***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 Depressed patients are often characterised by marital distress , but few studies investigate the effects of marital therapy on depressed mood and relationship dysfunction . METHOD Twenty-seven depressed patients experiencing marital distress were r and omly assigned to either individual behavioural-cognitive therapy or marital therapy . The individual treatment condition focused on depressed mood , behavioural activity and dysfunctional cognitions , whereas in the marital condition the partner was involved in the treatment and the focus was on the communication process in the marital relationship . MANOVAs revealed that treatment led to statistically significant improvements in depressed mood , behavioural activity and dysfunctional cognitions , an increase in relationship satisfaction and improvement of communication in patients and spouses . A significant interaction effect was found , showing that marital therapy had more impact on relationship variables than the individual treatment . CONCLUSION Both individual cognitive-behaviour therapy and marital therapy lead to less depressive complaints , and both treatment conditions have a positive effect on the relationship , although the effect on the relationship is significantly stronger in couples who were tested by marital therapy compared with patients who were treated individually Twenty-three non-maritally distressed depressed patients who were married or cohabitating were r and omly assigned to either individual behavioral-cognitive therapy or spouse-aided treatment . Both treatment conditions focused on depressed mood , behavioral activity , and dysfunctional cognitions , the difference being that in the spouse-aided treatment the partner was involved in all aspects of treatment , whereas in the individual condition the partner was not involved . MANOVAs revealed that treatment led to statistically significant improvement on depressed mood , behavioral activity , and dysfunctional cognitions . Treatment did not affect relationship variables ( marital satisfaction , communication , and expressed emotion ) for both spouses . Spouse-aided therapy was as effective as individual cognitive-behavior therapy Objective : To examine the relationship between remission of psychiatric disorders  and age . Methods : We interviewed 3258 r and omly selected adult residents of Edmonton using the Diagnostic Interview Schedule ( DIS ) , which yielded DIS/DSM-III diagnoses . Remission was defined as being free of symptoms of the index lifetime disorder in the year preceding the interview , this being the difference between the lifetime and one-year prevalence . For each age group , the proportion of cases with and without symptoms in the preceding year was calculated . Numbers and proportions of cases were estimated after adjusting to the census population and weighting for household size . Only the more common disorders were examined ; any comorbidities were ignored . Results : Drug abuse or dependence , antisocial personality disorder ( in both sexes ) , and alcohol abuse or dependence ( in men ) all showed remission rates that increased with age . Panic disorder and obsessive – compulsive disorder ( OCD ) showed a decreased likelihood of remission with increasing age . Major depression and phobias showed little tendency to remission with age . Considering all disorders together , the one-year remission rate for all ages combined was only 33.2 % , with a tendency for lower remission rates to be found in those aged 55 to 64 . Conclusions : As may be expected , antisocial personality , drug abuse or dependence , and alcohol abuse or dependence tend to show increased remission rates with increasing age . In OCD and panic disorder , the low rates of remission found in all age groups indicate that these disorders produce significant long-term morbidity . For depression , which had an overall remission rate of less than 50 % , the stable low rate of remission probably indicates not only the difficulties of treatment but also the low rates at which cases get treated The clinical significance of research findings is an important issue that , until recently , was often neglected . Statistical methods are available , however , to evaluate the meaningfulness of pre- to post-treatment change . The clinical significance of the National Institute of Mental Health Treatment of Depression Collaborative Research Program Data was evaluated . A substantial number of clients receiving treatment for depression  made reliable improvements and had posttreatment scores that fell within a functional distribution . A small number of clients reliably deteriorated despite undergoing 12 sessions of treatment . No differences in clinical significance rates among treatment groups existed for measures of depressive symptoms . Treatments differed in terms of clinical significance on a measure of general symptom severity . There was substantial agreement among diverse methods of measurement regarding the identification of individuals making clinical ly significant change Historically , depression was explained and treated intrapsychically and /or biochemically . In the 1970s theoretical propositions and treatment applications began to appear that offered that depression