***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: This pilot r and omized controlled trial evaluated a previously developed manualized telephone based cognitive behavioral therapy ( T-CBT ) intervention compared to face-to-face ( f2f ) therapy among low-income , urban dwelling HIV infected depressed individuals . The primary outcome was the reduction of depressive symptoms as measured by the Hamliton rating scale for depression scale . The secondary outcome was adherence to HAART as measured by r and om telephone based pill counts . Outcome measures were collected by trained research assistants masked to treatment allocation . Analysis was based on intention-to-treat . Thirty-four participants met eligibility criteria and were r and omly assigned to receive T-CBT ( n = 16 ) or f2f ( n = 18 ) . There was no statistically significant difference in depression treatment outcomes comparing f2f to T-CBT . Within group evaluation demonstrated that both the T-CBT and the f2f psychotherapy groups result ed in significant reductions in depressive symptoms . Those who received the T-CBT were significantly more likely to maintain their adherence to antiretroviral medication compared to the f2f treatment . None of the participants discontinued treatment due to adverse events . T-CBT can be delivered to low-income , urban dwelling HIV infected depressed individuals result ing in significant reductions in depression symptoms and improved adherence to antiretroviral medication . Trial Registry : Clinical Trial.gov identifier : NCT01055158 BACKGROUND Previous r and omized controlled trials have demonstrated that omega-3 polyunsaturated fatty acids ( n-3 PUFA ) are beneficial in reducing symptoms of depression . However , there is limited evidence regarding the influence of dietary n-3 PUFA intake on mood in adolescents drawn from population studies . OBJECTIVE In the present investigation , we examined the relationship between dietary n-3 PUFA intake on depression symptomatology in a large prospect i ve pregnancy cohort followed for 17 years . METHODS Adolescents enrolled in the Western Australian Pregnancy Cohort ( Raine ) Study completed a Food Frequency Question naire to assess dietary fatty acid intake , as well as other dietary factors at age 14 and a fasting blood sample was taken . Participants also completed the Beck Depression Inventory for Youth ( BDI-Y ) at age 14 ( N = 1,407 ) and at age 17 ( N = 995 ) . RESULTS An inverse relationship was observed between intake of both saturated fat and of n-3 PUFA  at age 14 and BDI-Y scores at both 14 and 17 years of age . However , after adjusting for energy ( kJ ) intake and other lifestyle confounders , the relationships were no longer significant . CONCLUSIONS Associations previously reported between n3 PUFA and depressive symptoms may be due to collinearity with other dietary and lifestyle factors Background : The impact of dietary flavonoid intakes on risk of depression is unclear . Objective : We prospect ively examined associations between estimated habitual intakes of dietary flavonoids and depression risk . Design : We followed 82,643 women without a previous history of depression at baseline from the Nurses ’ Health Study [ ( NHS ) aged 53–80 y ] and the Nurses ’ Health Study II [ ( NHSII ) aged 36–55 y ] .  Intakes of total flavonoids and subclasses ( flavonols , flavones , flavanones , anthocyanins , flavan-3-ols , polymeric flavonoids , and proanthocyanidins ) were calculated from vali date d food-frequency question naires collected every 2–4 y. Depression was defined as physician- or clinician-diagnosed depression or antidepressant use and was self-reported in response to periodic question naires . Cox proportional hazards models were performed to examine associations . Results : A total of 10,752 incident depression cases  occurred during a 10-y follow-up . Inverse associations between flavonol , flavone , and flavanone intakes and depression risk were observed . Pooled multivariable-adjusted HRs ( 95 % CIs ) were 0.93 ( 0.88 , 0.99 ) , 0.92 ( 0.86 , 0.98 ) , and 0.90 ( 0.85 , 0.96 ) when comparing the highest ( quintile 5 ) with the lowest ( quintile 1 ) quintiles , respectively , with evidence of linear trends across quintiles ( P-trend = 0.0004–0.08 ) . In flavonoid-rich food-based analyses , the HR was 0.82 ( 95 % CI : 0.74 , 0.91 ) among participants who consumed ≥2 servings citrus fruit or juices/d compared with < 1 serving/wk . In the NHS only , total flavonoids , polymers , and proanthocyanidin intakes showed significantly ( 9–12 % ) lower depression risks . In analyses among late-life NHS participants ( aged ≥65 y at baseline or during follow-up ) , for whom we were able to incorporate depressive symptoms into the outcome