***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: OBJECTIVE The study aim ed to assess the effectiveness of an 18-hr cognitive behavioral group intervention in reducing depressive symptoms ( and associated outcomes ) in a universal sample of students in mainstream schools in Engl and . The intervention , the UK Resilience Programme ( UKRP ) , was based on the Penn Resiliency Program for Children and Adolescents . METHOD Students ( N = 2,844 ; 49 % female ; 67 % White ) were ages 11 - 12 at 16 schools . Classes of students were assigned arbitrarily into intervention ( UKRP ) or control ( usual school provision ) conditions based on class timetables . Outcome measures were the Children 's Depression Inventory ( Kovacs , 1992 ) ( depressive symptoms , primary outcome ) ; Revised Children 's Manifest Anxiety Scale ( C. R. Reynolds & Richmond , 1985 ) ( anxiety ) ; and child-reported Goodman ( 1997 ) Strengths and Difficulties Question naire ( behavior ) . Students were surveyed at baseline , postintervention , 1-year follow-up , and 2-year follow-up . RESULTS At postintervention , UKRP students reported lower levels of depressive symptoms than control group students , but the effect was small ( d = 0.093 , 95 % CI [ -0.178 , -0.007 ] , p = .034 ) and did not persist to 1-year or 2-year follow-ups . There was no significant impact on symptoms of anxiety or behavior at any point . CONCLUSIONS UKRP produced small , short-term impacts on depression symptoms and did not reduce anxiety or behavioral problems . These findings suggest that interventions may produce reduced impacts when rolled out and taught by regular school staff . We discuss the implication s of these findings for policy and for future dissemination efforts BACKGROUND Anxiety in children is common , impairs everyday functioning , and increases the risk of severe mental health disorders in adulthood . We investigated the effect of a classroom-based cognitive behaviour therapy prevention programme ( FRIENDS ) on  anxiety symptoms in children . METHODS Preventing Anxiety in Children though Education in Schools ( PACES ) is a three-group parallel cluster r and omised controlled trial . Interventions were given between September , 2011 , and July , 2012 , with schools as the unit of allocation and individual participants as the unit of analysis . We enrolled state-funded junior schools in southwest Engl and . We sent information to all eligible schools ( state-funded junior schools in southwest Engl and ) inviting them to enrol in the study . School year groups were assigned by computer-generated r and omisation ( 1:1:1 ) to receive either school-led FRIENDS ( led by teacher or school staff member ) , health-led FRIENDS ( led by two trained health facilitators ) , or usual school provision . Children were not masked to treatment allocation . The allocated programme was given to all students ( aged 9 - 10 years ) in the school year ( ie , universal delivery ) as part of the school curriculum as nine , 60 min weekly sessions . Outcomes were collected by self-completed question naire administered by research ers masked to allocation . Primary outcome was symptoms of anxiety and low mood at 12 months assessed by the Revised Child Anxiety and Depression Scale ( RCADS 30 ) . Analyses were intention to treat and accounted for the clustered nature of the design . The study is registered , number IS RCT N23563048 . FINDINGS 45 schools were enrolled : 14 ( n=497 children ) were r and omly assigned to school-led FRIENDS , 14 ( n=509 ) to health-led FRIENDS , and 12 ( n=442 ) to usual school provision . 1257 ( 92 % ) children completed 12 month assessment s ( 449 in health-led FRIENDS , 436 in school-led FRIENDS , and 372 in usual school provision ) . We recorded a difference at 12 months in adjusted mean child-reported RCADS scores for health-led versus school-led FRIENDS ( 19·49 [ SD 14·81 ] vs 22·86 [ 15·24 ] ; adjusted difference -3·91 , 95 % CI -6·48 to -1·35 ; p=0·0004 ) and health-led FRIENDS versus usual school provision ( 19·49 [ 14·81 ] vs 22·48 [ 15·74 ] ; -2·66 , -5·22 to -0·09 ; p=0·043 ) . We noted no differences in parent or teacher ratings . Training teachers to deliver mental health programmes was not as effective as delivery by health professionals . INTERPRETATION Universally delivered anxiety prevention programmes can be effective when used in schools . However , programme effectiveness varies depending on who delivers them . FUNDING National Institute for Health Research Public Health Research Programme Objectives To investigate whether intergroup contact in addition to education is more effective than education alone in reducing stigma of mental illness in adolescents . Design A pragmatic cluster r and omised controlled trial compared education alone with education plus contact . Blocking was used to r and omly stratify classes within schools to condition . R and om allocation was concealed , generated by a computer algorithm , and undertaken after pretest . Data was collected at pretest and 2-week follow-up . Analyses use an intention-to-treat basis . Setting Secondary schools in Birmingham , UK . Participants The parents and guardians of all students in year 8 ( age 12–13 years ) were approached to take part . Interventions A 1-day educational programme in each school led by mental health professional staff . Students in the ‘ contact ’ condition received an interactive session with a young person with lived experience of mental illness . Outcomes The primary outcome was students ’ attitudinal stigma of mental illness . Secondary outcomes included knowledge-based stigma , mental health literacy , emotional well-being and resilience , and help-seeking attitudes . Results Participants were recruited between 1 May 2011 and 30 April 2012 . 