***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: Mild depressive syndromes are highly prevalent among primary -care patients . Evidence -based treatment recommendations need to be derived directly from this diagnostically heterogeneous group . The primary aim was to assess the efficacy of sertraline and cognitive-behavioural group therapy for treatment of depressed primary -care patients , the secondary aim was to evaluate if receiving treatment according to free choice is associated with a better outcome than r and omization to a particular treatment . We conducted a r and omized , placebo-controlled , single-centre , 10-wk trial with five arms : sertraline ( flexible dosages up to 200 mg/d ) ( n = 83 ) ; placebo ( n = 83 ) ; manual-guided cognitive-behavioural group therapy ( one individual session and nine group sessions per 90 min ) ( n = 61 ) ; guided self-help group ( control condition , n = 59 ) ; and treatment with sertraline or cognitive-behavioural group therapy according to patients ' choice ( n = 82 ) . From 1099 consecutively screened adult patients , 368 formed the intent-to-treat population with milder forms of depression . Primary outcome was a global efficacy measure combining z-converted Hamilton Depression Rating Scale and clinician-rated Inventory for Depressive Symptomatology scores .  Sertraline was superior to  placebo  ( p = 0.03 ) . Outcome for guided self-help groups was worse compared to cognitive-behavioural group therapy ( p = 0.002 ) and compared to all other treatment arms including pill placebo ( secondary analyses ) . Outcome in the patients ' choice arm was similar to that in the sertraline and cognitive-behavioural group therapy . Overall , sertraline is efficacious in primary -care patients with milder forms of depression . The superiority of cognitive-behavioural group therapy over guided self-help groups might partly be explained by ' nocebo ' effects of the latter 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 Depression in women is one of the commonest problems encountered in primary care . We aim ed to compare the effectiveness of a stepped-care programme with usual care in primary -care management of  depression in low-income women in Santiago , Chile . METHODS In a r and omised controlled trial , in three primary -care clinics in Chile , 240 adult female primary -care patients with major depression were allocated stepped care or usual care . Stepped care was a 3-month , multicomponent intervention led by a non-medical health worker , which included a psychoeducational group intervention , structured and systematic follow-up , and drug treatment for patients with severe depression . Data were analysed on an intention-to-treat basis . The primary outcome measure was the Hamilton depression rating scale ( HDRS ) administered at baseline and at 3 and 6 months after r and omisation . FINDINGS About 90 % of r and omised patients completed outcome assessment s. There was a substantial between-group difference in all outcome measures in favour of the stepped-care programme . The adjusted difference in mean HDRS score between the groups was -8.89 ( 95 % CI -11.15 to -6.76 ; p<0.0001 ) . At 6-months ' follow-up , 70 % ( 60 - 79 ) of the stepped-care compared with 30 % ( 21 - 40 ) of the usual-care group had recovered ( HDRS score < 8) . INTERPRETATION Despite few re sources and marked deprivation , women with major depression responded well to a structured , stepped-care treatment programme , which is being introduced across Chile . Socially disadvantaged patients might gain the most from systematic improvements in treatment of depression OBJECTIVE Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults , a significant number of these do not respond to treatment . Authors assessed the benefits of augmenting medication with group psychotherapy . METHODS They r and omly assigned 34 ( largely chronically ) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management , either alone ( MED ) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions ( MED+DBT ) . RESULTS Only MED+DBT showed significant decreases on mean self-rated depression scores , and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores . However , on interviewer-rated depression , 71 % of MED+DBT patients were in remission at post-treatment , in contrast to 47 % of MED patients . At a 6-month follow-up , 75 % of MED+DBT patients were in remission , compared with only 31 % of MED patients , a significant difference . Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression . CONCLUSION Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults Across studies , paying attention to and analyzing one 's emotions has been found to be both positively and negatively correlated with  depression symptoms . One way of reconciling these seemingly contradictory findings is the possibility that attending to emotions in a skillful manner may help to reduce depression whereas attending to emotions with limited skill may be counterproductive . Dialectical behavior therapy ( DBT ) is a clinical intervention design ed to foster adaptive awareness , expression , regulation , tolerance , and acceptance of emotions . Results of the present report come from a pilot study of a 16-week DBT-based skills training group for treatment-resistant major depressive disorder ( MDD ) as an adjunctive treatment to pharmacotherapy .  Patients were r and omized to treatment or a waitlist control group .  