definition , higher intakes of all flavonoid subclasses except for flavan-3-ols were associated with significantly lower depression risk ; flavones and proanthocyanidins showed the strongest associations ( HR for both : 0.83 ; 95 % CI : 0.77 , 0.90 ) . Conclusions : Higher flavonoid intakes may be associated with  lower depression risk  , particularly among older women . Further studies are needed to confirm these associations OBJECTIVES Despite the considerable and growing body of research about the clinical effectiveness of long-term psychoanalytic treatment , relatively little attention has been paid to economic evaluations , particularly with reference to the broader range of societal effects . In this cost-utility study , we examined the incremental cost-effectiveness ratio ( ICER ) of psycho analysis versus psychoanalytic psychotherapy . METHODS Incremental costs and effects were estimated by means of cross-sectional measurements in a cohort design ( psycho analysis , n = 78 ; psychoanalytic psychotherapy , n = 104 ) .  Quality -adjusted life-years ( QALYs ) were estimated for each treatment strategy using the SF-6D . Total costs were calculated from a societal perspective ( treatment costs plus other societal costs ) and discounted at 4 percent . Psycho analysis was more costly than psychoanalytic psychotherapy , but also more effective from a health-related quality of life perspective . The ICER -- that is , the extra costs to gain one additional QALY by delivering psycho analysis instead of psychoanalytic psychotherapy  -- was estimated at 52,384 euros per QALY gained . CONCLUSIONS Our findings show that the cost-utility ratio of psycho analysis relative to psychoanalytic psychotherapy is within an acceptable range . More research is needed to find out whether cost-utility ratios vary with different types of patients . We also encourage cost-utility analyses comparing psychoanalytic treatment to other forms of ( long-term ) treatment The authors r and omized 101 male veterans with chronic combat-related posttraumatic stress disorder ( PTSD ) and depressive disorder to an evidence -based depression treatment ( self-management therapy ; n = 51 ) or active-control therapy ( n = 50 ) . Main outcome measures for efficacy , using intention-to-treat analyses , were subjective and objective PTSD and depression scales at pretest , posttest , and 3- , 6- , and 12-month follow-up . Other measures included treatment compliance , satisfaction , treatment-targeted constructs , functioning , service utilization , and costs .  Self-management therapy 's modestly greater improvement on depression symptoms at treatment completion disappeared on follow-up . No other differences on symptoms or functioning appeared , although psychiatric outpatient utilization and overall outpatient costs were lower with self-management therapy . Despite success in other depressed population s , self-management therapy produced no clinical ly significant effect in depression with chronic PTSD BACKGROUND Although individual nutrients have been investigated in relation to depression risk , little is known about the overall role of diet in depression . OBJECTIVE We examined whether long-term dietary patterns derived from a food-frequency question naire ( FFQ ) predict the development of depression in middle-aged and older women . DESIGN We conducted a prospect i ve study in 50,605 participants ( age range : 50 - 77 y ) without depression in the Nurses ' Health Study at baseline ( 1996 ) who were followed until 2008 .  Long-term diet  was assessed by using  FFQs every 4 y since 1986 . Prudent ( high in vegetables ) and Western ( high in meats ) patterns were identified by using a principal component analysis . We used 2 definitions for clinical depression as follows : a strict definition that required both a reported clinical diagnosis and use of antidepressants ( 3002 incident cases ) and a broad definition that further included women who reported either a clinical diagnosis or antidepressant use ( 7413 incident cases ) . RESULTS After adjustment for age , body mass index , and other potential confounders , no significant association was shown between the diet patterns and depression risk under the strict definition . Under the broad definition , women with the highest scores for the Western pattern had 15 % higher risk of depression ( 95 % CI : 1.04 , 1.27 ; P-trend = 0.01 ) than did women with the lowest scores , but after additional adjustment for psychological scores at baseline , results were no longer significant ( RR : 1.09 ; 95 % CI : 0.99 , 1.21 ; P-trend = 0.08 ) . CONCLUSION Overall , results of this large prospect i ve study do not support a clear association between  dietary patterns  from factor analysis and