***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: The long-term effectiveness of a structured health education program ( HEP ) for spouses and frail older adults was evaluated in a staff model health maintenance organization ( HMO ) . HEP is a multicomponent group program that includes emotion-focused and problem-focused coping strategies , education , and support . For caregivers , HEP was more effective than usual care ( UC ) in reducing depression , increasing knowledge of community services and how to access them , and changing caregivers ' feelings of competence and the way they respond to the caregiving situation . For care recipients , HEP was more effective than UC in preventing increases in somatic symptoms and symptoms of anxiety/insomnia . ( ( c ) 2004 APA , all rights reserved Abstract Objective To evaluate the efficacy of two internet interventions for community-dwelling individuals with symptoms of depression — a psychoeducation website offering information about depression and an interactive website offering cognitive behaviour therapy . Design R and omised controlled trial . Setting Internet users in the community , in Canberra , Australia . Participants 525 individuals with increased depressive symptoms recruited by survey and r and omly allocated to a website offering information about depression ( n = 166 ) or a cognitive behaviour therapy website ( n = 182 ) , or a control intervention using an attention placebo ( n = 178 ) . Main outcome measures Change in depression , dysfunctional thoughts ; knowledge of medical , psychological , and lifestyle treatments ; and knowledge of cognitive behaviour therapy . Results Intention to treat analyses indicated that information about depression and interventions that used cognitive behaviour therapy and were delivered via the internet were more effective than a credible control intervention in reducing symptoms of depression in a community sample . For the intervention that delivered cognitive behaviour therapy the reduction in score on the depression scale of the Center for Epidemiologic Studies was 3.2 ( 95 % confidence interval 0.9 to 5.4 ) . For the “ depression literacy ” site ( BluePages ) , the reduction was 3.0 ( 95 % confidence interval 0.6 to 5.2 ) . Cognitive behaviour therapy ( MoodGYM )  reduced dysfunctional thinking and increased knowledge of cognitive behaviour therapy . Depression literacy ( BluePages ) significantly improved participants ' underst and ing of effective evidence based treatments for depression ( P < 0.05 ) . Conclusions Both cognitive behaviour therapy and psychoeducation delivered via the internet are effective in reducing symptoms of depression Abstract Objectives : To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness , symptoms , and subjective function . Design : A pragmatic multicentre r and omised controlled trial , stratified by centre . Setting : Nine urban and rural communities in Finl and , Republic of Irel and , Norway , Spain , and the United Kingdom . Participants : 452 participants aged 18 to 65 , identified through a community survey with depressive or adjustment disorders according to the international classification of diseases , 10th revision or Diagnostic and Statistical Manual of Mental Disorders , fourth edition . Interventions : Six individual sessions of problem solving treatment ( n=128 ) , eight group sessions of the course on prevention of depression ( n=108 ) , and controls ( n=189 ) . Main outcome measures : Completion rates for each intervention , diagnosis of depression , and depressive symptoms and subjective function . Results : 63 % of participants assigned to problem solving and 44 % assigned to prevention of depression completed their intervention . The proportion of problem solving participants depressed at six months was 17 % less than that for controls , giving a number needed to treat of 6 ; the mean difference in Beck depression inventory score was −2.63 ( 95 % confidence interval −4.95 to −0.32 ) , and there were significant improvements in SF-36 scores . For depression prevention , the difference in proportions of depressed participants was 14 % ( number needed to treat of 7 ) ; the mean difference in Beck depression inventory score was −1.50 ( −4.16 to 1.17 ) , and there were significant improvements in SF-36 scores . Such differences were not observed at 12 months . Neither specific diagnosis nor treatment with antidepressants affected outcome . Conclusions : When offered to adults with depressive disorders in the community , problem solving treatment was more acceptable than the course on prevention of depression . Both interventions reduced caseness and improved subjective function Background .Depression is common in primary care , but rates of adequate care are low . Little is known about the role of patient treatment preferences in encouraging entry into care . Objectives .To examine whether a primary care based depression quality improvement ( QI ) intervention design ed to accommo date patient and provider treatment choice increases the likelihood that patients enter depression treatment and receive preferred treatment . Methods .In 46 primary care clinics , patients with current depressive symptoms and either lifetime or current depressive disorder were identified through screening .  Treatment preferences , patient characteristics , and use of depression treatments were assessed at baseline and 6 months by patient self-report . Matched clinics were r and omized to usual care ( UC ) or 1 of 2 QI interventions . Data were analyzed using logistic regression models . Results .For patients not in care at baseline , the QI interventions increased rates of entry into depression treatment compared with usual care ( adjusted percentage : 50.0 % ± 5.3 and 33.0 % ± 4.9 for interventions vs. 15.9 % ± 3.6 for usual care ; F = 12.973 , P < 0.0001 ) . Patients in intervention clinics were more likely to get treatments they preferred compared with those in usual care ( adjusted percentage : 54.2 % ± 3.3 and 50.7 % ± 3.1 for interventions vs. 40.5 % ± 3.1 for usual care ; F = 6.034 , P < 0.003 ) ; however , in all clinics less than half of patients preferring counseling reported receiving it . Conclusions .QI interventions that support patient choice can improve the likelihood of patients receiving preferred treatments . Patient treatment preference appears to be related to likelihood of entering depression treatment , and patients preferring counseling may require additional interventions to enhance entry into treatment BACKGROUND Many people who are depressed do not receive any professional help and their beliefs about the helpfulness of treatment do not always correspond with those of health professionals . To facilitate choices about treatment , the present study examined the effects of providing depressed people in the community with evidence on whether various treatment options work . METHOD A r and omized controlled trial was carried out with 1094 persons selected at r and om from the community who screened positive for depressive symptoms and agreed to participate . Participants were mailed either an evidence -based consumer guide to treatments for depression or , as a control , a general brochure on depression . Outcomes were the rated usefulness of the information provided , changes in attitudes to depression treatments , actions taken to reduce depression , and changes in depressive symptoms , anxiety symptoms and disability . RESULTS Participants rated the evidence -based consumer guide as more useful than the control brochure . Attitudes to some treatments changed . Improvements in symptoms and disability did not differ significantly between interventions . CONCLUSION Providing people who are depressed with evidence on which treatments work produces some changes in attitudes and behaviour . However , this intervention may need to be enhanced if it is to produce symptom change The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden . Another rural district in the same region served as a control area . A 20-item question naire measuring attitudes towards end-of-life care was design ed , and the Hospital Anxiety and Depression ( HAD ) scale was used to measure mental well being . Increased agreement to 18 of 20 attitude statements was seen in the education group , while 2 of 20 items showed a decreased agreement in the control group . Test retest reliability of the 20-item question naire was good ( r = 0.92 ) . The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group ( 95 % CI=2.1– 3.7 ; P<0.001 ) , and was 6.8 for both years in the control group . Our study shows that a comprehensive educational programme not only improved attitudes towards end-of-life care , but also the mental well being of the home care staff 
    Output:
    
The primary outcome measure was significant improvement on the key depression measure .
Results Components which were found to significantly predict improvement were the revision of professional roles , the provision of a case manager who provided direct feedback and delivered a psychological therapy , and an intervention that incorporated patient preferences into care .
Nurse , psychologist and psychiatrist delivered care were effective , but pharmacist delivery was not .
Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention .
Community interventions were effective .
Conclusion Case management is important in the provision of care in general practice .
Certain community models of care ( education programs ) have potential while others are not successful in their current form ( pharmacist monitoring )