***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 a highly prevalent , often recurring or persistent disorder . The majority of patients are initially seen and treated in primary care . Effective treatments are available , but possibilities for providing adequate follow-up care are often limited in this setting . This study assesses the effectiveness of primary -care-based enhanced treatment modalities on short-term patient outcomes . METHOD In a r and omized controlled trial we evaluated a psycho-educational self-management intervention .  We included 267 adult patients meeting criteria for a DSM-IV diagnosis of major depressive disorder , assessed by a structured psychiatric interview . Patients were r and omly assigned to : the Depression Recurrence Prevention ( DRP ) program ( n=112 ) ; a combination of the DRP program with psychiatric consultation ( PC+DRP , n=39 ) ; a combination with brief cognitive behavior therapy ( CBT+DRP , n=44 ) ; and care as usual ( CAU , n=72 ) . Follow-up assessment s were made at 3 months ( response 90 % ) and 6 months ( 85 % ) . RESULTS Patient acceptance of enhanced care was good . The mean duration of the index episode was 11 weeks ( S.D.=9.78 ) and similar in CAU and enhanced care . Recovery rate after 6 months was 67 % overall ; 17 % of all participants remained depressed for the entire 6-month period . CONCLUSION Enhanced care did not result in better short-term outcomes . We found no evidence that the DRP program was more effective than CAU and no indications for added beneficial effects of either the psychiatric evaluation or the CBT treatment to the basic format of the DRP program . Observed depression treatment rates in CAU were high Background Evidence -based practice s design ed for large urban clinics are not necessarily portable into smaller isolated clinics . Implementing practice -based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists . Objective The purpose of the Telemedicine Enhanced Antidepressant Management ( TEAM ) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists . Design Matched sites were r and omized to the intervention or usual care . Participants Small VA Community-based outpatient clinics with no on-site psychiatrists , but access to telepsychiatrists .  In 2003–2004 , 395 primary care patients with PHQ9 depression severity scores ≥12 were enrolled , and followed for 12 months . Patients with serious mental illness and current substance dependence were excluded .  Measures Medication adherence , treatment response , remission , health status , health-related quality of life , and treatment satisfaction . Results The sample comprised mostly elderly , white , males with substantial physical and behavioral health comorbidity . At baseline , subjects had moderate depression severity (  Hopkins Symptom Checklist , SCL-20 = 1.8 ) , 3.7 prior depression episodes , and 67 % had received prior depression treatment . Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 ( odds ratio [ OR ] = 2.1 , p = .04 ) and 12 months ( OR = 2.7 , p = .01 ) . Intervention patients were more likely to respond by 6 months ( OR = 2.0 , p = .02 ) , and remit by 12 months ( OR = 2.4 , p = .02 ) . Intervention patients reported larger gains in mental health status and health-related quality of life , and reported higher satisfaction . Conclusions Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies OBJECTIVE To compare liaison psychiatric nursing with usual medical care in the management of older medical in patients who screen positive for depression . DESIGN Pragmatic r and omised controlled trial . SETTING Medical wards of UK district general hospital in rural East Anglia . PARTICIPANTS One hundred and thirty-eight medical in patients aged 65 + screened positive on the 15-item geriatric depression scale ( GDS ) . One hundred and twenty-one out of 138 screen positives entered the trial ( 58/121 fulfilled criteria for depressive disorder at baseline ) . INTERVENTIONS ( i ) A liaison psychiatric nurse assessed participants , formulated a care plan for treatment of their depression , ensured its implementation through liaison with appropriate agencies , and monitored participants ' mood and response to treatment for up to 12 weeks . ( ii ) Usual treatment by hospital and primary care staff . MAIN OUTCOME MEASURES ICD-10 depressive disorder , change in GDS-15 score , quality -adjusted life weeks ( QALWs ) and patient satisfaction rating . RESULTS Eighty-six out of 121 participants completed the 16-week trial . Participants in the intervention group were more satisfied with their care , but no significant differences in depressive disorder , depression rating or QALWs gained were found between groups . However , there was a trend towards improvement in the intervention group and effect sizes were higher in the subgroup with depressive disorder . CONCLUSIONS This study is the first RCT to evaluate liaison psychiatric nursing specifically for depression in older medical in patients ; the findings suggest improvement in mental health and quality of life , but a larger trial is required to provide convincing evidence OBJECTIVE This study evaluated the effectiveness of a structured telephone-based care management program for patients in a prepaid health plan receiving new antidepressant prescriptions from psychiatrists . METHODS Potential participants were identified with computerized medical records and contacted by telephone . Eligible and consenting participants were r and omly assigned to continued usual care ( N=104 ) or to a three-session telephone care management program ( N=103 ) . Care management contacts included assessment of depressive symptoms , medication adherence , and medication side effects with structured feedback to treating psychiatrists . Effectiveness was assessed three and six months after r and omization by blinded telephone assessment s ( depression scale on the Hopkins Symptom Checklist [ SCL ] and patient-rated global improvement ) . Computerized records were used to assess medication adherence and frequency of in-person follow-up visits . RESULTS Compared with usual care , the care management intervention had no significant effect on the mean score of the SCL depression scale at six months , on the probability of 50 percent improvement in depressive symptoms ( 41 percent for care management and 37 percent for usual care ) , or on the probability of patient-rated improvement ( 57 percent for care management and 52 percent for usual care ) . Patients assigned to care management made significantly more medication management visits over six months ( 2.4 visits compared with 2.0 visits ; p=.035 ) , but there were no significant differences in rates of adequate medication treatment . CONCLUSIONS This study found that a low-intensity telephone care management