***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 There is increasing awareness of the prognostic value of residual symptomatology in affective disorders and of the need for specific therapeutic strategies in this phase of illness . The aims of the study were to apply a novel , short-term psychotherapeutic approach for increasing well-being , based on Ryff 's conceptual model , to remitted patients with affective disorders and to compare the results with those obtained with symptom-oriented cognitive behavioural strategies . METHODS Twenty patients with affective disorders ( major depression , panic disorder with agoraphobia , social phobia , generalized anxiety disorder , obsessive-compulsive disorder ) who had been successfully treated by behavioural or pharmacological methods  were r and omly assigned to a well-being enhancing therapeutic strategy ( well-being therapy ) or cognitive-behavioural treatment of residual symptoms . RESULTS Both well-being and cognitive-behavioural therapies were associated with a significant reduction of residual symptoms . However , a significant advantage of well-being therapy over cognitive-behavioural strategies was observed with observer-rated methods . DISCUSSION These preliminary results suggest the feasibility of well-being therapy in the residual stage of affective disorders . Further research should determine its value as a relapse-preventive strategy in specific mood and anxiety disorders Abract Fifty-four children and adolescents ( age 8–17 ) were assessed two years after a clinical intervention trial of cognitive-behavioural vs. non-focused treatment for  depression . Eleven ( 20.4 % ) subjects fulfilled criteria for depression , while 21 ( 38.9 % ) reported significant depressive symptoms during the previous year . Seventeen young people ( 31.5 % ) had a psychiatric disorder ( including depression ) . Overall , the sample maintained the improvement since the termination of treatment , without detecting specific treatment effects . Presence of depression at two-year follow-up was best predicted by self-esteem ratings before and after treatment , and co-morbidity at post-treatment . Depression in young life carries a high risk of recurrence , despite initial remission . Continuation or preventative treatment for young people at risk of relapse needs development and evaluation OBJECTIVE To determine whether continuation of cognitive-behavioral therapy ( CBT-C ) could prevent relapse in adolescent psychiatric patients who had remitted from major depressive disorder ( MDD ) . METHOD Seventeen patients who continued to have CBT-C for 6 months after remission from MDD were compared with a historical control group of 12 cases who had no further treatment after remission . RESULTS Only 1 of the 17 cases who continued with CBT-C dropped out . The cumulative relapse risk during CBT-C was significantly lower ( 0.2 ) than it had been in the historical control group ( 0.5 ) . CONCLUSIONS CBT-C warrants further investigation in a r and omized , controlled trial OBJECTIVE This paper presents retrospective and prospect i ve data regarding time course parameters of major depressive disorder ( MDD ) in community adolescents ( 14 to 18 years old ) : time to onset and recovery and , among those who recovered , time to recurrence . METHOD Diagnostic interviews were conducted with 1,508 r and omly selected high school students . Three hundred sixty-two had experienced at least one past or current episode of MDD . RESULTS Mean age at onset of first episode was 14.9 ( SD = 2.8 ) . Early MDD onset was associated with female gender and suicidal ideation . MDD episode duration ranged from 2 to 520 weeks , with a mean of 26.4 weeks ( SE = 3.3 ) and a median of 8.0 weeks . Longer episodes were observed in those whose depression occurred early ( at or before age 15 ) , whose depression had been accompanied by suicidal ideation , and for whom treatment was sought . Of the adolescents who recovered , 5 % relapsed within 6 months , 12 % within 1 year , and approximately 33 % within 4 years . Shorter time to recurrence was associated with prior suicidal ideation and attempt and with later first onset . CONCLUSIONS Risk of MDD is low in childhood , increasing substantially with adolescence . The majority of episodes in community adolescents are relatively brief , although the risk of recurrence is substantial . Suicidal behaviors are important mediators of episode duration and of recurrence OBJECTIVE This study evaluated efficacy of a manual-based bereavement group intervention for children who suffered suicide of a parent or sibling . METHOD Seventy-five families ( 102 children ) were screened from medical examiners ' lists of suicide victims . Fifty-two families ( 75 children ) were eligible and assigned in alternating order to receive ( 27 families , 39 children ) or not to receive ( 25 families , 36 children ) the intervention . Intervention efficacy was evaluated as change in children 's symptoms of anxiety , depression , posttraumatic stress , social adjustment , and parents ' depressive symptoms from initial to outcome assessment s. RESULTS Changes in anxiety and depressive symptoms were significantly greater among children who received the intervention than in