***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: Traumatic stress due to conflict and war causes major mental health problems in many re source -poor countries . The objective of this study was to examine whether trained lay counselors can carry out effective treatment of  posttraumatic stress disorder ( PTSD )  in a refugee settlement . In a r and omized controlled dissemination trial in Ug and a with 277 Rw and an and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors . Strictly manualized narrative exposure therapy ( NET ) was compared with more flexible trauma counseling ( TC ) and a no-treatment monitoring group ( MG ) . Fewer participants ( 4 % ) dropped out of NET treatment than TC ( 21 % ) . Both active treatment groups were statistically and clinical ly superior to MG on PTSD symptoms and physical health but did not differ from each other . At follow-up , a PTSD diagnosis could not be established anymore in 70 % of NET and 65 % TC participants , whereas only 37 % in MG did not meet PTSD criteria anymore . Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement Background Despite harmful drinking causing a significant burden on global health , there is a large treatment gap , especially in low‐ and middle‐income countries . A major barrier to care is the lack of adequately skilled human re sources to deliver context ually appropriate treatments . This paper describes the systematic process used to develop Counselling for Alcohol Problems ( CAP ) , a brief psychological treatment ( PT ) for delivery by lay counselors in routine primary care setting s to men with harmful drinking in India . Methods CAP was developed using a methodology involving 3 sequential steps : ( i ) identifying potential treatment strategies ; ( ii ) developing a theoretical framework for the treatment ; and ( iii ) evaluating the acceptability and feasibility of the treatment . Results CAP is a 3‐phase treatment delivered over 1 to 4 sessions based on a motivational interviewing ( MI ) stance and involves the following strategies : assessment and personalized feedback , family engagement , drink refusal skills , skills to address drinking urges , problem‐solving skills and h and ling difficult emotions , and relapse prevention and management . Data from a case series were used to inform several adaptations to enhance the acceptability of CAP to the recipients and feasibility of delivery by lay counselors of the treatment , for example expansion of the target group to include alcohol‐dependent patients and the extension of the delivery setting s to include home‐based delivery . There was preliminary evidence of the effectiveness of CAP . Conclusions CAP is an acceptable brief PT for harmful drinking delivered by lay counselors in primary care whose effectiveness is currently being tested in a r and omized controlled trial based in primary care in Goa , India CONTEXT Despite the importance of mental illness in Africa , few controlled intervention trials related to this problem have been published . OBJECTIVES To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa . DESIGN , SETTING , AND PARTICIPANTS For this cluster r and omized , controlled clinical trial ( February-June 2002 ) , 30 villages in the Masaka and Rakai districts of rural Ug and a were selected using a r and om procedure ; 15 were then r and omly assigned for study ing men and 15 for women . In each village , adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function . Based on these interviews , lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) criteria for major depression or subsyndromal depression . Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village , totaling 284 . Of these , 248 agreed to be in the trial and 9 refused ; the remainder died or relocated . A total of 108 men and 116 women completed the study and were reinterviewed . INTERVENTION Eight of the 15 male villages and 7 of the 15 female villages were r and omly assigned to the intervention arm and the remainder to the control arm . The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks . MAIN OUTCOME MEASURES Depression and dysfunction severity scores on scales adapted and vali date d for local use ; proportion of persons meeting DSM-IV major depression diagnostic criteria . RESULTS Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls ( P<.001 ) . Mean reduction in dysfunction was 8.08 and 3.76 points , respectively ( P<.001 ) . After intervention , 6.5 % and 54.7 % of the intervention and control groups , respectively , met the criteria for major depression ( P<.001 ) compared with 86 % and 94 % , respectively , prior to intervention ( P = .04 ) . The odds of postintervention depression among controls was 17.31 ( 95 % confidence interval , 7.63 - 39.27 ) compared with the odds among intervention groups . Results from intention-to-treat analyses remained statistically significant . CONCLUSIONS Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction . A clinical trial proved feasible in the local setting . Both findings should encourage similar trials in similar setting s in Africa and beyond Background Experiencing systematic violence and trauma increases the risk of poor mental health outcomes ; few interventions for these types of exposures have been evaluated in low re source context s. The objective of this r and omized controlled trial was to assess the effectiveness of two psychotherapeutic interventions , Behavioral Activation Treatment for Depression ( BATD ) and Cognitive Processing Therapy ( CPT ) , in reducing depression symptoms using a locally adapted and vali date d version of the Hopkins Symptom Checklist and dysfunction measured with a locally developed scale . Secondary outcomes included posttraumatic stress , anxiety , and traumatic grief symptoms . Methods Twenty community mental health workers , working in rural health clinics , were r and omly assigned to training in one of the two interventions . The community mental health workers conducted baseline assessment s , enrolled survivors of systematic violence based on severity of depression symptoms , and r and omly assigned them to treatment or waitlist-control . Blinded community mental health workers conducted post-intervention assessment s on average five months later . Results Adult survivors of systematic violence were screened ( N = 732 ) with 281 enrolled in the trial ; 215 r and omized to an intervention ( 114 to BATD ; 101 to CPT ) and 66 to waitlist-control ( 33 to BATD ; 33 to CPT ) . Nearly 70 % ( n = 149 ) of the intervention participants completed treatment and post-intervention assessment s ; 53 ( 80 % ) waitlist-controls completed post-intervention assessment s. Estimated effect sizes for depression and dysfunction were 0.60 and 0.55 respectively , comparing BATD