***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 Behavioural activation appears as effective as cognitive-behaviour therapy ( CBT ) in the treatment of depression . If equally effective , then behavioural activation may be the preferred treatment option because it may be suitable for delivery by therapists with less training . This is the first r and omised controlled trial to look at this possibility . AIMS To examine whether generic mental health workers can deliver effective behavioural activation as a step-three high-intensity intervention . METHOD A r and omised controlled trial ( IS RCT N27045243 ) comparing behavioural activation ( n=24 ) with treatment as usual ( n=23 ) in primary care . RESULTS Intention-to-treat analyses indicated a difference in favour of behavioural activation of -15.79 ( 95 % CI -24.55 to -7.02 ) on the Beck Depression Inventory-II and Work and Social Adjustment Scale ( mean difference -11.12 , 95 % CI -17.53 to -4.70 ) . CONCLUSIONS Effective behavioural activation appears suitable for delivery by generic mental health professionals without previous experience as therapists . Large-scale trial comparisons with an active comparator ( CBT ) are needed Although rumination is an important mediator of depressive symptoms , there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of , depressed patients . This study investigates whether a time-limited cognitive behavioral intervention ( Competitive Memory Training , or COMET for depressive rumination ) is an effective treatment for depression and rumination . This intervention was tested in older adult depressed out patients . A total of 93 patients ( aged ≥ 65 years with major depression and suffering from rumination ) were treated in small groups according to the COMET protocol in addition to their regular treatment . Patients were r and omized to two treatment conditions : 7 weeks of COMET + treatment-as-usual ( TAU ) versus TAU only . COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone . This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults OBJECTIVE Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults , a significant number of these do not respond to treatment . Authors assessed the benefits of augmenting medication with group psychotherapy . METHODS They r and omly assigned 34 ( largely chronically ) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management , either alone ( MED ) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions ( MED+DBT ) . RESULTS Only MED+DBT showed significant decreases on mean self-rated depression scores , and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores . However , on interviewer-rated depression , 71 % of MED+DBT patients were in remission at post-treatment , in contrast to 47 % of MED patients . At a 6-month follow-up , 75 % of MED+DBT patients were in remission , compared with only 31 % of MED patients , a significant difference . Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression . CONCLUSION Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed BACKGROUND Psychotherapy 's equivalence paradox is that treatments tend to have equivalently positive outcomes despite non-equivalent theories and techniques . We replicated an earlier comparison of treatment approaches in a sample four times larger and restricted to primary -care mental health . METHOD Patients ( n=5613 ) who received cognitive-behavioural therapy ( CBT ) , person-centred therapy ( PCT ) or psychodynamic therapy ( PDT ) at one of 32 NHS primary -care services during a 3-year period ( 2002 - 2005 ) completed the Clinical Outcomes in Routine Evaluation - Outcome Measure ( CORE-OM ) at the beginning and end of treatment . Therapists indicated which approaches were used on an End of Therapy form . We compared outcomes of groups treated with CBT ( n=1045 ) , PCT ( n=1709 ) , or PDT ( n=261 ) only or with one of these plus one additional approach ( e.g. integrative , supportive , art ) , design ated CBT+1 ( n=1035 ) , PCT+1 ( n=1033 ) , or PDT+1 ( n=530 ) , respectively . RESULTS All six groups began treatment with equivalent CORE-OM scores , and all averaged marked improvement ( overall pre/post effect size=1.39 ) . Neither treatment approach nor degree of purity ( ' only ' v. ' + 1 ' ) had a statistically significant effect . Distributions of change scores were all similar . CONCLUSIONS Replicating the earlier results , the theoretically different approaches tended to have equivalent outcomes . Caution is warranted because of limited treatment specification , non-r and om assignment , incomplete data , and other issues . Insofar as these routine treatments appear effective for patients who complete them , those who fail to complete ( or to begin ) treatment deserve attention by research ers and policymakers BACKGROUND cognitive impairment is an important part of the diagnostic criteria for dementia . The Mini-Mental State Examination ( MMSE ) is recommended to test for cognitive impairment and to monitor medication response . OBJECTIVES we examined the prevalence of cognitive impairment in the UK and assessed associations with cognitive impairment . DESIGN cross-sectional survey as part of a cluster r and omised trial . SUBJECTS representative sample of people aged 75 years and over . METHODS all subjects had a detailed baseline health assessment including the MMSE . RESULTS a total of 15,051 subjects completed the assessment ( 71.9 % ) . Almost two-thirds of subjects were female ( 61.5 % ) and almost half were aged between 75 and 79 years ( 47.0 % ) . The prevalence of cognitive impairment was 18.3 % ( 95 % confidence intervals ( CI ) = 16.0 - 20.9 ) at a cut-off of 23/24 , and 3.3 % ( 95 % CI = 2.8 - 4.0 ) at 17/18 . Those with impairment ( MMSE 23/24 ) were significantly more likely to have hearing ( odds ratio ( OR ) 1.7 ) , vision ( OR 1.7 ) and urinary incontinence problems ( OR 1.3 ) , have two or more falls