***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 
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    Input: Summary Background Although structured psychological treatments are recommended as first-line interventions for depression , only a small fraction of people globally receive these treatments because of poor access in routine primary care . We assessed the effectiveness and cost-effectiveness of a brief psychological treatment ( Healthy Activity Program [ HAP ] ) for delivery by lay counsellors to patients with moderately severe to severe depression in primary health-care setting s. Methods In this r and omised controlled trial , we recruited participants aged 18–65 years scoring more than 14 on the Patient Health Question naire 9 ( PHQ-9 ) indicating moderately severe to severe depression from ten primary health centres in Goa , India . Pregnant women or patients who needed urgent medical attention or were unable to communicate clearly were not eligible . Participants were r and omly allocated ( 1:1 ) to enhanced usual care ( EUC ) alone or EUC combined with HAP in r and omly sized blocks ( block size four to six [ two to four for men ] ) , stratified by primary health centre and sex , and allocation was concealed with use of sequential numbered opaque envelopes . Physicians providing EUC were masked . Primary outcomes were depression symptom severity on the Beck Depression Inventory version II and remission from depression ( PHQ-9 score of < 10 ) at 3 months in the intention-to-treat population , assessed by masked field research ers . Secondary outcomes were disability , days unable to work , behavioural activation , suicidal thoughts or attempts , intimate partner violence , and re source use and costs of illness . We assessed serious adverse events in the per- protocol population . This trial is registered with the IS RCT N registry , number IS RCT N95149997 . Findings Between Oct 28 , 2013 , and July 29 , 2015 , we enrolled and r and omly allocated 495 participants ( 247 [ 50 % ] to the  EUC plus HAP  group [ two of whom were subsequently excluded because of protocol violations ] and 248 [ 50 % ] to the EUC alone group ) , of whom 466 ( 95 % ) completed the 3 month primary outcome assessment ( 230 [ 49 % ] in the EUC plus HAP group and 236 [ 51 % ] in the EUC alone group ) . Participants in the EUC plus HAP group had significantly lower symptom severity ( Beck Depression Inventory version II in EUC plus HAP group 19·99 [ SD 15·70 ] vs 27·52 [ 13·26 ] in EUC alone group ; adjusted mean difference −7·57 [ 95 % CI −10·27 to −4·86 ] ; p<0·0001 ) and higher remission ( 147 [ 64 % ] of 230 had a PHQ-9 score of < 10 in the HAP plus EUC group vs 91 [ 39 % ] of 236 in the EUC alone group ; adjusted prevalence ratio 1·61 [ 1·34–1·93 ] ) than did those in the EUC alone group . EUC plus HAP showed better results than did EUC alone  for the secondary outcomes of disability ( adjusted mean difference −2·73 [ –4·39 to −1·06 ] ; p=0·001 ) , days out of work ( −2·29 [ –3·84 to −0·73 ] ; p=0·004 ) , intimate partner physical violence in women ( 0·53 [ 0·29–0·96 ] ; p=0·04 ) , behavioural activation ( 2·17 [ 1·34–3·00 ] ; p<0·0001 ) , and suicidal thoughts or attempts ( 0·61 [ 0·45–0·83 ] ; p=0·001 ) . The incremental cost per quality -adjusted life-year gained was $ 9333 ( 95 % CI 3862–28 169 ; 2015 international dollars ) , with an 87 % chance of being cost-effective in the study setting . Serious adverse events were infrequent and similar between groups ( nine [ 4 % ] in the EUC plus HAP group vs ten [ 4 % ] in the EUC alone group ; p=1·00 ) . Interpretation HAP delivered by lay counsellors plus EUC was better than EUC alone was for patients with moderately severe to severe depression in routine primary care in Goa , India . HAP was readily accepted by this previously untreated population and was cost-effective in this setting . HAP could be a key strategy to reduce the treatment gap for depressive disorders , the leading mental health disorder worldwide . Funding Wellcome Trust Background Experiencing systematic violence and trauma increases the risk of poor mental health outcomes ; few interventions for these types of exposures have been evaluated in low re source context s. The objective of this r and omized controlled trial was to assess the effectiveness of two psychotherapeutic interventions , Behavioral Activation Treatment for Depression ( BATD ) and Cognitive Processing Therapy ( CPT ) , in reducing depression symptoms using a locally adapted and vali date d version of the Hopkins Symptom Checklist