should be viewed cognitively ( Beck 1963 , 1974 ; Beck et al. 1979 ) or interpersonally ( Coyne 1976a , 1976b ; Klerman et al. 1984 ) . Simultaneously , though more sporadically , marital interventions started to attract interest ( Feldman 1976 ; Friedman 1975 ) . The cognitive and interpersonal trends of thinking stimulated research ers to investigate the efficacy of these therapeutic modalities and to compare them with each other . Interest in these two treatments peaked with the publication of the study that emerged from the National Institute of Mental Health ( NIMH ) Treatment of Depression Collaborative Research Program ( Elkin et al. 1989 ) . This well-known research found that the two  psychotherapies  were similarly effective , but that the  interpersonal  approach was slightly more successful with more severely depressed patients BACKGROUND Relapse of depression is associated with a criticising attitude of the patient 's partner . AIMS To compare the relative efficacy and cost of  couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner . METHOD A r and omised controlled trial of antidepressant drugs v. couple therapy .  The subjects were 77 people meeting criteria for depression living with a critical partner . RESULTS Drop-outs were 56.8 % [ corrected ] from drug treatment and 15 % from couple therapy . Subjects ' depression improved in both groups , but couple therapy showed a significant advantage , according to the Beck Depression Inventory , both at the end of treatment and after a second year off treatment . Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments . CONCLUSIONS For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious , if not more so , both in the treatment and maintenance phases . It is no more expensive overall This study investigated the effects of behavioral couple therapy , cognitive-behavioral therapy , and their combination on female depression 6 and 12 months after therapy ended . We predicted that couples receiving a behavioral couple treatment would be less likely to relapse than those receiving a cognitive-behavioral treatment for the depressed spouse alone . Relapse rates , however , did not discriminate between treatments at any follow-up point . Reductions in husb and and wife dysphoria and increases in wife facilitative behavior during therapy predicted recovery . Moreover , high rates of husb and s ' facilitative behavior at posttest were associated with wife recovery and predicted low levels of depression at the 1-year follow-up Abstract Objectives : To compare the efficacy of antidepressant drugs and generic counselling for treating mild to moderate depression in general practice . To determine whether the outcomes were similar for patients with r and omly allocated treatment and those expressing a treatment preference . Design : R and omised controlled trial , with patient preference arms . Follow up at 8 weeks and 12 months and abstract ion of GP case notes . Setting : 31 general practice s in Trent region . Participants : Patients aged 18–70 who met research diagnostic criteria for major depression ; 103 patients were r and omised and 220 patients were recruited to the preference arms . Main outcome measures : Difference in mean Beck depression inventory score ; time to remission ; global outcome assessed by a psychiatrist using all data sources ; and research diagnostic criteria . Results : At 12 months there was no difference between the mean Beck scores in the r and omised arms . Combining the r and omised and patient preference groups , the difference in Beck scores was 0.4 ( 95 % confidence interval −2.7 to 3.5 ) . Patients choosing counselling did better than those r and omised to it ( mean difference in Beck score 4.6 , 0.0 to 9.2 ) . There was no difference in the psychiatrist 's overall assessment of outcome between any of the groups . 221/265 ( 83 % ) of participants with a known outcome had a remission . Median time to remission was shorter in the group r and omised to antidepressants than the other three groups ( 2 months v 3 months ) . 33/221 ( 15 % ) patients had a relapse . Conclusions : Generic counselling seems to be as effective as antidepressant treatment for mild to moderate depressive illness , although patients receiving antidepressants may recover more quickly . General practitioners should allow patients to have their preferred treatment . What is already known on this topic Antidepressants and specific psychological interventions are effective in major depression . Generic counselling has not previously been compared with antidepressants in primary care What this study adds 12 months after starting treatment , generic counselling is as effective as antidepressants Patients treated with antidepressants may recover more quickly Given a choice , more patients opt for counselling Patients who choose counselling may benefit more than those with no strong OBJECTIVE The recurrence of an affective disorder in people who initially recover from major depressive disorder was characterized by using the unique longitudinal prospect i ve follow-up data from the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression- Clinical Studies . METHOD Up to 15 years of prospect i ve follow-up data on the course of major depressive disorder were available for 380 