemographic characteristics . There was no significant independent contribution of disruptive disorders to suicide attempts , although its association with suicidal ideation was significant . Substance abuse/dependence independently differentiated suicide attempters from ideators . Noncriterion symptoms that remained significant predictors of suicide risk , after adjusting for psychiatric disorder , included panic attacks and aggressiveness . Perfectionism did not significantly increase suicide risk after adjusting for psychiatric disorder . The association of specific disorders and noncriterion symptoms with suicidality varied as a function of gender and age . CONCLUSION A monolithic diagnostic risk profile for suicidality , ignoring gender- and age-specific risks , is inadequate . The contribution of substance abuse/dependence in the escalation from suicidal thoughts to suicide attempts is underscored This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Summary Background Self-harm in adolescents is common and repetition occurs in a high proportion of these cases . Scarce evidence exists for effectiveness of interventions to reduce self-harm . Methods This pragmatic , multicentre , r and omised , controlled trial of family therapy versus treatment as usual was done at 40 UK Child and Adolescent Mental Health Services ( CAMHS ) centres . We recruited young people aged 11–17 years who had self-harmed at least twice and presented to CAMHS after self-harm . Participants were r and omly assigned ( 1:1 ) to receive manualised family therapy delivered by trained and supervised family therapists or treatment as usual by local CAMHS . Participants and therapists were aware of treatment allocation ; research ers were masked . The primary outcome was hospital attendance for repetition of self-harm in the 18 months after group assignment . Primary and safety analyses were done in the intention-to-treat population . The trial is registered at the IS RCT N registry , number IS RCT N59793150 . Findings Between Nov 23 , 2009 , and Dec 31 , 2013 , 3554 young people were screened and 832 eligible young people consented to participation and were r and omly assigned to receive family therapy ( n=415 ) or treatment as usual ( n=417 ) . Primary outcome data were available for 795 ( 96 % ) participants . Numbers of hospital attendances for repeat self-harm events were not significantly different between the groups ( 118 [ 28 % ] in the family therapy group vs 103 [ 25 % ] in the treatment as usual group ; hazard ratio 1·14 [ 95 % CI 0·87–1·49 ] p=0·33 ) . Similar numbers of adverse events occurred in both groups ( 787 in the family therapy group vs 847 in the treatment as usual group ) . Interpretation For adolescents referred to CAMHS after self-harm , having self-harmed at least once before , our family therapy intervention conferred no benefits over treatment as usual in reducing subsequent hospital attendance for self-harm . Clinicians are therefore still unable to recommend a clear , evidence -based intervention to reduce repeated self-harm in adolescents . Funding National Institute for Health Research Health Technology Assessment programme The purpose of this study was to examine the efficacy of the Youth-Nominated Support Team-Version II ( YST-II ) for suicidal adolescents , an intervention based on social support and health behavior models , which was design ed to supplement st and ard treatments . Psychiatrically hospitalized and suicidal adolescents , 13 - 17 years of age , were r and omly assigned to treatment-as-usual ( TAU ) + YST-II ( n = 223 ) or TAU only ( n = 225 ) . YST-II provided tailored psychoeducation to youth-nominated adults in addition to weekly check-ins for 3 months following hospitalization . In turn , these adults had regular supportive contact with adolescents . Adolescents assigned to TAU + YST-II had an average of 3.43 ( SD = 0.83 ) nominated adults . Measures included the Suicidal Ideation Question naire-Junior ( SIQ-JR ; W. M. Reynolds , 1988 ) , Children 's Depression Rating Scale-Revised ( E. O. Poznanski & H. B. Mokros , 1996 ) , Beck Hopelessness Scale ( A. T. Beck & R. A. Steer , 1993 ) , and Child and Adolescent Functional Assessment Scale ( CAFAS ; K. Hodges , 1996 ) . YST-II had very limited positive effects , which were moderated by history of multiple suicide attempts , and no negative effects . It result ed in more rapid decreases in suicidal ideation ( SIQ-JR ) for multiple suicide attempters during the initial 6 weeks after hospitalization ( small-to-moderate effect size ) . For nonmultiple attempters , it was associated with greater declines in functional impairment ( CAFAS ) at 3 and 12 months ( small effect sizes ) . YST-II had no effects on suicide attempts and no enduring effects on SIQ-JR scores OBJECTIVE To compare group therapy with routine care in adolescents who had deliberately harmed themselves on at least two occasions within a year . METHOD Single-blind pilot study with two r and omized parallel groups that took place in Manchester , Engl and . Sixty-three adolescents aged 12 through 16 years were r and omly assigned to group therapy and routine care or routine care alone . Outcome data on suicide attempts were obtained without knowledge of treatment allocation on all r and omized cases ( 62/63 by direct interview ) on average 29 weeks later . The primary outcomes were depression and suicidal behavior . RESULTS In intention-to-treat analyses , adolescents who had group therapy were less likely to be " repeaters " at the end of the study ( i.e. , to have repeated deliberate self-harm on two or more further occasions ) than adolescents who had routine care ( 2/32 versus 10/31 ; odds ratio 6.3 ) , but the confidence intervals for this ratio were wide ( 95 % confidence interval 1.4 to 28.7 ) . They were also less likely to use routine care , had better school attendance , and had a lower rate of behavioral disorder than adolescents given routine care alone . The interventions did not differ , however , in their effects on depression or global outcome . CONCLUSIONS Group therapy shows promise as a treatment for adolescents who repeatedly harm themselves , but larger studies are required to assess more accurately the efficacy of this intervention OBJECTIVE To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide . METHOD Adolescents ( N = 124 ) , ages 12 to 18 years , with a 90-day history of suicide attempt , a current diagnosis of depressive disorder ( 96.0 % had major depressive disorder ) , and a Children 's Depression Rating Scale-Revised ( CDRS-R ) score of 36 or higher , entered a 6-month treatment with antidepressant medication , cognitive-behavioral therapy focused on suicide prevention , or their combination ( Comb ) , at five academic sites . Treatment assignment could be either r and om or chosen by study participants . Intent-to-treat , mixed effects regression models of depression and other relevant ratings were estimated . Improvement and remission rates were computed with the last observation carried forward . RESULTS Most patients ( n = 104 or 84 % ) chose treatment assignment , and overall , three fourths ( n = 93 ) received Comb . In Comb , CDRS-R declined from a baseline adjusted mean of 49.6 ( SD 12.3 ) to 38.3 ( 8.0 ) at week 12 and to 27.0 ( 10.1 ) at week 24 ( p < .0001 ) , with a Clinical Global Impression -defined improvement rate of 58.0 % at week 12 and 72.2 % at week 24 and a remission ( CDRS-R ≤ 28 ) rate of 32.5 % at week 12 and 50.0 % at week 24 . The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline ( r = 0.43 , p < .0001 ) and declined in parallel . CONCLUSIONS When vigorously treated with a combination of medication and psychotherapy , adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression BACKG 
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Collapsing across different variations of Cognitive Behavior Therapy ( CBT ) , and classifying Dialectical Behavior Therapy for Adolescents ( DBT-A ) as a type of CBT , CBT is the only intervention with replicated positive impact on reducing self-harm in adolescents .
Conclusion : While the majority of studies were not able to determine efficacy of therapeutic interventions for both primary and secondary outcomes , our systematic review suggests that individual self-driven and socially-driven processes appeared to show the greatest promise for reducing suicide attempts , with benefits of combined self-driven and systems-driven approaches for reducing overall self-harm .