***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 Clinical studies have demonstrated a great clinical relevance of long-term depression ( LTD ) . Our study aims to characterise LTD in comparison with episodic ( non-chronic ) major depressive episodes ( MDE ) on the basis of data from a community sample . METHOD The Zurich Cohort Study is a prospect i ve study of young adults followed from age 20/21 to 40/41 with six interviews  . The stratified sample consisted of two thirds high scorers and one third lower scorers on the  Symptom Checklist-90 R ( SCL-90-R ) . LTD was assessed from age 27/28 to 40/41 and defined as being symptomatic more days than not over 2 years plus the presence of work impairment . MDE and dysthymia were defined by DSM-III-R criteria . RESULTS The cumulative incidence of LTD was 5.7 % , and of episodic MDE 20.9 % . In both groups we found a similar preponderance of women . LTD subjects reported disturbed memory , feelings of inferiority , hopelessness , fear of everyday tasks , fear of being alone and thoughts of dying significantly more often than subjects with episodic MDE . Subjects with LTD had an earlier age of onset . 82 % of them were treated over lifetime for depression compared to 61 % with MDE . LTD subjects were less often married , less often in fulltime employment  , more often unemployed , and more often  receiving social benefits . LTD was comorbid with cardiac and respiratory syndromes , and LTD subjects were more frequently treated for insomnia and pain . They suffered significantly more from social phobia and benzodiazepine abuse ; there was also a statistical trend to greater comorbidity with panic attacks , agoraphobia , obsessive-compulsive syndrome , binge eating and neurasthenia . Somatic and psychological well-being were also reduced . CONCLUSIONS LTD is common , clinical ly more serious than episodic MDE and highly comorbid . LIMITATIONS The sample is relatively small with an attrition rate of 38.5 % over 20 years . The results can not be generalised to persons over 40 years of age and may be dependent on the definition of LTD OBJECTIVE Interpersonal theories posit that chronically depressed individuals have hostile and su bmi ssive styles in their social interactions , which may undermine their interpersonal effectiveness and maintain their depression . Recent findings support this theory and also show that patients ' interpersonal impact messages , as perceived by their psychotherapists , change in theoretically predicted ways following cognitive-behavioral analysis system of psychotherapy ( CBASP ) alone or with medication . This study extended these previous findings by examining whether such changes were associated with their depression change and response status . METHOD Data derived from a large clinical trial for chronic depression compared the efficacy of CBASP , nefazodone , and their combination . To assess patients ' impact messages , CBASP clinicians completed the  Impact Message Inventory ( IMI ; Kiesler & Schmidt , 1993 ) following an early and late session .  Our sub sample ( N = 259 ) consisted of patients in the CBASP and combined conditions who had depression severity data for at least 1 post-r and omization visit and whose clinicians completed at least 1 IMI rating . We used hierarchical linear modeling ( HLM ) to calculate IMI change scores and to model depression change . We used HLM and logistic regression to test our predictor questions . RESULTS As hypothesized , decreases in patients ' hostile-su bmi ssive impact messages were significantly associated with depression reduction ( γ = 0.27 , 95 % CI [ 0.11 , 0.43 ] , p < .01 ) and favorable treatment response ( B = -0.05 , 95 % CI [ -0.09 , -0.01 ] , p = .03 ) , regardless of treatment condition . CONCLUSIONS The findings support CBASP theory , suggesting that interpersonal change is related to depression reduction among chronically depressed patients Theoretical accounts posit that chronically depressed individuals are perceived as hostile and /or su bmi ssive , which compromises their ability to satisfy their interpersonal needs . The current study assessed the interpersonal tenets of McCullough 's ( 2000 ) chronic depression theory and examined change in interpersonal functioning following McCullough 's treatment for chronic depression ( viz . , Cognitive-Behavioral Analysis System of Psychotherapy ; CBASP ) . Data derive from a r and omized 12-week clinical trial that compared the efficacy of CBASP , nefazodone , and their combination for chronic depression . To assess patients ' interpersonal impacts , CBASP  therapists completed the  Impact Message Inventory ( IMI ) following an early and a late session .  