program did not appear to significantly improve clinical outcomes for patients starting antidepressant treatment . Compared with findings from earlier primary care studies , this study found that patients receiving care from a psychiatrist received more intensive treatment , although many still experienced poor outcomes Background and Purpose — Poststroke depression is a prevalent and disabling disorder , yet evidence regarding the effectiveness of treating poststroke depression is inconclusive . Our objective was to determine the effectiveness of the Activate-Initiate-Monitor care management program for the treatment of poststroke depression . Methods — We conducted a prospect i ve , r and omized , outcome -blinded trial in 188 ischemic stroke survivors identified at the time of admission to one of 4 Indianapolis hospitals . Depression screening and enrollment occurred between 1 and 2 months poststroke . The Activate-Initiate-Monitor intervention was a care management program that included Activation of the patient to recognize depression symptoms and accept treatment , Initiation of an antidepressant medication , and Monitoring and adjusting treatment . Usual care subjects received nondepression-related education and were prescribed antidepressants at the discretion of their provider . The primary outcome measure was depression response , defined as a Hamilton Depression Inventory score < 8 ( remission ) or a decrease from baseline of at least 50 % at 12 weeks . Results — Intervention and usual care groups did not differ on any key baseline measures . Both depression response ( 51 % versus 30 % , P=0.005 ) and remission ( 39 % versus 23 % , P=0.01 ) were more likely in the Activate-Initiate-Monitor intervention than in the usual care group . This difference in depression scores was present by 6 weeks and persisted through the 12-week assessment . Serious adverse events did not differ between the 2 groups . Conclusion — The Activate-Initiate-Monitor care management model is significantly more effective than usual care in improving depression outcomes in patients with poststroke depression BACKGROUND Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer , but evidence to guide its management is scarce . We aim ed to assess the efficacy and cost of a nurse-delivered complex intervention that was design ed to treat major depressive disorder in patients who have cancer . METHODS We did a r and omised trial in a regional cancer centre in Scotl and , UK . 200 out patients who had cancer with a prognosis of greater than 6 months and major depressive disorder ( identified by screening ) were eligible and agreed to take part . Their mean age was 56.6 ( SD 11.9 ) years , and 141 ( 71 % ) were women . We r and omly assigned 99 of these participants to usual care , and 101 to usual care plus the intervention , with minimisation for sex , age , diagnosis , and extent of disease . The intervention was delivered by a cancer nurse at the centre over an average of seven sessions . The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale ( range 0 to 4 ) at 3 months after r and omisation . Analysis was by intention to treat . This trial is registered as IS RCT N84767225 . FINDINGS Primary outcome data were missing for four patients . For 196 patients for whom we had data at 3 months , the adjusted difference in mean Symptom Checklist-20 depression score , between those who received the intervention and those who did not , was 0.34 ( 95 % CI 0.13 - 0.55 ) . This treatment effect was sustained at 6 and 12 months . The intervention also improved anxiety and fatigue but not pain or physical functioning . It cost an additional pound sterling 5278 ( US$ 10 556 ) per quality -adjusted life-year gained . INTERPRETATION The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible , acceptable , and potentially cost effective The purpose of this study was to examine the impact of the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment ( UPBEAT ) Program , an interdisciplinary mental health care management program , on the behavioral health symptoms of elderly veterans . Participants , 60 years and older , included 2637 veterans recruited from medical/surgical units who screened positively for significant depressive or anxiety symptoms and /or at-risk alcohol drinking . Participants were r and omized to UPBEAT or to usual care . Primary outcomes were measured at baseline and at 6 , 12 , and 24 months . Participant nonadherence to the protocol was common and is a major limitation . There were no differences between UPBEAT and usual care patients on symptom or functional outcomes at any follow-up point . Exploratory analyses suggested that among participants with more physical health problems , there were greater improvements in depressive symptoms in those assigned to UPBEAT care . Despite a theoretical and practically sound intervention , participation was low and treatment outcomes , while generally good , appeared unaffected by the addition of the program PURPOSE We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and antihypertensive medications , depression outcomes , and blood pressure control among older primary care patients . METHODS Older adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were r and omly assigned to an integrated care intervention or usual care . Outcomes were assessed at baseline , 2 , 4 , and 6 weeks using the Center for Epidemiologic Studies Depression Scale ( CES-D ) to assess depression , an electronic monitor to measure blood pressure , and the Medication Event Monitoring System to assess adherence . RESULTS In all , 64 participants aged 50 to 80 years participated . Participants in the integrated care intervention had fewer depressive symptoms ( CES-D mean scores , intervention 9.9 vs usual care 19.3 ; P < .01 ) , lower systolic blood pressure ( intervention 127.3 mm Hg vs usual care 141.3 mm Hg ; P < .01 ) , and lower diastolic blood pressure ( intervention 75.8 mm Hg vs usual care 85.0 mm Hg ; P < .01 ) compared with participants in the usual care group at 6 weeks . Compared with the usual care group , the proportion of participants in the intervention group who had 80 % or greater adherence to an antidepressant medication  ( intervention 71.9 % vs usual care 31.3 % ; P < .01 ) and to an antihypertensive medication  ( intervention 78.1 % vs usual care 31.3 % ; P < .001 ) was greater at 6 weeks . CONCLUSION A pilot , r and omized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes . Integrated interventions may be more feasible and effective in real-world practice s , where 
    Output:
    
CONCLUSIONS Collaborative care models are effective in achieving clinical ly meaningful improvements in depression outcomes and public health benefits in a wide range of population s , setting s , and organizations .