and dysfunction measured with a locally developed scale . Secondary outcomes included posttraumatic stress , anxiety , and traumatic grief symptoms . Methods Twenty community mental health workers , working in rural health clinics , were r and omly assigned to training in one of the two interventions . The community mental health workers conducted baseline assessment s , enrolled survivors of systematic violence based on severity of depression symptoms , and r and omly assigned them to treatment or waitlist-control . Blinded community mental health workers conducted post-intervention assessment s on average five months later . Results Adult survivors of systematic violence were screened ( N = 732 ) with 281 enrolled in the trial ; 215 r and omized to an intervention ( 114 to BATD ; 101 to CPT ) and 66 to waitlist-control ( 33 to BATD ; 33 to CPT ) . Nearly 70 % ( n = 149 ) of the intervention participants completed treatment and post-intervention assessment s ; 53 ( 80 % ) waitlist-controls completed post-intervention assessment s. Estimated effect sizes for depression and dysfunction were 0.60 and 0.55 respectively , comparing BATD participants to all controls and 0.84 and 0.79 respectively , compared to BATD controls only . Estimated effect sizes for depression and dysfunction were 0.70 and 0.90 respectively comparing CPT participants to all controls and 0.44 and 0.63 respectively compared to CPT controls only . Using a permutation-based hypothesis test that is robust to the model assumptions implicit in regression models , BATD had significant effects on depression ( p = .003 ) and dysfunction ( p = .007 ) , while CPT had a significant effect on dysfunction only ( p = .004 ) . Conclusions Both interventions showed moderate to strong effects on most outcomes . This study demonstrates effectiveness of these interventions in low re source environments by mental health workers with limited prior experience . Trial Registration Clinical Trials . Gov NCT00925262 . Registered June 3 , 2009 Providing survivors of torture , imprisonment , and /or military attacks with a counseling program that includes support , skills and psychoeducation by well-trained and supervised community mental health workers can result in moderate yet meaningful improvements in depression and dysfunction . Providing survivors of torture , imprisonment , and /or military attacks with a counseling program that includes support , skills and psychoeducation by well-trained and supervised community mental health workers can result in moderate yet meaningful improvements in depression and dysfunction . ABSTRACT Supportive counseling type interventions are frequently provided to meet the mental health needs of population s in emergency and post-conflicts context s , but it has seldom been rigorously evaluated . Existing evaluations from low- and middle-income countries provide mixed evidence of effectiveness . While Iraqi Kurdistan experienced relative stability following the fall of Saddam Hussein ’s government , the population in the northern Dohuk region has continued to experience periodic violence due to conflicts with neighboring Turkey as well as more recent ISIS-associated violence . We evaluated the impact of a trauma-informed support , skills , and psychoeducation intervention provided by community mental health workers ( CMHWs ) on depressive symptoms and dysfunction ( primary outcomes ) as well as post-traumatic stress , traumatic grief , and anxiety symptoms ( secondary outcomes ) . Between June 2009 and June 2010 , 295 adults were screened ; 209 ( 71 % ) met eligibility criteria ( trauma exposure and a symptom severity score indicating significant distress and functional impairment , among others ) and consented to participate . Of these , 159 were r and omized to supportive counseling while 50 were r and omized to a waitlist control condition . Comparing average symptom severity scores post-treatment among those in the intervention group with those in the waitlist control group , the supportive counseling program had statistically and clinical ly significant impacts on the primary outcomes of depression ( Cohen ’s d , 0.57 ; P = .02 ) and dysfunction ( Cohen ’s d , 0.53 ; P = .03 ) and significant but smaller impacts on anxiety . Although studies by the same research team of psychotherapeutic interventions in other parts of Kurdistan and in southern Iraq found larger effects , this study adds to the global research literature on mental health and psychosocial support and shows that a well-trained and supervised program of trauma-informed support , skills , and psychoeducation that emphasizes the therapeutic relationship can also be effective Background Personalized healthcare relies on the identification of factors explaining why individuals respond differently to the same intervention . Analyses identifying such factors , so called predictors and moderators , have their own set of assumptions and limitations which , when violated , can result in misleading cl aims , and incorrect actions . The aim of this study was to develop a checklist for critically appraising the results of predictor and moderator analyses by combining recommendations from published guidelines and experts in the field . Methods C and i date criteria for the checklist were retrieved through systematic search es of the literature . These criteria were evaluated for appropriateness using a Delphi procedure . Two Delphi rounds yielded a pilot checklist , which was tested on a set of papers included in a systematic review on reinforced home-based palliative care . The results of the pilot informed a third Delphi round , which served to finalize the checklist . Results Forty-nine appraisal criteria were identified in the literature . Feedback was obtained from fourteen experts from (bio)statistics , epidemiology and other associated fields elicited via three Delphi rounds . Additional feedback from other research ers was collected in a pilot test . The final version of our checklist included seventeen criteria , covering the design ( e.g. a priori plausibility ) , analysis ( e.g. use of interaction tests ) and results ( e.g. complete reporting ) of moderator and predictor analysis , together with the transferability of the results ( e.g. clinical importance ) . There are criteria both for individual papers and for bodies of evidence . Conclusions The proposed checklist can be used for critical appraisal of reported moderator and predictor effects , as assessed in r and omized or non-r and omized studies using individual participant or aggregate data . This checklist is accompanied by a user ’s guide to facilitate implementation . Its future use across a wide variety of research domains and study types will provide insights about its usability and feasibility Background Gender-based violence ( GBV ) represents a major cause of psychological morbidity worldwide , and particularly in low- and middle-income countries ( LMICs ) . Although there are effective treatments for common mental disorders associated with GBV , they typically require lengthy treatment programs that may limit scaling up in LMICs . The aim of this study was to test the effectiveness of a new 5-session behavioural treatment called Problem Management Plus ( PM+ ) that lay community workers can be taught to deliver . Methods and findings In this single-blind , parallel , r and omised controlled trial , adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi , Kenya . Participants were r and omly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care ( EUC ) provided by community nurses . Participants were aware of treatment allocation , but research assessors were blinded . The primary outcome was psychological distress as measured by the total score on the 12-item General Health Question naire ( GHQ-12 ) assessed at 3 months after treatment . Secondary outcomes were impaired functioning ( measured by the WHO Disability Adjustment Schedule [ WHODAS ] ) , symptoms of posttraumatic stress ( measured by the Posttraumatic Stress Disorder Checklist [ PCL ] ) , personally identified problems ( measured by Psychological Outcome Profiles [ PSYCHLOPS ] ) , stressful life events ( measured by the Life Events Checklist [ LEC ] ) , and health service utilisation . Between 15 April 2015 and 20 August 2015 , 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning . Of these , 518 women ( 37 % ) screened positive , of whom 421 ( 81 % ) were women who had experienced GBV . Of these 421 women , 209 were assigned to PM+ and 212 to EUC . Follow-up assessment s were completed on 16 January 2016 . The primary analysis was intention to treat and included 53 women in PM+ ( 25 % ) and 49 women in EUC ( 23 % ) lost to follow-up . The difference between PM+ and EUC in the change from baseline to 3 months on the GHQ-12 was  
    Output:
    
INTERPRETATION Psychological interventions  treat anxiety effectively in women with current or recent intimate partner violence exposure in LMICs when delivered by appropriately trained and supervised health-care staff , even when not tailored for this population or targeting intimate partner violence directly .