IMI data were compared to normative and clinical comparison sample s to assess depression-related interpersonal profiles and clinical ly significant change in interpersonal functioning . As predicted , chronically depressed patients were initially perceived as more su bmi ssive and hostile than the comparison groups . Patients ' interpersonal impacts on their therapists changed in adaptive , theoretically predicted ways by the end of CBASP treatment , either with or without medication . Individual-level clinical significance data were less robust . The findings generally substantiate McCullough 's interpersonal theory and provide preliminary evidence of change in interpersonal impacts following treatment . ( PsycINFO Data base Record ( c ) 2010 APA , all rights reserved ) OBJECTIVE  Chronic depression  has often been associated with childhood trauma . There may , however , be an interaction between personality pathology , childhood trauma , and chronic depression . This interaction has not yet been studied . METHOD This retrospective analysis is based on 279 patients contacted for a r and omized trial in an outpatient psychotherapy center over a period of 18 months from 2010 to 2012 . Current diagnoses of a personality disorder and presence of chronic depression were systematic ally assessed using the Structured Clinical Interview for DSM-IV . Retrospective reports of childhood trauma were collected using the short form of the Childhood Trauma Question naire ( CTQ-SF ) . DSM-IV-defined chronic depression was the primary outcome . The association between chronic depression , childhood trauma , and personality disorders was analyzed using correlations . Variables that had at least a small effect on correlation analysis were entered into a series of logistic regression analyses to determine the predictors of chronic depression and the moderating effect of childhood trauma . RESULTS The presence of avoidant personality disorder , but no CTQ-SF scale , was associated with the chronicity of depression ( odds ratio [ OR ] = 2.20 , P = .015 ) . The emotional abuse subscale of the CTQ-SF did , however , correlate with avoidant personality disorder ( OR = 1.15 , P = .000 ) . The level of emotional abuse had a moderating effect on the effect of avoidant personality disorder on the presence of chronic depression ( OR = 1.08 , P = .004 ) . Patients who did not suffer from avoidant personality disorder had a decreased rate of chronic depression if they retrospectively reported more severe levels of emotional abuse ( 18.9 % vs 39.7 % , respectively ) . CONCLUSIONS The presence of avoidant personality pathology may interact with the effect of childhood trauma in the development of chronic depression . This has to be confirmed in a prospect i ve study . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01226238 This study addressed 2 questions : ( a ) is early-onset dysthymia associated with reports of a disturbed childhood home environment ; and ( b ) can adverse early experiences account , at least in part , for the differing clinical presentations of dysthymia and major depression ? Participants included 97 out patients with early-onset dysthymia , 45 out patients with episodic major depression , and 45 normal controls . The early home environment was assessed blind to diagnosis using both interview and self-report measures . Early-onset dysthymia patients reported significantly more physical and sexual abuse and poorer relationships with both parents than normal controls . In addition , patients with dysthymia reported having received significantly poorer parenting than those with episodic major depression . The results could not be accounted for by mood state effects , comorbidity with borderline and antisocial personality disorder , or comorbid major depression Background : The Cognitive Behavioral Analysis System of Psychotherapy ( CBASP ) , initially developed as an outpatient treatment for chronic depression ( CD ) , has been adapted as a multidisciplinary 12-week inpatient program for CD . Methods : Seventy in patients with CD and treatment resistance were included in a noncontrolled trial . The Hamilton Depression Rating Scale served as the primary outcome measure . Prospect i ve naturalistic follow-up assessment s were conducted 6 and 12 months after discharge . Results : Dropout rate was 7.1 % ; 90.4 % perceived the program as helpful . Pre-post comparisons yielded strong effect sizes ; 75.7 % of the intention-to-treat sample responded , and 40.0 % remitted . Nonremission was associated with experiencing temporary deterioration of symptoms during treatment . After 6 months 75.0 % and after 12 months 48.0 % of patients sustained response . Conclusions : The CBASP program