***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: Outcomes of seven treatment trials comparing cognitive behavioral therapy to treatment with tricyclic antidepressant medication in major depressive disorder have been quite similar to one another . This led us to question whether treatment outcome in time-limited studies reflected a unique effect of cognitive behavioral therapy . To test the uniqueness hypothesis , relaxation training , a nonpharmacologic , noncognitive treatment , was chosen as a comparison for cognitive behavioral therapy as well as drug therapy . Treatment duration was 16 weeks . The sample of 37 patients treated for major depressive disorder was less depressed than those previously studied . For both cognitive behavioral therapy and relaxation training , outcome of depression was superior to that of tricyclic antidepressant medication by endpoint analysis . The posttreatment scores on the Beck Depression Inventory of 82 % of the group receiving cognitive behavioral therapy improved to a Beck Depression Inventory score ≤9 which was not significantly greater than that for the group receiving relaxation training.(73 % ) , so a unique effect was not demonstrated for cognitive behavioral therapy . The outcome for tricyclic antidepressant medication  ( 29 % improved to criteria ) was significantly worse than that for cognitive behavioral therapy . The patient 's pretreatment initial expectancy was not predictive 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 In a study design ed to maximize the effectiveness of treatment by allowing participants to select the target of treatment , 40 depressed older adults were r and omly assigned to a waiting-list control condition or to conditions in which the target of treatment was either chosen or assigned . All participants received self-management therapy and the choice was between changing behavior or changing cognition . It was found that individually administered self-management therapy was effective in treating depression  for older adults . There were no differences in outcome between versions of  self-management therapy  that targeted behavioral or cognitive change . Among those who completed treatment , there were no differences in outcome between those who received a choice and those who did not . Individuals who were given a choice of treatment options , however , were less likely to drop out of treatment prematurely 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 OBJECTIVE Different studies show the negative effects on caregivers ' health of maladaptive thoughts and the positive effects of engaging in pleasurable activities on distress . The aim of this study is to ( a ) test the efficacy of a cognitive-behavioral intervention aim ed at training caregivers to flexibilize maladaptive thoughts regarding caregiving and increasing their leisure activities and to ( b ) analyse the mediator role in the effects of the intervention of caregivers ' change in dysfunctional thoughts and behavioral activation . METHODS A total of 170 caregivers were contacted and r and omly distributed to the intervention condition or to the control group .  Depression , behavioral activation , and dysfunctional thoughts were assessed at baseline and post-intervention by ' blinded ' interviewers . The intervention consisted in twelve group based sessions in which in addition to cognitive-behavioral techniques , caregivers ' were trained in basic principles for caring for a relative with dementia . RESULTS Significant intervention by time effects were found for depression , dysfunctional thoughts and frequency of leisure activities . Only significant positive effects were found for the intervention group . The regression analysis for testing mediational effects of dysfunctional thoughts and leisure activities on the relationship between participating on the intervention and changes in depressive symptomatology show that mediation is established in both cases . CONCLUSIONS The results of our study contribute to the literature on interventions for dementia caregivers highlighting the positive mediator effect that modifying caregivers ' dysfunctional thoughts and increasing their behavioral activation has on caregivers ' depressive symptomatology Older adults who met criteria for major depressive disorder were r and omly assigned to behavioral , cognitive , or brief dynamic therapy . Symptoms were equally reduced across the three treatment conditions . Early in treatment , alliance ratings were obtained from both therapists and patients and were related to outcome . We calculated one therapist alliance composite score and five patient alliance factor scores . In general , no agreement was found between therapists ' and patients ' judgments of alliance . Levels of alliance were found to be not significantly different across the three treatment conditions . For the sample as a whole , only the patient factor of Patient Commitment was found to be associated with depressive symptoms after treatment , with the strongest findings in the cognitive therapy condition . The Patient Commitment factor uniquely contributed to outcome over and above the contribution of initial symptomatology and symptomatic change at midpoint in therapy . Expected trends of association with outcome were observed for the therapist alliance composite score in brief dynamic therapy and for the patient factor of Patient Working Capacity in both cognitive and brief dynamic therapy . Findings are discussed in terms of their theoretical and clinical implication 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 Cross-sectional and longitudinal data are presented from a 2-year follow-up study of 91 older adults , initially diagnosed as in an episode of major depressive disorder ( MDD ) , who were treated with brief cognitive , behavioral , or psychodynamic psychotherapy .  Using research diagnostic criteria ( RDC ) , 52 % , 58 % , and 70 % of the sample did not meet criteria for any RDC depressive disorder at posttherapy , and 12- and 24-month follow-ups , respectively . There were no significant differences in response rate by therapy modality . Using  Longitudinal Interval Follow-up Evaluation ( LIFE ; Shapiro & Keller , 1979 ; Keller et al. , 1987 ) methodology , we noted that patients not depressed at posttreatment remained depression-free for longer time periods than those who were minor or MDD . These rates compare favorably with published reports on younger depressed patients 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 .  
    Output:
    
AUTHORS ' CONCLUSIONS We found low- to moderate- quality evidence that behavioural therapies and other psychological therapies are equally effective .