human
***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 Depression is associated with immense suffering and costs , and many patients receive inadequate care , often because of the limited availability of treatment . Web-based treatments may play an increasingly important role in closing this gap between dem and and supply . We developed the integrative , Web-based program Deprexis , which covers therapeutic approaches such as behavioral activation , cognitive restructuring , mindfulness/acceptance exercises , and social skills training . OBJECTIVE To evaluate the effectiveness of the Web-based intervention in a r and omized controlled trial . METHODS There were 396 adults recruited via Internet depression forums in Germany , and they were r and omly assigned in an 80:20 weighted r and omization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual ( N = 320 ) , or to a 9-week delayed-access plus treatment-as-usual condition ( N = 76 ) . At pre- and post-treatment and 6-month follow-up , we measured depression ( Beck Depression Inventory ) as the primary outcome measure and social functioning ( Work and Social Adjustment Scale ) as the secondary outcome measure . Complete analyses and intention-to-treat analyses were performed . RESULTS Of 396 participants , 216 ( 55 % ) completed the post-measurement 9 weeks later . Available case analyses revealed a significant reduction in depression severity ( BDI ) , Cohen 's d = .64 ( CI 95 % = 0.33 - 0.94 ) , and significant improvement in social functioning ( WSA ) , Cohen 's d = .64 , 95 % ( CI 95 % = 0.33 - 0.95 ) . These improvements were maintained at 6-month follow-up . Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements ( BDI : Cohen 's d = .30 , CI 95 % = 0.05 - 0.55 ; WSA : Cohen 's d = .36 , CI 95 % = 0.10 - 0.61 ) . Moreover , a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms ( BDI : odds ratio [ OR ] = 6.8 , CI 95 % = 2.90 - 18.19 ) and recovered more often ( OR = 17.3 , 95 % CI 2.3 - 130 ) . More than 80 % of the users felt subjectively that the program had been helpful . CONCLUSIONS This integrative , Web-based intervention was effective in reducing symptoms of depression and in improving social functioning . Findings suggest that the program could serve as an adjunctive or st and -alone treatment tool for patients suffering from symptoms of depression Objective This report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse . Material s and Methods Primary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription . Patients responding to initial treatment but at high risk for relapse were r and omized to usual care or a relapse prevention intervention ( N = 386 ) . The 12-month relapse prevention program included systematic patient education , two psycho-educational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and ongoing monitoring of medication adherence and depressive symptoms via telephone and mail .  Disability outcomes were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months using SF-36 and Sheehan Disability scales . Results Usual care patients and relapse prevention program patients had high rates of use of maintenance pharmacotherapy . Both relapse prevention and usual care patients showed improved functioning over the 12-month follow-up period . One of the three disability measures ( the SF-36 Social Function scale ) showed a significant intervention effect because of continuing improvement at 9 and 12 month follow-up , whereas the Sheehan Disability Scale showed a nonsignificant trend toward greater improvements in disability among relapse prevention patients than among usual care controls . Conclusions Moderate effects of a relapse prevention intervention on depressive symptoms were associated with modest and variable effects on disability outcomes . Inconsistent effects of the intervention for disability outcomes may be because of the high rates of maintenance pharmacotherapy among usual care patients , relatively mild levels of depressive symptoms among both intervention and control patients at baseline , the absence of a specific relapse prevention effect of the intervention , and the result ant modest differences in depressive symptoms between intervention and control patients in this trial Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders , but little is known about what these programs change about families . The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy ( FFT ; n = 22 ) or crisis management with naturalistic follow-up ( CMNF ; n = 22 ) , both administered with maintenance pharmacotherapy . Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF , although no corresponding decreases were seen in negative interactional behaviors . The positive effect of family treatment on patients ' symptom trajectories over 1 year was partially mediated by increases in patients ' positive nonverbal interactional behaviors during this same interval This clinical project compares the relative impact of two types of multiple family groups on psychiatric in patients and their families . Forty patients with a diagnosis of affective disorder , and their family members , were r and omly assigned to a traditional multiple family group with a process orientation that emphasized support , destigmatization , and self-help about common problems ; or to a psychoeducational multiple family group that emphasized the provision of information about the patient 's illness and methods of coping with it effectively . Both groups , which met for four hours on