in the previous 6 months ( OR 1.4 ) , and report poorer health ( OR 1.9 ) . Almost half the participants lived alone ( n = 7,073 ; 47.0 % ) and of these almost one-fifth were impaired ( MMSE 23/24 ; 19.4 % ) . CONCLUSIONS there was a high prevalence of cognitive impairment . This representative sample demonstrates the potential burden of disease and service dem and s. It supports the need for a broader assessment of functioning as recommended by the National Service Framework for Older People , particularly in people with cognitive impairment OBJECTIVES To describe the patterns of self-reported medication use , including both prescription and non-prescription drugs , for older people in five areas in Engl and and Wales , and to identify the effects of socio-demographic features on medication use . DESIGN A cross-sectional survey on population r and om sample s of people aged 65 and over . The survey is a part of the screening interviews at the first stage of the Medical Research Council Cognitive Function and Ageing Study ( MRC CFAS ) carried out between 1991 and 1994 . The sample was stratified to provide equal numbers in the 65 - 74 years and 75 years and over age groups . SETTING Three urban ( Newcastle , Nottingham and Oxford ) and two rural ( Cambridgeshire and Gwynedd ) centres . Older people living in both the general community and institutions were included . PARTICIPANTS 12489 older people whose medication data were collected among the 13009 participants of the CFAS , of which the participation rate is 80 % . RESULTS Overall prevalence of medication use was 75 % ( 95 % confidence interval 74 - 76 % ) for people aged 65 - 74 and 84 % ( 83 - 85 % ) for people aged 75 and over , with a mean number of 2.03 ( st and ard deviation 1.95 ) and 2.47 ( 2.02 ) drugs reported per respondent in each group , respectively . Concurrent use of five or more drugs ( polypharmacy ) was found in 11 % ( 10 - 12 % ) of people in the 65 - 74 age group and in 15 % ( 14 - 16 % ) in the 75 and over age group . People aged 75 and over were more likely to be taking at least one drug than people aged 65 - 74 ( OR=1.69 , 1.54 - 1.85 ) , and women were more likely to be so compared with men ( OR=1.43 , 1.30 - 1.56 ) . Centre variation was found but none of the centres consistently showed higher or lower usage of medications across the major drug categories . People living in institutions were more likely to be taking gastrointestinal drugs , central nervous system drugs and experience polypharmacy . The use of respiratory and central nervous system drugs ( except hypnotics and anxiolytics ) increased in lower social class and decreased in people attending full-time education for 10 years or more . The use of haematology/dietetic drugs ( 85 % of which were vitamin and mineral preparations ) decreased in lower social class . CONCLUSION This study provides representative estimates of medication usage among older people in Engl and and Wales and identified associated factors and regional variations for medication use in a category-specific manner . The findings , suggesting the existence of centre variation and the association between type of accommodation , social class and medication use warrant further investigation OBJECTIVE Clinical guidelines recommend that antidepressant treatment should be continued for a minimum of 6 months following response in depression and anxiety disorders . However , adherence to antidepressants is low . This prospect i ve cohort study investigated the influence of patients ' antidepressant concerns , treatment preferences , and illness perceptions on adherence to antidepressants over a 6-month period . METHOD A cohort of 178 patients aged 18 to 74 years and newly issued with a prescription for antidepressants to treat any condition was followed up prospect ively at 5 primary care practice s in Southeast Engl and .  Adherence was measured through self-report and prescription refill data . Patient perceptions were quantified using vali date d outcome measures , the  Beliefs about Medicine Question  naire and the  Illness Perception Question  naire , at 4 timepoints . Patient treatment preferences were recorded using a specially design ed question naire . Data collection took place between September 2000 and May 2002 . RESULTS Of 147 participants ( 83 % ) who completed the study , 19 % persisted with antidepressants in accordance with guideline recommendations throughout the 6-month period . Specific concern about antidepressant side effects ( OR = 3.30 , 95 % CI = 2.20 to 4.97 ) and general worry about taking antidepressants ( OR = 1.65 , 95 % CI = 1.13 to 2.40 ) were independent predictors of antidepressant nonuse . Preference for different treatment/uncertainty about preferred treatment was also a strong predictor ( OR = 3.82 , 95 % CI = 1.35 to 10.77 ) . However , illness perceptions were not associated with adherence . CONCLUSIONS Concerns about antidepressants and a mismatch between patients ' preferred and prescribed treatment act as significant barriers to sustained adherence . This study highlights the central role of the patient-physician partnership in exploring antidepressant concerns , working with treatment preferences , and providing supportive continued management . The findings may inform the development of interventions within primary care programs to enhance commitment to treatment for common mental disorders BACKGROUND Self-esteem is a major concern in mood disorders . Low self-esteem is a symptom of depressive disorders and is considered by some to be a predictor for relapse , whereas high self-esteem seems to buffer against depression . Recently ,  Competitive Memory Training ( COMET ) has shown to be effective for the enhancement of self-esteem 
    Output:
    
Very low quality evidence suggests that third wave CBT approaches appear to be more effective than treatment as usual in the treatment of acute depression .