participants to all controls and 0.84 and 0.79 respectively , compared to BATD controls only . Estimated effect sizes for depression and dysfunction were 0.70 and 0.90 respectively comparing CPT participants to all controls and 0.44 and 0.63 respectively compared to CPT controls only . Using a permutation-based hypothesis test that is robust to the model assumptions implicit in regression models , BATD had significant effects on depression ( p = .003 ) and dysfunction ( p = .007 ) , while CPT had a significant effect on dysfunction only ( p = .004 ) . Conclusions Both interventions showed moderate to strong effects on most outcomes . This study demonstrates effectiveness of these interventions in low re source environments by mental health workers with limited prior experience . Trial Registration Clinical Trials . Gov NCT00925262 . Registered June 3 , 2009 In a r and omized controlled trial , Paul Bolton and colleagues investigate whether a transdiagnostic community-based intervention is effective for improving mental health symptoms among Burmese refugees in Thail and . Please see later in the article for the Editors ' BACKGROUND In situations of ongoing violence , childhood psychosocial and mental health problems require care . However , re sources and evidence for adequate interventions are scarce for children in low- and middle-income countries . This study evaluated a school-based psychosocial intervention in conflict-affected , rural Nepal . METHODS A cluster r and omized controlled trial was used to evaluate changes on a range of indicators , including psychiatric symptoms ( depression , anxiety , posttraumatic stress disorder ) , psychological difficulties , resilience indicators ( hope , prosocial behavior ) and function impairment .  Children ( n = 325 ) ( mean age = 12.7 , SD = 1.04 , range 11 - 14 years ) with elevated psychosocial distress were allocated to a treatment or waitlist group . RESULTS Comparisons of crude change scores showed significant between-group differences on several outcome indicators , with moderate effect sizes ( Cohen d = .41 to .58 ) . After correcting for nested variance within schools , no evidence for treatment effects was found on any outcome variable . Additional analyses showed gender effects for treatment on prosocial behavior ( mean change difference : 2.70 ; 95 % CI , .97 to 4.44 ) , psychological difficulties ( -2.19 ; 95 % CI , -3.82 to -.56 ) , and aggression ( -4.42 ; 95 % CI , -6.16 to -2.67 ) . An age effect for treatment was found for hope ( .90 ; 95 % CI , -1.54 to -.26 ) . CONCLUSIONS A school-based psychosocial intervention demonstrated moderate short-term beneficial effects for improving social-behavioral and resilience indicators among subgroups of children exposed to armed conflict . The intervention reduced psychological difficulties and aggression among boys , increased prosocial behavior among girls , and increased hope for older children . The intervention did not result in reduction of psychiatric symptoms To determine whether a Nurse-Community Health Worker ( CHW ) home visiting team , in the context of a Medicaid enhanced prenatal/postnatal services ( EPS ) , would demonstrate greater reduction of depressive symptoms and stress and improvement of psychosocial re sources ( mastery , self-esteem , social support ) when compared with usual Community Care ( CC ) that includes Medicaid EPS delivered by professionals . Greatest program benefits were expected for women who reported low psychosocial re sources , high stress , or both at the time of enrollment . Medicaid eligible pregnant women ( N = 613 ) were r and omly assigned to either usual CC or the Nurse-CHW team . Mixed effects regression was used to analyze up to five prenatal and postnatal psychosocial assessment s. Compared to usual CC , assignment to the Nurse-CHW team result ed in significantly fewer depressive symptoms , and as hypothesized , reductions in depressive symptoms were most pronounced for women with low psychosocial re sources , high stress , or both high stress and low re sources . Outcomes for mastery and stress approached statistical significance , with the women in the Nurse-CHW group reporting less stress and greater mastery . Women in the Nurse-CHW group with low psychosocial re sources reported significantly less perceived stress than women in usual CC . No differences between the groups were found for self-esteem and social support . A Nurse-CHW team approach to EPS demonstrated advantage for alleviating depressive symptoms in Medicaid eligible women compared to CC , especially for women at higher risk Two-thirds of those with HIV worldwide live in sub-Saharan Africa . Alcohol use is associated with the HIV epidemic through risky sex and suboptimal ARV adherence . In western Kenya , hazardous drinking was reported by HIV ( 53 % ) and general medicine ( 68 % ) out patients .  Cognitive behavioral treatment ( CBT ) has demonstrated strong efficacy to reduce alcohol use . This article reports on a systematic cultural adaptation and pilot feasibility study of group paraprofessional-delivered CBT to reduce alcohol use among HIV-infected out patients in Eldoret , Kenya . Following adaptation and counselor training , five pilot groups were run ( n = 27 ) . Overall attendance was 77 % . Percent days abstinent from alcohol ( PDA ) before session 1 was 52–100 % ( women ) and 21–36 % ( men ) , and by session 6 was 96–100 % ( women ) and 89–100 % ( men ) . PDA effect sizes ( Cohen ’s d ) between first and last CBT session were 2.32 ( women ) and 2.64 ( men ) . Participants reported treatment satisfaction . Results indicate feasibility , acceptability and preliminary efficacy for CBT in Kenya Background Systematic violence is a long-st and ing problem in Iraq . Research indicates that survivors often experience multiple mental health problems , and that there is a need for more rigorous research that targets symptoms beyond post-traumatic stress ( PTS ) . Our objective was to test the effectiveness of two counseling therapies in Southern Iraq in addressing multiple mental health problems among survivors of systematic violence : ( 1 ) a transdiagnostic intervention ( Common Elements Treatment Approach or CETA ) ; and ( 2 ) cognitive processing therapy ( CPT ) . The therapies were provided by non-specialized health workers since few MH professionals are available to provide therapy in Iraq . Methods This was a r and omized , parallel , two site , two-arm ( 1:1 allocation ) , single-blinded , wait-list controlled ( WLC ) trial of  CETA in one site ( 99 C 
    Output:
    
The majority of trials found that CHW-delivered interventions led to symptom reduction .
Training CHWs to support the delivery of evidence -based practice s may help to address mental health disparities .