a Saturday afternoon , were an integral part of an ongoing inpatient program specializing in the treatment of affective disorders . Pre- and post- measures were obtained regarding family and patient knowledge about affective disorders , level of personal distress , attitudes about the illness , and dyadic adjustment . In addition , both patients and family members were asked to rate their satisfaction with the group experience . A number of differences in knowledge , attitude and dyadic adjustment were found in the participants of both groups immediately following their respective group sessions , but there were only a few statistically significant differences between the two groups . Those who attended the psychoeducational session , however , reported significantly more satisfaction with the experience BACKGROUND Depression is a remitting but recurring disease . However , there is a paucity of prospect ively recorded data on the course of depression after recovery . METHOD A multi-centre prospect i ve serial follow-up study of an inception cohort of hitherto untreated unipolar major depression ( N = 95 ) for 6 years . We report the time to recurrence after recovery from the index depressive episode and their predictors . RESULTS The cumulative probability of remaining well without subthreshold symptoms was 57 % ( 95 % CI , 46 to 68 % ) at 1 year , 47 % ( 95 % CI , 36 to 58 % ) at 2 years and 35 % ( 95 % CI , 23 to 47 % ) at 5 years . The same without full relapse was 79 % ( 95 % CI , 70 to 88 % ) at 1 year , 70 % ( 95 % CI , 60 to 80 % ) at 2 years and 58 % ( 95 % CI , 46 to 70 % ) at 5 years . The median duration of well-interval from the end of the index episode to the beginning of the subthreshold episode was 19 - 0 months ( 95 % CI , 2 - 4 to 35 - 7 ) , and that to the end of the full episode was over 6 years . Residual symptoms at time of recovery predicted earlier recurrence . CONCLUSIONS The median length of the well-interval was much longer than previously reported in studies employing similar definitions but dealing with a more severe spectrum of patients . However , the sobering fact remains that less than half of the patients can expect to remain virtually symptom-free for 2 years or more after recovery from the depressive episode The relative benefit of adding a structured psychoeducational intervention to st and ard medication treatment for married patients with bipolar disorder and their spouses was assessed . Patients were r and omly assigned to receive either medication management or medication management plus a marital intervention with their spouses for an 11-month period . Patients '  symptoms , functioning , and adherence to their medication regimens were measured at study entry and at 11 months . Significant effects favoring the combined treatments were observed for overall patient functioning but not for symptom levels . The marital intervention was associated with improved medication adherence . Combined psychosocial and medication treatment does not affect patients ' symptom levels beyond the effects of medication alone , but it does result in significant incremental gains in overall patient functioning Abstract Objective To evaluate the efficacy of two internet interventions for community-dwelling individuals with symptoms of depression — a psychoeducation website offering information about depression and an interactive website offering cognitive behaviour therapy . Design R and omised controlled trial . Setting Internet users in the community , in Canberra , Australia . Participants 525 individuals with increased depressive symptoms recruited by survey and r and omly allocated to a website offering information about depression ( n = 166 ) or a cognitive behaviour therapy website ( n = 182 ) , or a control intervention using an attention placebo ( n = 178 ) . Main outcome measures Change in depression , dysfunctional thoughts ; knowledge of medical , psychological , and lifestyle treatments ; and knowledge of cognitive behaviour therapy . Results Intention to treat analyses indicated that information about depression and interventions that used cognitive behaviour therapy and were delivered via the internet were more effective than a credible control intervention in reducing symptoms of depression in a community sample . For the intervention that delivered cognitive behaviour therapy the reduction in score on the depression scale of the Center for Epidemiologic Studies was 3.2 ( 95 % confidence interval 0.9 to 5.4 ) . For the “ depression literacy ” site ( BluePages ) , the reduction was 3.0 ( 95 % confidence interval 0.6 to 5.2 ) . Cognitive behaviour therapy ( MoodGYM )  reduced dysfunctional thinking and increased knowledge of cognitive behaviour therapy . Depression literacy ( BluePages ) significantly improved participants ' underst and ing of effective evidence based treatments for depression ( P < 0.05 ) . Conclusions Both cognitive behaviour therapy and psychoeducation delivered via the internet are effective in reducing symptoms of depression Background Coping with  Depression Course ( CWD ) has shown to be effective in the treatment of depression . However , there are very few r and omized controlled trials on unipolar depression in adults Aims To test the effect of a modified CWD on unipolar depression in a r and omized controlled trial design in adults . Methods Participants were recruited through mass media , tested by BDI and clinical interview , and r and omized into intervention group ( N = 81 ) and control group ( N = 74 ) . The program was mainly conducted by nurses with background in psychiatry and primary health care , and the intervention encompassed 8 weekly sessions of 2 1/2 hours , with 3 booster sessions . Results By " intention-to-treat " analysis a statistically significant effect on depressive symptoms at follow up at 6 months was found , and the level of symptoms was sustained after 12 months . Conclusion The study shows that the intervention is effective in the treatment of unipolar depression , and suitable for specialized psychiatric services as well as primary health care In a waiting-list controlled study on a multi-family psycho-educational intervention in bipolar disorder , key relatives in the treatment group showed a significant change from high to low levels of expressed emotion ( EE ) compared with the control group . In addition , patients with low-EE key relatives had a significantly lower number of hospital admissions compared with those living with high-EE key relatives . The multi-family groups were well received by the participants , and there were only a few drop-outs Objective . Evaluate the incremental cost-effectiveness of a  depression relapse prevention program in primary care Material s and Methods . Primary care patients initiating antidepressant treatment completed a st and ardized telephone assessment 6–8 weeks later . Those recovered from the current episode but at high risk for relapse ( based on history of recurrent depression or dysthymia ) were offered r and omization to usual care or a relapse prevention intervention . The intervention included systematic patient education , two psychoeducational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and telephone and mail monitoring of medication adherence and depressive symptoms . Outcomes in both groups were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months and health plan cl aims and accounting data . Results . Intervention patients experienced 13.9 additional depression-free days during a 12-month period ( 95 % CI , −1.5 to 29.3 ) . Incremental costs of the intervention were $ 273 ( 95 % CI , $ 102 to $ 418 ) for depression treatment costs only and $ 160 ( 95 % CI , −$173 to $ 512 ) for total outpatient costs . Incremental cost-effectiveness ratio was $ 24 per depression-free day ( 95 % CI , −$59 to $ 496 ) for depression treatment costs only and $ 14 per depression-free day ( 95 % CI , −$35 to $ 248 ) for total outpatient costs . Conclusions . A program to prevent de 
    Output:
    
agent
Conclusions : Psychoeducation is a psychosocial treatment that has been well documented as an adjunct to pharmacological therapy .
However , there are only a few studies regarding its effectiveness on adult patients with major depressive disorder .
Although the publications in this area are still very limited , the articles selected in this review suggest that psychoeducation is effective in improving the clinical course , treatment adherence , and psychosocial functioning of depressive patients
***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 Depression is associated with immense suffering and costs , and many patients receive inadequate care , often because of the limited availability of treatment . Web-based treatments may play an increasingly important role in closing this gap between dem and and supply . We developed the integrative , Web-based program Deprexis , which covers therapeutic approaches such as behavioral activation , cognitive restructuring , mindfulness/acceptance exercises , and social skills training . OBJECTIVE To evaluate the effectiveness of the Web-based intervention in a r and omized controlled trial . METHODS There were 396 adults recruited via Internet depression forums in Germany , and they were r and omly assigned in an 80:20 weighted r and omization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual ( N = 320 ) , or to a 9-week delayed-access plus treatment-as-usual condition ( N = 76 ) . At pre- and post-treatment and 6-month follow-up , we measured depression ( Beck Depression Inventory ) as the primary outcome measure and social functioning ( Work and Social Adjustment Scale ) as the secondary outcome measure . Complete analyses and intention-to-treat analyses were performed . RESULTS Of 396 participants , 216 ( 55 % ) completed the post-measurement 9 weeks later . Available case analyses revealed a significant reduction in depression severity ( BDI ) , Cohen 's d = .64 ( CI 95 % = 0.33 - 0.94 ) , and significant improvement in social functioning ( WSA ) , Cohen 's d = .64 , 95 % ( CI 95 % = 0.33 - 0.95 ) . These improvements were maintained at 6-month follow-up . Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements ( BDI : Cohen 's d = .30 , CI 95 % = 0.05 - 0.55 ; WSA : Cohen 's d = .36 , CI 95 % = 0.10 - 0.61 ) . Moreover , a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms ( BDI : odds ratio [ OR ] = 6.8 , CI 95 % = 2.90 - 18.19 ) and recovered more often ( OR = 17.3 , 95 % CI 2.3 - 130 ) . More than 80 % of the users felt subjectively that the program had been helpful . CONCLUSIONS This integrative , Web-based intervention was effective in reducing symptoms of depression and in improving social functioning . Findings suggest that the program could serve as an adjunctive or st and -alone treatment tool for patients suffering from symptoms of depression Objective This report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse . Material s and Methods Primary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription . Patients responding to initial treatment but at high risk for relapse were r and omized to usual care or a relapse prevention intervention ( N = 386 ) . The 12-month relapse prevention program included systematic patient education , two psycho-educational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and ongoing monitoring of medication adherence and depressive symptoms via telephone and mail .  