***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 great heterogeneity of clinical presentation and outcome in paediatric depression . AIMS To identify which clinical and environmental risk factors at baseline and during treatment predicted major depression at 28-week follow-up in a sample of adolescents with depression . METHOD One hundred and ninety-two British adolescents with unipolar major depression were enrolled in a r and omised controlled trial ( the Adolescent Depression Antidepressants and Psychotherapy Trial , ADAPT ) . Participants were treated for 28 weeks with routine psychosocial care and selective serotonin reuptake inhibitors ( SSRIs ) , with half also receiving cognitive-behavioural therapy ( CBT ) . Full clinical and demographic assessment was carried out at baseline and 28 weeks . RESULTS Depression at 28 weeks was predicted by the additive effects of severity , obsessive-compulsive disorder and suicidal ideation at entry together with presence of at least one disappointing life event over the follow-up period . CONCLUSIONS Clinicians should assess for severity , suicidality and comorbid obsessive-compulsive disorder at presentation and should monitor closely for subsequent life events during treatment OBJECTIVE The authors sought to identify predictors of self-harm adverse events in treatment-resistant , depressed adolescents during the first 12 weeks of treatment . METHOD Depressed adolescents ( N=334 ) who had not responded to a previous trial with an SSRI antidepressant were r and omized to a switch to either another SSRI or venlafaxine , with or without cognitive behavior therapy .  Self-harm events , i.e. , suicidal and non-suicidal self-injury adverse events were assessed by spontaneous report for the first 181 participants , and by systematic weekly assessment for the last 153 participants . RESULTS Higher rates of suicidal ( 20.8 % vs. 8.8 % ) and nonsuicidal self-injury ( 17.6 % vs. 2.2 % ) , but not serious adverse events ( 8.4 % vs. 7.3 % ) were detected with systematic monitoring . Median time to a suicidal event was 3 weeks , predicted by high baseline suicidal ideation , family conflict , and drug and alcohol use . Median time to nonsuicidal self-injury was 2 weeks , predicted by previous history of nonsuicidal self-injury . While there were no main effects of treatment , venlafaxine treatment was associated with a higher rate of self-harm adverse events in those with higher suicidal ideation . Adjunctive use of benzodiazepines , while in a small number of participants ( N=10 ) was associated with higher rate of both suicidal and nonsuicidal self-injury adverse events . CONCLUSIONS Since predictors of suicidal adverse events also predict poor response to treatment , and many of these events occurred early in treatment , improving the speed of response to depression , by targeting of family conflict , suicidal ideation , and drug use may help to reduce their incidence . The relationship of venlafaxine and of benzodiazepines to self-harm events requires further study and clinical caution AIM The aim of the present study was to examine the intervention effects of intensive interpersonal psychotherapy for depressed adolescents with suicidal risk ( IPT-A-IN ) by comparison with treatment as usual ( TAU ) at schools . METHODS A total of 347 students from one-fifth of the classes of a high school in southern Taiwan completed the Beck Depression Inventory-II , the Beck Scale for Suicide Ideation , the Beck Anxiety Inventory and the Beck Hopelessness Scale for screening for suicidal risk . Of them , 73 depressed students who had suicidal risk on screening were r and omly assigned to the IPT-A-IN or TAU group . Analysis of covariance ( ANCOVA ) was performed to examine the effect of IPT-A-IN on reducing the severity of depression , suicidal ideation , anxiety and hopelessness . RESULTS Using the pre-intervention scores as covariates , the IPT-A-IN group had lower post-intervention severity of depression , suicidal ideation , anxiety and hopelessness than the TAU group . CONCLUSION Intensive school-based IPT-A-IN is effective in reducing the severity of depression , suicidal ideation , anxiety and hopelessness in depressed adolescents with suicidal risk The objective of this paper is to adapt attachment-based family therapy ( ABFT ) for use with suicidal lesbian , gay , and bisexual ( LGB ) adolescents and to obtain preliminary data on the feasibility and efficacy of the treatment with this population . In Phase I , a treatment development team modified ABFT to meet the unique