***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: Objectives The aim of this r and omized controlled trial ( RCT ) was to investigate the effects of internet-based cognitive behavior therapy ( ICBT ) treatment for depression compared to treatment-as-usual ( TAU ) on improving work ability and quality of life in patients with mild-to-moderate depression . We also examined whether patients treated with  ICBT  returned to work more rapidly , that is , had fewer days of sick leave , than patients treated with TAU . Design This study is based on material from the PRIM-NET RCT that took place between 2010 and 2013 . Setting Primary care centers in Region Vastra Gotal and , Sweden , population about 1.6 million . Patients A total of 77 patients with depression r and omized to either ICBT ( 46 patients ) or TAU ( 31 patients ) . Mean age of participants was 35.8 years , and 67.5 % were women . Main outcome measures Work ability was measured with the Work Ability Index , depressive symptoms with Montgomery Asberg Depression Rating Scale – self-rating version ( MADRS-S ) , quality of life with EuroQoL-5D ( EQ-5D ) , and number of sick leave days . Results Both groups showed an association between improved work ability and reduction of depressive symptoms and between improved work ability and better quality of life .  ICBT could not be shown to improve work ability more than TAU among patients with mild-to-moderate depression . There were no differences between the groups concerning number of patients with sick leave or number of sick leave days . Conclusion Our study indicates that a high level of work ability has an association with high health-related quality of life in patients with mild-to-moderate depression , whether they are treated with ICBT or TAU . ICBT has previously been found to be cost-effective and can be seen as a good alternative to TAU . In addition to the ICBT , an intervention oriented toward the work place might improve work ability and reduce the number of sick leave days among patients with depression Publication bias , sometimes known as the " file-drawer problem " or " funnel-plot asymmetry , " is common in empirical research . The authors review the implication s of publication bias for quantitative research synthesis ( meta- analysis ) and describe existing techniques for detecting and correcting it . A new approach is proposed that is suitable for application to meta-analytic data sets that are too small for the application of existing methods . The model estimates parameters relevant to fixed-effects , mixed-effects or r and om-effects meta- analysis contingent on a hypothetical pattern of bias that is fixed independently of the data . The authors illustrate this approach for sensitivity analysis using 3 data sets adapted from a commonly cited reference work on research synthesis ( H. M. Cooper & L. V. Hedges , 1994 ) 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 Study queStion How effective is supported computerised cognitive behaviour therapy ( cCBT ) as an adjunct to usual primary care for adults with depression ? MethodS This was a pragmatic , multicentre , three arm , parallel r and omised controlled trial with simple r and omisation . Treatment allocation was not blinded . Participants were adults with symptoms of depression ( score ≥10 on nine item patient health question naire , PHQ-9 ) who were r and omised to receive a commercially produced cCBT programme ( “ Beating the Blues ” ) or a free to use cCBT programme ( MoodGYM ) in addition to usual GP care . Participants were supported and encouraged to complete the programme via weekly telephone calls . Control participants were offered usual GP care , with no constraints on the range of treatments that could be accessed . The primary outcome was severity of depression assessed with the PHQ-9 at four months . Secondary outcomes included health related quality of life ( measured by SF-36 ) and psychological wellbeing ( measured by CORE-OM ) at four , 12 , and 24 months and depression at 12 and 24 months . Study anSwer and liMitationS Participants offered commercial or free to use cCBT experienced no additional improvement in depression compared with usual GP care at four months ( odds ratio 1.19 ( 95 % confidence interval 0.75 to 1.88 ) for Beating the Blues v usual GP care ; 0.98 ( 0.62 to 1.56 ) for MoodGYM v usual GP care ) . There was no evidence of an overall difference between either programme compared with usual GP care ( 0.99 ( 0.57 to 1.70 ) and 0.68 ( 0.42 to 1.10 ) , respectively ) at any time point . Commercially provided cCBT conferred no additional benefit over free to use cCBT or usual GP care at any follow-up point . Uptake  and use of cCBT was low , despite regular telephone support . Nearly a quarter of participants ( 24 % ) had dropped out by four months . The study did not have enough power to detect small differences so these can not be ruled out . Findings can not be generalised to cCBT offered with a much higher level of guidance and support . what thiS Study addS Supported cCBT does not substantially improve depression outcomes compared with usual GP care alone . In this study , neither a commercially available nor free to use computerised CBT intervention was superior to usual GP care . Funding , CoMpeting intereStS , data Sharing Commissioned and funded by the UK National Institute for Health Research ( NIHR ) Health Technology Assessment ( HTA ) programme ( project No 06/43/05 ) . The authors have no competing interests . Requests for patient level data will be considered by the REEACT trial management group trial regiStration Current Controlled Trials IS RCT N91947481 Background Group Cognitive Behavioural Therapy ( CBT ) may provide a means of improving mental health among people with depression but few studies have explored its effectiveness . Our aim was to examine the feasibility and acceptability of a r and omised controlled trial of a group intervention based on CBT principles for women with depression in primary care . Methods Women aged 30 to 55 years were recruited and r and omly assigned to either 12 weeks of the group intervention or usual