appears as a feasible acute treatment for treatment-resistant CD in patients with promising outcome . However , the continuation of treatment after discharge should be optimized especially for patients with subjective deterioration during treatment OBJECTIVE The DSM-5 Field Trials were design ed to obtain precise ( st and ard error,0.1 ) estimates of the intraclass kappa asa measure of the degree to which two clinicians could independently agree on the presence or absence of selected DSM-5 diagnoses when the same patient was interviewed on separate occasions , in clinical setting s , and evaluated with usual clinical interview methods . METHOD Eleven academic centers in the United States and Canada were selected , and each was assigned several target diagnoses frequently treated in that setting .Consecutive patients visiting a site during the study were screened and stratified on the basis of DSM-IV diagnoses or symptomatic presentations . Patients were r and omly assigned to two clinicians for a diagnostic interview ; clinicians were blind to any previous diagnosis . All data were entered directly via an Internet-based software system to a secure central server . Detailed research design and statistical methods are presented in an accompanying article . RESULTS There were a total of 15 adult and eight child/adolescent diagnoses for which adequate sample sizes were obtained to report adequately precise estimates of the intraclass kappa . Overall , five diagnoses were in the very good range(kappa=0.60–0.79 ) , nine in the good range(kappa=0.40–0.59 ) , six in the question able range ( kappa = 0.20–0.39 ) , and three in the unacceptable range ( kappa values,0.20 ) . Eight diagnoses had insufficient sample sizes to generate precise kappa estimates at any site . CONCLUSIONS Most diagnoses adequately tested had good to very good reliability with these representative clinical population s assessed with usual clinical interview methods . Some diagnoses that were revised to encompass a broader spectrum of symptom expression or had a more dimensional approach tested in the good to very good range OBJECTIVE To compare sociodemographic and clinical features , acute and continuation treatment outcomes , and adverse events/side effect burden between out patients with chronic ( current episode > 2 years ) versus nonchronic major depressive disorder ( MDD ) who were treated with combination antidepressant therapy or selective serotonin reuptake inhibitor ( SSRI ) monotherapy . METHOD 663 out patients with chronic ( n = 368 ) or nonchronic ( n = 295 ) moderate to severe DSM-IV-TR MDD ( 17-item Hamilton Depression Rating Scale score ≥ 16 ) were enrolled from March 2008 through September 2009 in a single-blind 7-month prospect i ve r and omized trial conducted at 6 primary and 9 psychiatric care sites across the United States . Participants were treated with escitalopram monotherapy plus placebo or 1 of 2 combination treatments ( bupropion sustained-release [ SR ] + escitalopram or venlafaxine extended-release [ XR ] + mirtazapine ) . Analyses compared baseline sociodemographic and clinical characteristics , rates of remission ( at least 1 of the last 2 consecutive scores on the 16-item Quick Inventory of Depressive Symptomatology-Self-Report [ QIDS-SR16 ] < 6 , with the other < 8) , and adverse events/side effect burden ( Frequency , Intensity , and Burden of Side Effects Ratings ) obtained at 12 and 28 weeks . RESULTS Participants with chronic MDD were at greater socioeconomic disadvantage and had greater medical and psychiatric disease burden  . The chronic and nonchronic groups did not differ in rates of remission at 12 weeks ( 35.9 % vs 42.0 % , respectively ; odds ratio [ OR ] = 0.778 , P = .1500 ; adjusted OR [ AOR ] = 0.956 , P = .8130 ) or at 28 weeks ( 41.0 % vs 49.8 % , respectively ; OR = 0.706 , P = .0416 ; AOR = 0.837 , P = .3448 ) . Participants with chronic MDD had higher final QIDS-SR(16 ) scores and smaller overall percent changes in QIDS-SR(16 ) from baseline to exit , but these differences did not remain after adjusting for covariates . There were no significant differences in adverse events or side effect burden . No significant interactions were found between chronicity and type 
    Output:
    
We also found some evidence for specific features in the psychopathology of  CD patients ( su bmi ssive and hostile interpersonal styles ) in contrast to non-CD patients .
Results were inconsistent with regard to childhood maltreatment .
No differences were found regarding the severity of depressive symptoms and most sociodemographic factors .
Despite some inconsistencies , the results of this review verified important differences between CD and non-CD .