those who did not . A greater dropout of children assigned not to receive ( 75 % ) than to receive ( 18 % ) intervention led to an imbalance in retention of intervention and nonintervention participants . CONCLUSIONS A bereavement group intervention focusing on reactions to death and suicide and strengthening coping skills can lessen distress of children bereaved after parental or sibling suicide . Such intervention may prevent future morbidities Twenty families participated in a r and om assignment trial of two cognitive psychoeducational preventive interventions for families with parental affective disorder . Twelve families were assigned to a clinician-based intervention and eight to a lecture-based intervention  , with assessment prior to intervention and an average of 18 weeks following intervention . Both groups were satisfied and believed they received help from the intervention . The clinician-based group was significantly more satisfied overall , and reported significantly more changes in both behaviors and attitudes about their illness from pre- to postintervention . Both groups showed significant decrease in degree of upset over issues of concern from pre- to postintervention . The clinician-based group reported receiving significantly more help with their primary concern . The implication s of these findings are discussed Thirty-seven families who had a child between the ages of 8 and 15 ( mean age = 12.0 years ) and had at least one parent , who had experienced a recent episode of affective disorder were assigned r and omly to one of two psychoeducational interventions . The interventions ( clinician-facilitated or lecture-group discussion ) were design ed to prevent childhood depression and related problems through decreasing the impact of related risk factors and encouraging resiliency-promoting behaviors and attitudes . They were similar in content but differed in the level of the children 's involvement and the degree to which the families ' individual life experiences were linked to the educational material . Assessment s included st and ard diagnostic and social functioning instruments and interviews design ed specifically for this project to assess behavior and attitude change . Each parent and child was individually assessed by separate assessors who were blind to information about the other family members . Parent participants in both groups reported being satisfied with the intervention . Clinician group participants reported a significantly larger number of overall changes , as well as higher levels of change regarding communications about the illness with their children and increased underst and ing by the children of their illness . Significantly more children in the clinician group also reported they gained a better underst and ing of parental affective illness as a result of their participation in the project This paper describes the development and preliminary efficacy of a program design ed to prevent depressive symptoms in at-risk 10 - 13 year-olds , and relates the findings to the current underst and ing of childhood depression . The treatment targets depressive symptoms and related difficulties such as conduct problems , low academic achievement , low social competence , and poor peer relations , by proactively teaching cognitive techniques .  Children were identified as ' at-risk ' based on depressive symptoms and their reports of parental conflict . Sixty-nine children participated in treatment groups  and were compared to 73 children in control groups .  Depressive symptoms were significantly reduced and classroom behavior was significantly improved in the treatment group as compared to controls at post-test . Six-month follow-up showed continued reduction in depressive symptoms , as well as significantly fewer externalizing conduct problems , as compared to controls . The reduction in symptoms was most pronounced in the children who were most at risk This study explored the intervention processes of an indicated prevention program for high-risk youth . It was hypothesized that intervention effects would be influenced by the direct and mediating effects of teacher social support on both peer group support and perceived personal control . In turn , personal control was hypothesized to mediate between teacher and peer group support , contributing to reductions in depression and suicide risk behaviors . The hypotheses were tested using a three-wave , longitudinal design incorporating data from preintervention , 5-month follow-up , and 10-month follow-up assessment s of 106 high-risk youth divided into three comparison groups : two experimental , one control . For the two intervention groups , there were direct and /or indirect effects of teacher and peer group support on personal control , depression , and suicide risk behaviors . The general hypothesis that personal control mediates between support re sources and reductions in depression and suicide risk behaviors received partial support across the study groups BACKGROUND Adolescent offspring of depressed parents are at high risk for development of depression . Cognitive restructuring therapy holds promise for preventing progression to depressive episodes . METHODS A r and omized , controlled trial