A significant interaction revealed that increases in emotional processing were associated with decreases in depression symptoms in the DBT-based skills group ; however , increases in emotional processing in the waitlist condition were associated with increases in depression . Results offer preliminary support for the idea that participating in DBT-based skills training may help individuals with treatment-resistant MDD to develop skills that facilitate processing emotions in a way that helps to reduce rather than exacerbate depression symptoms This study examined the effectiveness of a cognitive-behavioral treatment ( CBT ) group for Chinese people with depression in Hong Kong . Ninety-six subjects with depression were r and omly assigned to CBT and control groups . After 10 weeks of treatment , participants in the CBT group had significantly fewer symptoms of depression , dysfunctional rules , and negative emotions , and significantly more adaptive coping skills when compared to the participants in the control group . Effect size statistics showed medium to large differences in symptoms of depression , coping skills , dysfunctional rules , and assumptions and negative emotions between the participants of the two groups ( Cohen 's d , between 0.50 and 0.88 , except for positive emotions ) . Forty percent of the participants in the experimental group achieved a clinical ly significant level [ reliable change index (RC)>1.96 ] of improvement . Lastly , the results of a multiple regression analysis provided some evidence of a linkage between cognition and depression among the participants in the experimental group . The design and content of the CBT groups , which aim ed at facilitating the underst and ing and modification of automatic thoughts and dysfunctional rules , and of negative and positive coping skills among the participants , might have contributed to the initial positive results OBJECTIVE This study assessed the efficacy of antidepressant treatment ( sertraline ) and group cognitive behavior therapy , alone or in combination , in primary dysthymia . The clinical features of dysthymia , as well as the functional impairments associated with the illness ( e.g. , quality of life , stress perception , coping styles ) , were evaluated . METHOD Patients ( N = 97 ) diagnosed with primary dysthymia , but no other current comorbid disorder , received either sertraline or placebo in a double-blind design over 12 weeks . In addition , a subgroup of the patients ( N = 49 ) received a structured , weekly group cognitive behavior therapy intervention . RESULTS Treatment with sertraline , with or without group cognitive behavior therapy , reduced the functional impairment of depression . The reductions were similar in the drug-cognitive therapy group and in subjects who received the drug alone . Furthermore , while group cognitive behavior therapy alone reduced the depression scores , this effect was not significantly greater than the effect of the placebo . The drug treatment also induced pronounced improvement in the functional measures , and in some respects these effects were augmented by group cognitive behavior therapy . Among patients who responded favorably to cognitive behavior therapy , the improvements in the functional measures were similar to those who responded to drug treatment , whereas such functional changes were not seen among patients who responded to placebo . CONCLUSIONS Sertraline treatment effectively reduces the clinical symptoms and functional impairments associated with dysthymia . Although the group cognitive behavior therapy intervention was less effective in alleviating clinical symptoms , it augmented the effects of sertraline with respect to some functional changes , and in a subgroup of patients it attenuated the functional impairments characteristic of dysthymia OBJECTIVE The authors compared the incremental cost-effectiveness of a stepped-care , multicomponent program with usual care for the treatment of depressed women in primary care in Santiago , Chile . METHOD A cost-effectiveness study was conducted of a previous r and omized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics . The patients were r and omly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker . Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months . A health service perspective was used in the economic analysis . RESULTS Complete data were determined for 80 % of the r and omly assigned patients . After we adjusted for initial severity , women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care . The stepped-care program was marginally more expensive than usual care ( an extra 216 Chilean pesos per depression-free day ) . There was a 90 % probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos ( 1.04 US dollars ) . CONCLUSIONS The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care . Small investments to improve depression appear to yield larger gains in poorer environments . Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries ABSTRACT ‐ An 8‐week multidimensional program of behavioral management , cognitive restructuring , and assertiveness training was administered to depressed out patients either individually with a single therapist ( n= 12 ) , in two small groups ( n= 11 ) , or one large group ( n= 11 ) , or as bibliotherapy ( n= 12 ) . A r and omly assigned waiting list control group was also included ( n= 10 ) . 
    Output:
    
Group CBT confers benefit for individuals who are clinical ly depressed over that of usual care alone .
Individually delivered CBT is more effective than group CBT immediately following treatment but after 3 months there is no evidence of difference .