***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: Cognitive therapy and antidepressant medications are effective treatments for depression , but little is known about their relative efficacy in reducing individual depressive symptoms . Using data from a recent clinical trial comparing cognitive therapy , antidepressant medication , and placebo in the treatment of moderate-to-severe depression , we examined whether there was a relative advantage of any treatment in reducing the severity of specific depressive symptom clusters . The sample consisted of 231 depressed out patients r and omly assigned to : cognitive therapy for 16 weeks ( n = 58 ) ; paroxetine treatment for 16 weeks ( n = 116 ) ; or pill placebo for 8 weeks ( n = 57 ) . Differential change in five subsets of depressive symptoms was examined : mood , cognitive/suicide , anxiety , typical-vegetative , and atypical-vegetative symptoms . Medication led to a greater reduction in cognitive/suicide symptoms relative to placebo by 4 weeks , and both active treatments reduced these symptoms more than did placebo by 8 weeks . Cognitive therapy reduced the atypical-vegetative symptoms more than placebo by 8 weeks and more than medications throughout the trial . These findings suggest that medications and cognitive therapy led to different patterns of response to specific symptoms of depression and that the general efficacy of these two well-vali date d treatments may be driven in large part by changes in cognitive or atypical-vegetative symptoms IMPORTANCE In the United States , approximately 1 physician dies by suicide every day . Training physicians are at particularly high risk , with suicidal ideation increasing more than 4-fold during the first 3 months of internship year . Despite this increase , to our knowledge , very few efforts have been made to prevent the escalation of suicidal thoughts among training physicians . OBJECTIVE To assess the effectiveness of a web-based cognitive behavioral therapy ( wCBT ) program delivered prior to the start of internship year in the prevention of suicidal ideation in medical interns . DESIGN , SETTING , AND PARTICIPANTS A r and omized clinical trial conducted at 2 university hospitals with 199 interns from multiple specialties during academic years 2009 - 2010 or 2011 - 2012 . The current study was conducted from May 2009 to June 2010 and May 2011 to June 2012 , and data were analyzed using intent-to-treat principles , including last observation carried forward . INTERVENTIONS Interns were r and omly assigned to 2 study groups ( wCBT and attention-control group [ ACG ] ) , and completed study activities lasting 30 minutes each week for 4 weeks prior to starting internship year . Participants assigned to wCBT completed online CBT modules and those assigned to ACG received emails with general information about depression , suicidal thinking , and local mental health professionals . MAIN OUTCOMES AND MEASURES The Patient Health Question naire-9 was used to assess suicidal ideation ( ie , " thoughts that you would be better off dead or hurting yourself in some way " ) prior to the start of intern year and at 3-month intervals throughout the year . RESULTS A total of 62.2 % of interns ( 199 of 320 ) agreed to take part in the study ; 100 were assigned to the wCBT group and 99 to the ACG . During at least 1 point over the course of internship year , 12 % of interns ( 12 of 100 ) assigned to wCBT endorsed suicidal ideation compared with 21.2 % of interns ( 21 of 99 ) assigned to ACG . After adjusting for covariates identified a priori that have previously shown to increase the risk for suicidal ideation , interns assigned to wCBT were less likely to endorse suicidal ideation during internship year ( relative risk , 0.40 ; 95 % CI , 0.17- 0.91 ; P = .03 ) compared with those assigned to ACG . CONCLUSIONS AND RELEVANCE This study demonstrates that a free , easily accessible , brief wCBT program is associated with reduced likelihood of suicidal ideation among medical interns . Prevention programs with these characteristics could be easily disseminated to medical training programs across the country . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12610000628044 A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Objectives The effect of web-based interventions for depression on  suicide ideation in callers to helplines is not known . The aim of this study was to determine if web-based Cognitive Behaviour Therapy ( CBT ) with and without telephone support is effective in reducing suicide ideation in callers to a helpline compared with treatment as usual ( TAU ) . A secondary aim was to examine the factors that predict change in suicide ideation . Putative predictors included level of baseline depression , suicide behaviour , baseline anxiety and type of intervention . Design R and omised controlled trial . Setting Lifeline , Australia 's 24 h telephone counselling service participants : 155 callers to a national helpline service with moderate-to-high psychological distress . Interventions Participants were recruited and r and omised to receive either 6 weeks of internet CBT plus weekly telephone follow-up ; internet CBT only ; weekly telephone follow-up only or a wait-list TAU control group . Primary and secondary outcome measures Suicidal ideation was measured using four items from the 28-item General Health Question naire . Predictors of change in ideation were tested using logistic regression analysis . Results Regardless of the intervention condition , participants showed significant reductions in suicidal ideation over 12 months ( p<0.001 ) . Higher baseline suicidal behaviour decreased the odds of remission of suicidal ideation at postintervention ( OR 0.409 , p<0.001 ) . However , change in depression over the course of the interventions was associated with improvement in suicide ideation ( OR 1.165 , p<0.001 ) . Conclusions Suicide ideation declines with and without proactive intervention . Improvements in depression are associated with the resolution of suicide ideation . Specific interventions focusing on suicide ideation should be further investigated . Trial registration Controlled-Trials.com IS RCT N93903959 OBJECTIVE The authors evaluated the effectiveness of brief cognitive-behavioral therapy ( CBT ) for the prevention of  suicide attempts in military personnel . METHOD In a r and omized controlled trial , active-duty Army soldiers at Fort Carson , Colo. , who either attempted suicide or experienced suicidal ideation with intent , were r and omly assigned to treatment as usual ( N=76 ) or treatment as usual plus brief CBT ( N=76 ) . Assessment of incidence of suicide attempts during the follow-up period was conducted with the Suicide Attempt Self-Injury Interview . Inclusion criteria were the presence of suicidal ideation with intent to die during the past week