was conducted to prevent depressive episodes in at-risk offspring ( aged 13 - 18 years ) of adults treated for depression in a health maintenance organization ( HMO ) . Potential adult cases were found by review ing the HMO pharmacy records for dispensation of antidepressant medication and the mental health appointment system . Medical charts were review ed for a depression diagnosis . Recruitment letters signed by treating physicians were mailed to adults . Eligible offspring had subdiagnostic depressive symptoms insufficient to meet full DSM-III-R criteria for affective disorder and /or a past mood disorder . These youth were r and omized to usual HMO care ( n = 49 ) or usual care plus a 15-session group cognitive therapy prevention program ( n = 45 ) . RESULTS We detected significant treatment-by-time ( program ) effects for the Center for Epidemiological Studies Depression Scale ( P=.005 ) and the Global Assessment of Functioning scores ( P = .04 ) . Survival analysis of incident major depressive episodes during a median 15-month follow-up found a significant advantage ( P = .003 ) for the experimental condition ( 9.3 % cumulative major depression incidence ) compared with the usual-care control condition ( 28.8 % ) . CONCLUSION A brief , group cognitive therapy prevention program can reduce the risk for depression in the adolescent offspring of parents with a history of depression OBJECTIVES This investigation attempted to prevent unipolar depressive episodes in a sample of high school adolescents with an elevated risk of depressive disorder . METHOD Adolescents at risk for future depressive disorder by virtue of having elevated depressive symptomatology were selected with a two-stage case-finding procedure . The Center for Epidemiologic Studies -Depression Scale ( CES-D ) was administered to 1,652 students ; adolescents with elevated CES-D scores were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children . Subjects with current affective diagnoses were referred to nonexperimental services . The remaining 150 consenting subjects were considered at risk for future depression and r and omized to either a 15-session cognitive group prevention intervention or an " usual care " control condition . Subjects were reassessed for DSM-III-R diagnostic status after the intervention and at 6- and 12-month follow-up points . RESULTS Survival analyses indicated a significant 12-month advantage for the prevention program , with affective disorder total incidence rates of 14.5 % for the active intervention , versus 25.7 % for the control condition . No differences were detected for nonaffective disorders across the study period . CONCLUSION Depressive disorder can be successfully prevented among adolescents with an elevated future risk OBJECTIVE To examine long-term effects of two forms of preventive intervention design ed to increase families ' underst and ing of parental affective disorder and to prevent depression in children . METHOD Thirty-six families who had a nondepressed child between ages 8 and 15 years and a parent who had experienced affective disorder were enrolled and r and omly assigned to either a clinician-facilitated intervention or a lecture discussion group . Each parent and child were assessed prior to r and omization , after intervention , and approximately 1 1/2 years after enrollment . Assessment s included st and ard diagnostic interviews , measures of child and family functioning , and interviews about experience of parental affective disorder and intervention effects . RESULTS Children in the clinician-facilitated group reported greater underst and ing of parental affective disorder , as rated by self-report , rater-generated scales , and parent report , and had better adaptive functioning after intervention . Parents in the clinician-facilitated intervention group reported significantly more change . CONCLUSION Findings from both interventions support the value of a future-oriented resiliency-based approach . The greater effects of the clinician-facilitated intervention support the need for linking cognitive information to families ' life experience and involving children directly in order to achieve long-term effects PURPOSE To evaluate a program design ed to help high school students with depressive symptomology to effectively cope . DESIGN Two-phase experimental study . METHODS Rural high school students ( N = 222 ) , ages 14 through 19 years , were surveyed to identify teens with depressive symptomatology , identify stressful life events 
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While small effect sizes were reported , these were associated with a significant reduction in depressive episodes .
The only analysis in which there was significant statistical heterogeneity was the sub-group analysis by gender where there was variability in the response to different programmes for both girls and boys .
For the most part funnel plots indicate findings are robust for short term effects with no publication bias evident .
Given the gender differences in prevalence , and the change in these that occurs in adolescence with a disproportionate increase in prevalence rates for girls , it is likely that girls and boys will respond differently to interventions .