needs of LGB suicidal youth . In Phase II , 10 suicidal LGB youth were offered 12 weeks of LGB sensitive ABFT . Adolescents ' report of suicidal ideation , depressive symptoms , and maternal attachment-related anxiety and avoidance were gathered at pretreatment , 6 weeks , and 12 weeks ( posttreatment ) . In Phase I , the treatment was adapted to : ( a ) include more individual time working with parents in order to process their disappointments , pain , anger , and fears related to their adolescent 's minority sexual orientation ; ( b ) address the meaning , implication s , and process of acceptance ; and ( c ) heighten parents ' awareness of subtle yet potent invalidating responses to their adolescents ' sexual orientation . Results of Phase II suggest this population can be recruited and successfully treated with a family based therapy , evidence d by high levels of treatment retention and significant decreases in suicidal ideation , depressive symptoms , and maternal attachment-related anxiety and avoidance . This is the first family-based treatment adapted and tested specifically for suicidal LGB adolescents . Though promising , the results are preliminary and more research on larger sample s is warranted BACKGROUND Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders . AIMS To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive-behavioural therapy ( CBT ) . METHOD We undertook a multicentre , pragmatic , r and omised controlled treatment trial ( n=253 ) . Patients were assessed every 8 weeks for 18 months . RESULTS More than half of the patients had a recurrence by 18 months , with no significant differences between groups ( hazard ratio=1.05 ; 95 % CI 0.74 - 1.50 ) . Post hoc analysis demonstrated a significant interaction ( P=0.04 ) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes , but less effective in those with more episodes . CONCLUSIONS People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT . However , such cases form the minority of those receiving mental healthcare In this report , we conducted a secondary analysis of the Treatment of SSRI-Resistant Depression in Adolescents ( TORDIA ) study to explore the impact of specific cognitive-behavioral therapy ( CBT ) treatment components on outcome . In TORDIA , 334 youths ( ages 12 to 18 years ) with major depressive disorder who had failed to respond to an adequate course of selective serotonin reuptake inhibitor ( SSRI ) medication were r and omized to a medication switch ( either to an alternative SSRI or venlafaxine ) with or without 12 weeks of adjunctive CBT . Participants who had more than 9 CBT sessions were 2.5 times more likely to have adequate treatment response than those who had 9 or fewer sessions . CBT participants who received problem-solving and social skills treatment components , controlling for number of sessions and other confounding variables , were 2.3 and 2.6 times , respectively , more likely to have a positive response . These preliminary findings underscore the importance of receiving an adequate number of sessions to attain an adequate clinical response . Finally , social skills and problem solving may be active elements in CBT for adolescent depression and should be considered in treatment by those working with seriously depressed youths BACKGROUND Previous studies in non clinical sample s have shown psychosocial treatments to be efficacious in the treatment of adolescent depression , but few psychotherapy treatment studies have been conducted in clinical ly referred , depressed adolescents . METHODS One hundred seven adolescent patients with DSM-III-R major depressive disorder ( MDD ) were r and omly assigned to 1 of 3 treatments : individual cognitive behavior therapy , systemic behavior family therapy ( SBFT ) , or individual nondirective supportive therapy ( NST ) . Treatments were 12 to 16 sessions provided in as many weeks . Intent-to-treat analyses were conducted using all follow-up data . RESULTS Of the 107 patients enrolled in the study , 78 ( 72.9 % ) completed the study , 4 ( 3.7 % ) never initiated treatment , 10 ( 9.3 % ) had exclusionary criteria that were undetected at entry , 8 ( 7.5 % ) dropped out , and 7 ( 6.5 % ) were removed for clinical reasons . Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST ( 17.1 % vs 42.4 % ; P = .02 ) , and result ed in a higher rate of remission ( 64.7 % , defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores < 9 ) than SBFT ( 37.9 % ; P = .03 ) or NST ( 39.4 % ; p = .04 ) . Cognitive behavior therapy result ed in more rapid relief in interviewer-rated ( vs both treatments , P = .03 ) and self-reported depression ( vs SBFT , P = .02 ) . All 3 treatments showed significant and similar reductions in suicidality and functional impairment . Parents ' views of the credibility of cognitive behavior therapy improved compared with parents ' views of both SBFT ( P = .01 ) and NST ( P = .05 ) . CONCLUSIONS Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical setting s , result ing in more rapid and complete treatment response OBJECTIVE To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide . METHOD Adolescents ( N = 124 ) , ages 12 to 18 years , with a 90-day history of suicide attempt , a current diagnosis of depressive disorder ( 96.0 % had major depressive disorder ) , and a Children 's Depression Rating Scale-Revised ( CDRS-R ) score of 36 or higher , entered a 6-month treatment with antidepressant medication , cognitive-behavioral therapy focused on suicide prevention , or their combination ( Comb ) , at five academic sites . Treatment assignment could be either r and om or chosen by study participants . Intent-to-treat , mixed effects regression models of depression and other relevant ratings were estimated . Improvement and remission rates were computed with the last observation carried forward . RESULTS Most patients ( n = 104 or 84 % ) chose treatment assignment , and overall , three fourths ( n = 93 ) received Comb . In Comb , CDRS-R declined from a baseline adjusted mean of 49.6 ( SD 12.3 ) to 38.3 ( 8.0 ) at week 12 and to 27.0 ( 10.1 ) at week 24 ( p < .0001 ) , with a Clinical Global Impression -defined improvement rate of 58.0 % at week 12 and 72.2 % at week 24 and a remission ( CDRS-R ≤ 28 ) rate of 32.5 % at week 12 and 50.0 % at week 24 . The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline ( r = 0.43 , p < .0001 ) and declined in parallel . CONCLUSIONS When vigorously treated with a combination of medication and psychotherapy , adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression Background : Informant discrepancies have been reported between parent and adolescent measures of  depressive disorders  and suicidality . We aim ed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and question naire measures and assess multi-informant and multi- method approaches to classification . Method : Within the context of assessment of eligibility for a r and omized clinical trial , 50 parent – adolescent pairs ( mean age of adolescents = 15.0 years ) were interviewed separately with a structured diagnostic interview for depression , the KID-SCID . Adolescent self-report and parent-report versions of the Strengths and Difficulties Question naire , the Short Mood and Feelings Question naire and the Depressive Experiences Question naire were also administered . We examined the diagnostic concordance rates of the parent vs. adolescent structured interview methods and the prediction of adolescent diagnosis via question naire methods . Results : Parent proxy reporting of adolescent depression and suicidal thoughts and behavior is not strongly concordant with adolescent report . Adolescent self-reported symptoms on depression scales provide a more accurate report of diagnosable adolescent depression than parent proxy reports of adolescent depressive symptoms . Adolescent self-report measures can be combined to improve the accuracy of classification . Parents tend to over report their adolescent ’s depressive symptoms while under reporting their suicidal thoughts and behavior . Conclusion : Parent proxy report is clearly less reliable than the adolescent ’s own report of their symptoms and subjective experiences , and could be considered inaccurate for research purpose s. While 
    Output:
    
In both intervention and active control groups , suicidality decreased over time ; however , most structured psychological depression treatment interventions did not outperform pharmaceutical or treatment as usual control groups .
Depression prevention studies demonstrated small but statistically significant reductions in suicidality .
Conclusions : It is unclear whether psychological treatments are more effective than no treatment since no study has used a no-treatment control group .
There is evidence to suggest that Cognitive Behavioural Therapy interventions produce pre – post reductions in suicidality with moderate effect sizes and are at least as efficacious as pharmacotherapy in reducing suicidality ; however , it is unclear whether these effects are sustained .
Depression prevention interventions show promising short-term effects