subjects who recovered from an index episode of major depressive disorder and for 105 subjects who subsequently remained well for at least 5 years after recovery . Baseline demographic and clinical characteristics were examined as predictors of recurrence of an affective disorder . The authors also examined naturalistically applied antidepressant therapy . RESULTS A cumulative proportion of 85 % ( Kaplan-Meier estimate ) of the 380 recovered subjects experienced a recurrence , as did 58 % ( Kaplan-Meier estimate ) of those who remained well for at least 5 years . Female sex , a longer depressive episode before intake , more prior episodes , and never marrying were significant predictors of a recurrence . None of these or any other characteristic persisted as a predictor of recurrence in subjects who recovered and were subsequently well for at least 5 years . Subjects reported receiving low levels of antidepressant treatment during the index episode , which further decreased in amount and extent during the well interval . CONCLUSIONS Few baseline demographic or clinical characteristics predict who will or will not experience a recurrence of an affective disorder after recovery from an index episode of major depressive disorder , even in persons with lengthy well intervals . Naturalistically applied levels of antidepressant treatment are well below those shown effective in maintenance pharmacotherapy studies Assessing the quality of r and omized controlled trials ( RCTs ) is important and relatively new . Quality gives us an estimate of the likelihood that the results are a valid estimate of the truth . We present an annotated bibliography of scales and checklists developed to assess quality . Twenty-five scales and nine checklists have been developed to assess quality . The checklists are most useful in providing investigators with guidelines as to what information should be included in reporting RCTs . The scales give readers a quantitative index of the likelihood that the reported methodology and results are free of bias . There are several shortcomings with these scales . Future scale development is likely to be most beneficial if questions common to all trials are assessed , if the scale is easy to use , and if it is developed with sufficient rigor Comparative effects of the antidepressant drug , amitriptyline hydrochloride , marital therapy , and the drug-psychotherapy interaction effects were studied in a 12-week course of treatment of outpatient depressives . Patients were assigned r and omly to four treatment groups , in a 2 times 2 factorial design : ( 1 ) drug-marital therapy ; ( 2 ) drug-minimal contact ; ( 3 ) placebo-marital therapy ; and ( 4 ) placebo-minimal contact . Both drug and marital therapy showed substantial beneficial advantages over their control conditions , but drug therapy was faster and generally superior in symptom relief and clinical improvement . Marital therapy was superior in family role task performance and perception of the marital relationship . For reducing hostility and enhancing the perception of the marital relationship , drug therapy had a better early effect , but marital therapy had superior effects by the end of treatment Long-term beta blockade for perhaps a year or so following discharge after an MI is now of proven value , and for many such patients mortality reductions of about 25 % can be achieved . No important differences are clearly apparent among the benefits of different beta blockers , although some are more convenient than others ( or have slightly fewer side effects ) , and it appears that those with appreciable intrinsic sympathomimetic activity may confer less benefit . If monitored , the side effects of long-term therapy are not a major problem , as when they occur they are easily reversible by changing the beta blocker or by discontinuation of treatment . By contrast , although very early IV short-term beta blockade can definitely limit infa rct size , more reliable information about the effects of such treatment on mortality will not be available until a large trial ( ISIS ) reports later this year , with data on some thous and s of patients entered within less than 4 hours of the onset of pain . Our aim has been not only to review the 65-odd r and omized beta blocker trials but also to demonstrate that when many r and omized trials have all applied one general approach to treatment , it is often not appropriate to base inference on individual trial results . Although there will usually be important differences from one trial to another ( in eligibility , treatment , end-point assessment , and so on ) , physicians who wish to decide whether to adopt a particular treatment policy should try to make their decision in the light of an overview of all these related r and omized trials and not just a few particular trial results . Although most trials are too small to be individually reliable , this defect of size may be rectified by an overview of many trials , as long as appropriate statistical methods are used . Fortun 
    Output:
    
There is no evidence to suggest that marital therapy is more or less effective than individual psychotherapy or drug therapy in the treatment of depression .
Improvement of relations in distressed couples might be expected from marital therapy .