Disability outcomes were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months using SF-36 and Sheehan Disability scales . Results Usual care patients and relapse prevention program patients had high rates of use of maintenance pharmacotherapy . Both relapse prevention and usual care patients showed improved functioning over the 12-month follow-up period . One of the three disability measures ( the SF-36 Social Function scale ) showed a significant intervention effect because of continuing improvement at 9 and 12 month follow-up , whereas the Sheehan Disability Scale showed a nonsignificant trend toward greater improvements in disability among relapse prevention patients than among usual care controls . Conclusions Moderate effects of a relapse prevention intervention on depressive symptoms were associated with modest and variable effects on disability outcomes . Inconsistent effects of the intervention for disability outcomes may be because of the high rates of maintenance pharmacotherapy among usual care patients , relatively mild levels of depressive symptoms among both intervention and control patients at baseline , the absence of a specific relapse prevention effect of the intervention , and the result ant modest differences in depressive symptoms between intervention and control patients in this trial Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders , but little is known about what these programs change about families . The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy ( FFT ; n = 22 ) or crisis management with naturalistic follow-up ( CMNF ; n = 22 ) , both administered with maintenance pharmacotherapy . Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF , although no corresponding decreases were seen in negative interactional behaviors . The positive effect of family treatment on patients ' symptom trajectories over 1 year was partially mediated by increases in patients ' positive nonverbal interactional behaviors during this same interval This clinical project compares the relative impact of two types of multiple family groups on psychiatric in patients and their families . Forty patients with a diagnosis of affective disorder , and their family members , were r and omly assigned to a traditional multiple family group with a process orientation that emphasized support , destigmatization , and self-help about common problems ; or to a psychoeducational multiple family group that emphasized the provision of information about the patient 's illness and methods of coping with it effectively . Both groups , which met for four hours on a Saturday afternoon , were an integral part of an ongoing inpatient program specializing in the treatment of affective disorders . Pre- and post- measures were obtained regarding family and patient knowledge about affective disorders , level of personal distress , attitudes about the illness , and dyadic adjustment . In addition , both patients and family members were asked to rate their satisfaction with the group experience . A number of differences in knowledge , attitude and dyadic adjustment were found in the participants of both groups immediately following their respective group sessions , but there were only a few statistically significant differences between the two groups . Those who attended the psychoeducational session , however , reported significantly more satisfaction with the experience BACKGROUND Depression is a remitting but recurring disease . However , there is a paucity of prospect ively recorded data on the course of depression after recovery . METHOD A multi-centre prospect i ve serial follow-up study of an inception cohort of hitherto untreated unipolar major depression ( N = 95 ) for 6 years . We report the time to recurrence after recovery from the index depressive episode and their predictors . RESULTS The cumulative probability of remaining well without subthreshold symptoms was 57 % ( 95 % CI , 46 to 68 % ) at 1 year , 47 % ( 95 % CI , 36 to 58 % ) at 2 years and 35 % ( 95 % CI , 23 to 47 % ) at 5 years . The same without full relapse was 79 % ( 95 % CI , 70 to 88 % ) at 1 year , 70 % ( 95 % CI , 60 to 80 % ) at 2 years and 58 % ( 95 % CI , 46 to 70 % ) at 5 years . The median duration of well-interval from the end of the index episode to the beginning of the subthreshold episode was 19 - 0 months ( 95 % CI , 2 - 4 to 35 - 7 ) , and that to the end of the full episode was over 6 years . Residual symptoms at time of recovery predicted earlier recurrence . CONCLUSIONS The median length of the well-interval was much longer than previously reported in studies employing similar definitions but dealing with a more severe spectrum of patients . However , the sobering fact remains that less than half of the patients can expect to remain virtually symptom-free for 2 years or more after recovery from the depressive episode The relative benefit of adding a structured psychoeducational intervention to st and ard medication treatment for married patients with bipolar disorder and their spouses was assessed . Patients were r and omly assigned to receive either medication