769 participants completed the pretest and were r and omised to condition . 657 ( 85 % ) provided follow-up data . At 2-week follow-up , attitudinal stigma improved in both conditions with no significant effect of condition ( 95 % CI −0.40 to 0.22 , p=0.5 , d=0.01 ) . Significant improvements were found in the education-alone condition compared with the contact and education condition for the secondary outcomes of knowledge-based stigma , mental health literacy , emotional well-being and resilience , and help-seeking attitudes . Conclusions Contact was found to reduce the impact of the intervention for a number of outcomes . Caution is advised before employing intergroup contact with younger student age groups . The education intervention appeared to be successful in reducing stigma , promoting mental health knowledge , and increasing mental health literacy , as well as improving emotional well-being and resilience . A larger trial is needed to confirm these results . Trial registration number IS RCT N07406026 ; Results BACKGROUND Mindfulness-based approaches for adults are effective at enhancing mental health , but few controlled trials have evaluated their effectiveness among young people . AIMS To assess the acceptability and efficacy of a schools-based universal mindfulness intervention to enhance mental health and well-being . METHOD A total of 522 young people aged 12 - 16 in 12 secondary schools either participated in the  Mindfulness in Schools Programme ( intervention ) or took part in the usual school curriculum ( control ) . RESULTS Rates of acceptability were high . Relative to the controls , and after adjusting for baseline imbalances , children who participated in the intervention reported fewer depressive symptoms post-treatment ( P = 0.004 ) and at follow-up ( P = 0.005 ) and lower stress ( P = 0.05 ) and greater well-being ( P = 0.05 ) at follow-up . The degree to which students in the intervention group practised the mindfulness skills was associated with better well-being ( P<0.001 ) and less stress ( P = 0.03 ) at 3-month follow-up . CONCLUSIONS The findings provide promising evidence of the programme 's acceptability and efficacy Background Effective methods to prevent  adolescent depressive symptoms  could reduce suffering and burden across the lifespan . However , psychological interventions delivered to adolescents show efficacy only in symptomatic or high-risk youth . Targeting causal risk factors and assessing mechanistic change can help devise efficacious universal or classroom based prevention programs . Methods A non-r and omized longitudinal design was used to compare three classroom-based prevention programs for adolescent depression  ( Behavioral Activation with Reward Processing , “ Thinking about Reward in Young People ” ( TRY ) ; Cognitive Behavioral Therapy ( CBT ) and Mindfulness Based Cognitive Therapy ( MBCT ) ) , and determine cognitive mechanisms of change in these programs . Cognitive mechanisms examined were reward-seeking , negative self-beliefs ( assessed with behavioral tasks ) and over-general autobiographical memory .  256 healthy adolescents aged 13–14 participated with 236 ( 92 % ) and 227 ( 89 % ) completing the pre- and post- assessment s. Results TRY was the only intervention associated with a reduction in depressive symptoms at follow-up . Reward-seeking increased following TRY . In the other programs there were non-significant changes in cognitive mechanisms , with more reflective negative self-beliefs in CBT and fewer over-general autobiographical memories in MBCT In the TRY program , which focused on increasing sensitivity to rewarding activities , reward seeking increased and this was associated with decreased depressive symptoms . Limitations Due to the infeasibility of a cluster r and omized controlled trial , a non-r and omized design was used . Conclusions Increased reward-seeking was associated with decreased depressive symptoms and may be a mechanism of depressive symptom change in the intervention with a focus on enhancing sensitivity and awareness of reward . This study provides preliminary evidence to suggest that incorporating activities to enhance reward sensitivity may be fruitful in r and omized controlled trials of universal prevention programs for depression OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Research suggests that the sequelae of childhood anxiety disorders , if left untreated , can include chronic anxiety , depression , and substance abuse . The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders ( generalized , separation , and social anxiety disorders ) an average of 7.4 years earlier . The 86 participants ( ages 15 to 22 years ; 91 % of the original sample ) and their parents completed  diagnostic interviews and self- and parent-report measures .  According to the diagnostic interviews , a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up . With regard to sequelae , positive responders to anxiety treatment , as compared with less positive responders , had a reduced amount of substance use involvement and related problems at long-term follow-up . The findings are discussed with regard to child anxiety and some of its sequelae 
    Output:
    
1 RESULTS : Effectiveness of  school-based universal interventions  was found to be neutral or small with more positive effects found for poorer quality studies and those based in primary schools ( pupils aged 9 - 12 years ) .
Overall , results suggested a trend whereby higher quality studies reported less positive effects .
The current evidence suggests there are neutral to small effects of universal , school-based interventions in the UK that aim to promote emotional or mental well-being or the prevention of mental health difficulties .