care ( control ) . The group intervention was based on a manual and used CBT and problem solving principles with weekly topics including raising activity levels , spotting and catching negative thoughts , problem solving and relaxation . Women were recruited from deprived areas of Bristol . The groups were run by facilitators with some experience and background in group work and one weeks training in use of the course manual . Assessment s of mental health were made using measures including the PHQ-9 . Follow-up was at 3 and 6 months after the intervention . Qualitative methods were used to support the design of the intervention and to help underst and issues of acceptability and feasibility . Interviews were conducted with all participants at baseline and at 3 and 6 months although detailed qualitative analysis was based on a purposive sample of 20 participants at the 3 time points . Results Of the 86 participants assessed for eligibility , 52 were allocated to the intervention arm and 21 to the control group .  The intervention was delivered according to the manual despite the limited training of the facilitators . The intervention was received favourably by participants and facilitators , with good attendance at sessions for those who engaged with the intervention . Follow up rates at 3 and 6 months for women in both the intervention and control arms were also good . The trial methodology used was appropriate and feasible . Conclusions This study showed that a r and omised controlled trial of group CBT for women with depression is feasible and the intervention is acceptable , and may possibly prove to be effective in a larger trial . The cost effectiveness of group CBT for depression should be explored further in a full trial . Trial registration OBJECTIVE In the current study , we compared measures of treatment outcome and engagement for Latino and non-Latino White patients receiving a cognitive behavioral therapy ( CBT ) program delivered in primary care . METHOD Participants were 18 - 65 years old and recruited from 17 clinics at 4 different sites to participate in a r and omized controlled trial for anxiety disorders , which compared the Coordinated Anxiety Learning and Management ( CALM ) intervention ( consisting of CBT , medication , or both ) with usual care . Of those participants who were r and omized to the intervention arm and selected CBT ( either alone or in combination with medication )  , 85 were Latino and 251 were non-Latino White ; the majority of the Latino participants received the CBT intervention in English ( n = 77 ) . Blinded assessment s of clinical improvement and functioning were administered at baseline and at 6 , 12 , and 18 months after baseline . Measures of engagement , including attendance , homework adherence , underst and ing of CBT principles , and commitment to treatment , were assessed weekly during the CBT intervention . RESULTS Findings from propensity-weighted linear and logistic regression models revealed no statistically significant differences between Latinos and non-Latino Whites on symptom measures of clinical improvement and functioning at almost all time points . There were significant differences on 2 of 7 engagement outcomes , namely , number of sessions attended and patients ' underst and ing of CBT principles . CONCLUSIONS These findings suggest that CBT can be an effective treatment approach for Latinos who are primarily English speaking and likely more acculturated , although continued attention should be directed toward engaging Latinos in such interventions BACKGROUND Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence .  Maintenance antidepressants for at least 2 years is the current recommended treatment , but many individuals are interested in alternatives to medication . Mindfulness-based cognitive therapy ( MBCT ) has been shown to reduce risk of relapse or recurrence compared with usual care , but has not yet been compared with maintenance antidepressant treatment in a definitive trial . We aim ed to see whether MBCT with support to taper or discontinue antidepressant treatment ( MBCT-TS ) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months . METHODS In this single-blind , parallel , group r and omised controlled trial ( PREVENT ) , we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants , from primary care general practice s in urban and rural setting s in the UK . Participants were r and omly assigned to either MBCT-TS or maintenance antidepressants ( in a 1:1 ratio ) with a computer-generated r and om number sequence with stratification by centre and symptomatic status . Participants were aware of treatment allocation and research assessors were masked to treatment allocation . The primary outcome was time to relapse or recurrence of depression , with patients followed up at five separate intervals during the 24-month study period . The primary analysis was based on the principle of intention to treat . The trial is registered with Current Controlled Trials , IS RCT N26666654 . FINDINGS Between March 23 , 2010 , and Oct 21 , 2011 , we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practice s. 212 patients were r and omly assigned to MBCT-TS and 212 to maintenance antidepressants . The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months ( hazard ratio 0·89 , 95 % CI 0·67 - 1·18 ; p=0·43 ) , nor did the number of serious adverse events . Five adverse events were reported , including two deaths , in each of the MBCT-TS and maintenance antidepressants groups . No adverse events were attributable to the interventions or the trial . INTERPRETATION We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence . Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence , residual depressive symptoms , and quality of life . FUNDING National Institute for Health Research ( NIHR ) Health Technology Assessment ( HTA ) programme , and NIHR Collaboration for Leadership in Applied Health Research and Care South West Pen 
    Output:
    
The percentage of White participants , treatment composition ( CBT only versus CBT + other approaches ) , and treatment duration were significant moderators .