management or medication management plus a marital intervention with their spouses for an 11-month period . Patients '  symptoms , functioning , and adherence to their medication regimens were measured at study entry and at 11 months . Significant effects favoring the combined treatments were observed for overall patient functioning but not for symptom levels . The marital intervention was associated with improved medication adherence . Combined psychosocial and medication treatment does not affect patients ' symptom levels beyond the effects of medication alone , but it does result in significant incremental gains in overall patient functioning Abstract Objective To evaluate the efficacy of two internet interventions for community-dwelling individuals with symptoms of depression — a psychoeducation website offering information about depression and an interactive website offering cognitive behaviour therapy . Design R and omised controlled trial . Setting Internet users in the community , in Canberra , Australia . Participants 525 individuals with increased depressive symptoms recruited by survey and r and omly allocated to a website offering information about depression ( n = 166 ) or a cognitive behaviour therapy website ( n = 182 ) , or a control intervention using an attention placebo ( n = 178 ) . Main outcome measures Change in depression , dysfunctional thoughts ; knowledge of medical , psychological , and lifestyle treatments ; and knowledge of cognitive behaviour therapy . Results Intention to treat analyses indicated that information about depression and interventions that used cognitive behaviour therapy and were delivered via the internet were more effective than a credible control intervention in reducing symptoms of depression in a community sample . For the intervention that delivered cognitive behaviour therapy the reduction in score on the depression scale of the Center for Epidemiologic Studies was 3.2 ( 95 % confidence interval 0.9 to 5.4 ) . For the “ depression literacy ” site ( BluePages ) , the reduction was 3.0 ( 95 % confidence interval 0.6 to 5.2 ) . Cognitive behaviour therapy ( MoodGYM )  reduced dysfunctional thinking and increased knowledge of cognitive behaviour therapy . Depression literacy ( BluePages ) significantly improved participants ' underst and ing of effective evidence based treatments for depression ( P < 0.05 ) . Conclusions Both cognitive behaviour therapy and psychoeducation delivered via the internet are effective in reducing symptoms of depression Background Coping with  Depression Course ( CWD ) has shown to be effective in the treatment of depression . However , there are very few r and omized controlled trials on unipolar depression in adults Aims To test the effect of a modified CWD on unipolar depression in a r and omized controlled trial design in adults . Methods Participants were recruited through mass media , tested by BDI and clinical interview , and r and omized into intervention group ( N = 81 ) and control group ( N = 74 ) . The program was mainly conducted by nurses with background in psychiatry and primary health care , and the intervention encompassed 8 weekly sessions of 2 1/2 hours , with 3 booster sessions . Results By " intention-to-treat " analysis a statistically significant effect on depressive symptoms at follow up at 6 months was found , and the level of symptoms was sustained after 12 months . Conclusion The study shows that the intervention is effective in the treatment of unipolar depression , and suitable for specialized psychiatric services as well as primary health care In a waiting-list controlled study on a multi-family psycho-educational intervention in bipolar disorder , key relatives in the treatment group showed a significant change from high to low levels of expressed emotion ( EE ) compared with the control group . In addition , patients with low-EE key relatives had a significantly lower number of hospital admissions compared with those living with high-EE key relatives . The multi-family groups were well received by the participants , and there were only a few drop-outs Objective . Evaluate the incremental cost-effectiveness of a  depression relapse prevention program in primary care Material s and Methods . Primary care patients initiating antidepressant treatment completed a st and ardized telephone assessment 6–8 weeks later . Those recovered from the current episode but at high risk for relapse ( based on history of recurrent depression or dysthymia ) were offered r and omization to usual care or a relapse prevention intervention . The intervention included systematic patient education , two psychoeducational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and telephone and mail monitoring of medication adherence and depressive symptoms . Outcomes in both groups were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months and health plan cl aims and accounting data . Results . Intervention patients experienced 13.9 additional depression-free days during a 12-month period ( 95 % CI , −1.5 to 29.3 ) . Incremental costs of the intervention were $ 273 ( 95 % CI , $ 102 to $ 418 ) for depression treatment costs only and $ 160 ( 95 % CI , −$173 to $ 512 ) for total outpatient costs . Incremental cost-effectiveness ratio was $ 24 per depression-free day ( 95 % CI , −$59 to $ 496 ) for depression treatment costs only and $ 14 per depression-free day ( 95 % CI , −$35 to $ 248 ) for total outpatient costs . Conclusions . A program to prevent de 
    Output:
    