***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 one of the most disabling diseases , and causes a significant burden both to the individual and to society . WHO data suggests that depression causes 6 % of the burden of all diseases in Europe in terms of disability adjusted life years ( DALYs ) . Yet , the knowledge of the economic impact of depression has been relatively little research ed in Europe . AIMS OF THE STUDY The present study aims at estimating the total cost of depression  in Europe based on published epidemiologic and economic evidence . METHODS A model was developed to combine epidemiological and economic data on depression in Europe to estimate the cost . The model was populated with data collected from extensive literature review s of the epidemiology and economic burden of depression in Europe . The cost data was calculated as annual cost per patient , and epidemiologic data was reported as 12-month prevalence estimates . National and international statistics for the model were retrieved from the OECD and Eurostat data bases . The aggregated annual cost estimates were presented in Euro for 2004 . RESULTS In 28 countries with a population of 466 million , at least 21 million were affected by depression . The total annual cost of depression in Europe was estimated at Euro 118 billion in 2004 , which corresponds to a cost of Euro 253 per inhabitant . Direct costs alone totalled dollar 42 billion , comprised of outpatient care ( Euro 22 billion ) , drug cost ( Euro 9 billion ) and hospitalization ( Euro 10 billion ) . Indirect costs due to morbidity and mortality were estimated at Euro 76 billion . This makes depression the most costly brain disorder in Europe , accounting for 33 % of the total cost . The cost of depression corresponds to 1 % of the total economy of Europe ( GDP ) . DISCUSSION Our cost results are in good agreement with previous research findings . The cost estimates in the present study are based on model simulations for countries where no data was available . The predictability of our model is limited to the accuracy of the input data employed . As there is no earlier cost-of-illness study conducted on depression in Europe , it is , however , difficult to evaluate the validity of our results for individual countries and thus further research is needed . CONCLUSION The cost of depression poses a significant economic burden to European society . The simulation model employed shows good predictability of the cost of depression in Europe and is a novel approach to estimate the cost-of-illness in Europe . IMPLICATION S FOR HEALTH CARE PROVISION AND POLICIES : Health and social care policy and commissioning must be evidence -based . The empirical results from this study confirm previous findings , that depression is a major concern to the economic welfare in Europe which has consequences to both healthcare providers and policy makers . One important way to stop this explosion in cost is through increased research efforts in the field . Moreover , better detection , prevention , treatment and patient management are imperatives to reduce the burden of depression and its costs . Mental healthcare policies and better access to healthcare for mentally ill are other challenges to improve for Europe . IMPLICATION S FOR FURTHER RESEARCH This study has identified several research gaps which are of interest for future research . In order to better underst and the impact of depression to European society long-term prospect i ve epidemiology and cost-of-illness studies are needed . In particular data is lacking for Central European countries . On the basis of our findings , further economic evaluations of treatments for depression are necessary in order to ensure a cost-effective use of European healthcare budgets 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 AIMS The purpose of this r and omized controlled clinical trial was to examine the effects of three couples-focused interventions and a control condition on women and men 's resolution of depression and grief during the first year after miscarriage . METHODS Three hundred forty-one couples were r and omly assigned to nurse caring ( NC ) ( three counseling sessions ) , self-caring ( SC ) ( three video and workbook modules ) , combined caring ( CC ) ( one counseling session plus three SC modules ) , or control ( no treatment ) . Interventions , based on Swanson 's Caring Theory and Meaning of Miscarriage Model , were offered 1 , 5 , and 11 weeks after enrollment . Outcomes included depression ( CES-D ) and grief , pure grief ( PG ) and grief-related emotions ( GRE ) . Differences in rates of recovery were estimated via multilevel modeling conducted in a Bayesian framework . RESULTS Bayesian odds ( BO ) ranging from 3.0 to 7.9 favored NC over all other conditions for accelerating women 's resolution of depression . BO of 3.2 - 6.6 favored NC and no treatment over SC and CC for resolving men 's depression . BO of 3.1 - 7.0 favored all three interventions over no treatment for accelerating women 's PG resolution , and BO of 18.7 - 22.6 favored NC and CC over SC or no treatment for resolving men 's PG . BO ranging from 2.4 to 6.1 favored NC and SC over CC or no treatment for hastening women 's resolution of GRE . BO from 3.5 to 17.9 favored NC , CC , and control over SC for resolving men 's GRE . CONCLUSIONS NC had the overall broadest positive impact on couples ' resolution of grief and depression . In addition , grief resolution ( PG and GRE ) was accelerated by SC for women and CC for men 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 Abstract Objectives . This 2013 up date of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry ( WFSBP ) . The goal has been to systematic ally review all available evidence pertaining to the treatment of unipolar depressive disorders , and to produce a series of practice recommendations that are clinical ly and scientifically meaningful based on the available evidence . The guidelines are intended for use by all physicians seeing and treating patients with these conditions . Methods . The 2013 up date was conducted by a systematic up date literature search and appraisal . All recommendations were approved by the Guidelines Task Force . Results . This first part of the guidelines ( Part 1 ) covers disease definition , classification , epidemiology , and course of unipolar depressive disorders , as well as the management of the acute and continuation phase treatment . It is primarily concerned with the biological treatment ( including antidepressants , other psychopharmacological medications , electroconvulsive therapy , light therapy , adjunctive and novel therapeutic strategies ) of adults . Conclusions . To date , there is a variety of evidence -based antidepressant treatment options available . Nevertheless there is still a substantial proportion of patients not achieving full remission . In addition , somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated . Therefore , further high- quality informative r and omized controlled trials are urgently needed To examine the efficacy of a couples treatment approach for promoting recovery from a recently disclosed affair , 89 couples that disclosed an affair by one of the partners in the past 6 months were r and omly assigned to treatment ( n = 46 ) or to a control group that waited about 3 months for treatment ( n = 43 ) . The couples completed  self-report measures ( Beck Depression Inventory , Impact of Event Scale-Revised , Partnership Question naire )  at pre- and post-treatment . Since about half of the couples dropped out for various reasons ( e.g. , ongoing affair , separation ) , we used multiple imputations to h and le the missing data problem . We analyzed the dyadic data with hierarchical linear modeling in a two-level model . Significant improvements on scores of anxiety corresponded with large effect sizes for both partners . Yet significant improvements on depression scores were only found for the unfaithful partner with moderate effect size . Results suggest that the treatment can improve individual complaints , but not relationship satisfaction in a sufficient amount for both partners . Hence , future research should address how this intervention could encourage couples to maintain therapy , and how they might achieve more and sustained improvement in relationship satisfaction 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 . 
    Output:
    
On average , participants had moderate depression  , preventing the extension of results to severely depressed patients .
The results were weakened by the low quality of evidence related to the effects on depressive symptoms , in comparison with individual psychotherapy , and by very low quality evidence for all other comparisons and for the effects on relationship distress .
Heterogeneity was , in particular , a problem for data about relationship distress .
Future trials of high quality should test in large sample s with a long follow-up of the effects of couple therapy in comparison to other interventions in discordant couples with a depressed partner , considering the role of relationship quality as a potential effect mediator in the improvement of depression