depression risk Background : exercise may reduce depressive symptoms both in healthy aged population s and in old patients diagnosed with MDD , but few specific analysis were conducted on the efficacy of exercise as an adjunctive treatment with antidepressants , which may be probably more useful in clinical practice , considered the high prevalence of treatment resistant depression in late life , the low cost and safety of physical activity interventions . Objective : to establish the new findings on the effectiveness of  exercise  on  depression in elderlies , with particular focus on the efficacy of the exercise as an adjunctive treatment with antidepressants drug therapy . Method : the search of significant articles was carried out in PubMed / Medline with the following key words : “ exercise ” , “ physical activity ” , “ physical fitness ” , “ depressive disorder ” , “ depression ” , “ depressive symptoms ” , “ late life ” , “ old people ” , and “ elderly ” . Results : 44 papers were retrieved by the search . Among the 10 included r and omized controlled trials , treatment allocation was adequately conceived in 4 studies , intention-to-treat analysis was performed in 6 studies , but no study had a double-blinded assessment . We examined and discussed the results of all these trials . Conclusion : in the last 20 years , few progresses were done in showing the efficacy of exercise  on depression , due in part to the persistent lack of high quality research , in part to clinical issues of management of depression in late life , in part to the difficult to establish the real effectiveness of  exercise  on depressive symptoms in elderlies . However , there are some promising findings on physical activity combined with antidepressants in treatment resistant late life depression Abstract Plain English summary There is some evidence that there is a mismatch between what patients and health professionals want to see research ed and the research that is actually done . The James Lind Alliance ( JLA ) research Priority Setting Partnerships ( PSPs ) were created to address this mismatch . Between 2007 and 2014 , JLA partnerships of patients , carers and health professionals agreed on important treatment research questions ( priorities ) in a range of health conditions , such as Type 1 diabetes , eczema and stroke . We were interested in how much these JLA PSP priorities were similar to treatments undergoing evaluation and research over the same time span . We identified the treatments described in all the JLA PSP research priority lists and compared these to the treatments described in a group of research studies ( r and omly selected ) registered publically . The priorities identified by JLA PSPs emphasised the importance of non-drug treatment research , compared to the research actually being done over the same time period , which mostly involved evaluations of drugs . These findings suggest that the research community should make greater efforts to address issues of importance to users of research , such as patients and healthcare professionals . Abstract Background Comparisons of treatment research priorities identified by patients and clinicians with research actually being done by research ers are very rare . One of the best known of these comparisons ( Tallon et al. Relation between agendas of the research community and the research consumer 355:2037–40 , 2000 ) revealed important mismatches in priorities in the assessment of treatments for  osteoarthritis of the knee  : research ers preferenced drug trials , patients and clinicians prioritised non-drug treatments . These findings were an important stimulus in creating the James Lind Alliance ( JLA ) . The JLA supports research Priority Setting Partnerships ( PSPs ) of patients , carers and clinicians , who are actively involved in all aspects of the process , to develop shared treatment research priorities . We have compared the types of treatments ( interventions ) prioritised for evaluation by JLA PSPs with those being studied in sample s of clinical trials being done over the same period . Objective We used treatment research priorities generated by JLA PSPs to assess whether , on average , treatments prioritised by patients and clinicians differ importantly from those being studied by research ers . Methods We identified treatments mentioned in prioritised research questions generated by the first 14 JLA PSPs . We compared these treatments with those assessed in r and om sample s of commercial and non-commercial clinical trials recruiting 
    Output:
    
For example , there is evidence supporting the effectiveness of many non-pharmacological interventions ( including psychological interventions and exercise ) to reduce depressive symptoms .