and /or a suicide attempt within the past month . Soldiers were excluded if they had a medical or psychiatric condition that would prevent informed consent or participation in outpatient treatment , such as active psychosis or mania . To determine treatment efficacy with regard to incidence and time to suicide attempt , survival curve analyses were conducted . Differences in psychiatric symptoms were evaluated using longitudinal r and om-effects models . RESULTS From baseline to the 24-month follow-up assessment , eight participants in brief CBT ( 13.8 % ) and 18 participants in treatment as usual ( 40.2 % ) made at least one suicide attempt ( hazard ratio=0.38 , 95 % CI=0.16 - 0.87 , number needed to treat=3.88 ) , suggesting that soldiers in brief CBT were approximately 60 % less likely to make a suicide attempt during follow-up than soldiers in treatment as usual . There were no between-group differences in severity of psychiatric symptoms . CONCLUSIONS Brief CBT was effective in preventing follow-up suicide attempts among active-duty military service members with current suicidal ideation and /or a recent suicide attempt BACKGROUND Bereavement following suicide is associated with an increased vulnerability for depression , complicated grief , suicidal ideation , and suicide . There is , however , a paucity of studies of the effects of interventions in suicide survivors . AIMS This study therefore examined the effects of a cognitive behavioral therapy (CBT)-based psychoeducational intervention on depression , complicated grief , and suicide risk factors in suicide survivors . METHOD In total , 83 suicide survivors were r and omized to the intervention or the control condition in a cluster r and omized controlled trial . Primary outcome measures included maladaptive grief reactions , depression , suicidal ideation , and hopelessness . Secondary outcome measures included grief-related cognitions and coping styles . RESULTS There was no significant effect of the intervention on the outcome measures . However , the intensity of symptoms of grief , depressive symptoms , and passive coping styles decreased significantly in the intervention group but not in the control group . CONCLUSION The CBT-based psychoeducational intervention has no significant effect on the development of complicated grief reactions , depression , and suicide risk factors among suicide survivors . The intervention may , however , serve as supportive counseling for suicide survivors BACKGROUND Depression and alcohol misuse are among the most prevalent diagnoses in suicide fatalities . The risk posed by these disorders is exacerbated when they co-occur . Limited research has evaluated the effectiveness of common depression and alcohol treatments for the reduction of suicide vulnerability in individuals experiencing comorbidity . METHODS Participants with depressive symptoms and hazardous alcohol use were selected from two r and omised controlled trials . They had received either a brief ( 1 session ) intervention , or depression-focused cognitive behaviour therapy ( CBT ) , alcohol-focused CBT , therapist-delivered integrated CBT , computer-delivered integrated CBT or person-centred therapy ( PCT ) over a 10-week period . Suicidal ideation , hopelessness , depression severity and alcohol consumption were assessed at baseline and 12-month follow-up . RESULTS Three hundred three participants were assessed at baseline and 12 months . Both suicidal ideation and hopelessness were associated with higher severity of depressive symptoms , but not with alcohol consumption . Suicidal ideation did not improve significantly at follow-up , with no differences between treatment conditions . Improvements in hopelessness differed between treatment conditions ; hopelessness improved more in the CBT conditions compared to PCT and in single-focused CBT compared to integrated CBT . LIMITATIONS Low retention rates may have impacted on the reliability of our findings . Combining data from two studies may have result ed in heterogeneity of sample s between conditions . CONCLUSIONS CBT appears to be associated with reductions in hopelessness in people with co-occurring depression and alcohol misuse , even when it is not the focus of treatment . Less consistent results were observed for suicidal ideation . Establishing specific procedures or therapeutic content for clinicians to monitor these outcomes may result in better management of individuals with higher vulnerability for suicide BACKGROUND The World Health Organisation SUicide PREvention-Multisite Intervention Study on Suicide ( WHO/SUPRE-MISS ) investigates suicidal behaviours in a number of nations . The feasibility of the different branches of the study was piloted in Queensl and , Australia . This paper reports on the community survey component . METHOD  R and omised telephone interviews ( n=11,572 ) were conducted to determine the lifetime prevalence of suicidal ideation and attempts , and corresponding socio-demographic and cultural characteristics . A subsequent postal survey sent to consenting individuals reporting lifetime suicide ideation/attempt ( n=1311 ) was meant to ascertain the possible development of that behaviour along a continuum , psychiatric and psychological factors , suicidal transmission , help-seeking , and service utilisation . RESULTS Suicide ideation and attempts prevailed in individuals aged 25 - 44 years , and declined with increasing age . In most cases , suicidal experience/s did not develop over time with progressively increasing severity . Knowledge of someone else 's suicidal behaviour significantly increased the risk of similar acts . Almost half of the subjects contended with their suicidal crisis by over-drinking alcohol , and 1/3 through other forms of reckless behaviour . The ratio completed/attempted suicide was 1 to 23 . Less than 30 % of subjects went to the hospital after their suicidal behaviour , and treatment received and staff attitudes were rated less favourably than that of General Practitioners . CONCLUSIONS This survey provides a reliable picture of suicide ideation and behaviour in the general population . Information on the development of suicidal process , recklessness , and help-seeking attitudes may be valuable for future prevention strategies The outcome of a r and omized controlled trial of cognitive behavior therapy in addition to treatment as usual ( CBT plus TAU ) compared with TAU alone ( TAU ) in one hundred and six participants meeting diagnostic criteria for borderline personality disorder is described . We anticipated that CBT plus TAU would decrease the number of participants with  in 
    Output:
    
There was a statistically significant , small to medium effect for face-to-face delivered CBT in reducing suicidal ideation and behaviour although there was significant heterogeneity between the included studies .