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: Rates of recurrent depression peak among women in their childbearing years , yet a large number of these women are not treated or do not seek maintenance treatment between episodes . Barriers to treatment include time constraints , dem and s of child care , and finances . A method for improving access to treatment of depression may be delivery of psychotherapy over the telephone . A 12‐week pilot controlled clinical trial with r and om assignment was conducted to test the feasibility and efficacy of Interpersonal Psychotherapy delivered over the telephone ( IPT‐T ) for depression in women ( N=15 IPT‐T and N=15 no treatment ) with a life‐time history of recurrent depression and low rates of previous treatment . Patients were interviewed at baseline and at 12 weeks by a blind and independent clinical evaluator to assess their symptom level and social functioning . IPT‐T as compared to no treatment was significantly better in lowering symptoms of depression as measured by the Hamilton Rating Scale for Depression ( p<.02 ) , improving global functioning ( GAS ) ( p<.02 ) , and improving work and social functioning ( p<.03–.05 , respectively ) . These preliminary findings support the feasibility and helpfulness of IPT‐T in preventing an increase in depressive symptoms among women with recurrent depression but current mild to moderately levels of depression .  Depression and Anxiety 16:114–117 , 2002 . © 2002 Wiley‐Liss , Background : Although face-to-face cognitive – behavioral therapy ( CBT ) was found to be beneficial for the treatment of depression in Parkinson disease ( dPD ) in a recent r and omized-controlled trial , access to care was identified as a critical issue that needs to be addressed in order to improve the management of this nonmotor complication in PD . The purpose of this study was to examine the feasibility and effect of telephone-based CBT for dPD . Methods : Twenty-one depressed people with PD participated in a National Institutes of Health – sponsored uncontrolled pilot trial of  telephone-based CBT  in an academic medical center from October 2009 to February 2011 . The Hamilton Depression Rating Scale was the primary outcome . Treatment was provided to people with PD for 10 weeks , modified for delivery over the phone , and supplemented with 4 separate phone-based caregiver educational sessions . Assessment s were completed at baseline and 5 ( midpoint ) , 10 ( end-of-treatment ) , and 14 weeks ( follow-up ) post-enrollment . Results : Twenty ( 95 % ) people with PD completed the study treatment  . Phone-based CBT was associated with significant improvements in depression , anxiety , negative thoughts , and coping . Mean Hamilton Depression Rating Scale change from baseline to week 10 was 7.91 points ( P < .001 , Cohen d = 1.21 ) . Conclusions : Telephone-based CBT may be a feasible and helpful approach for treating dPD and warrants further exploration in r and omized-controlled trials . Results were comparable to those observed in the few in-person cognitive – behavioral treatment studies for dPD conducted to date BACKGROUND There is substantial evidence that antidepressant medications treat moderate to severe depression effectively , but there is less data on cognitive therapy 's effects in this population . OBJECTIVE To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial . DESIGN R and om assignment to one of the following : 16 weeks of medications ( n = 120 ) , 16 weeks of cognitive therapy ( n = 60 ) , or 8 weeks of pill placebo ( n = 60 ) . SETTING Research clinics at the University of Pennsylvania , Philadelphia , and V and erbilt University , Nashville , Tenn. PATIENTS Two hundred forty out patients , aged 18 to 70 years , with moderate to severe major depressive disorder . INTERVENTIONS Some study subjects received paroxetine , up to 50 mg daily , augmented by lithium carbonate or desipramine hydrochloride if necessary ; others received individual cognitive therapy . MAIN OUTCOME MEASURE The Hamilton Depression Rating Scale provided continuous severity scores and allowed for design ations of response and remission . RESULTS At 8 weeks , response rates in medications ( 50 % ) and cognitive therapy ( 43 % ) groups were both superior to the placebo ( 25 % ) group . Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo , each with a medium effect size . The advantage was significant for medication relative to placebo , and at the level of a nonsignificant trend for cognitive therapy relative to placebo . At 16 weeks , response rates were 58 % in each of the active conditions ; remission rates were 46 % for medication , 40 % for cognitive therapy . Follow-up tests of a site x treatment interaction indicated a significant difference only at V and erbilt University , where medications were superior to cognitive therapy . Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction . CONCLUSION Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression , but this degree of effectiveness may depend on a high level of therapist experience or expertise BACKGROUND Several studies have shown that telephone-administered cognitive-behavioral therapy ( T-CBT ) is superior to forms of no treatment controls . No study has examined if the skills-training component to T-CBT provides any benefit beyond that provided by nonspecific factors . OBJECTIVE To test the efficacy of a 16-week T-CBT against a strong control for attention and nonspecific therapy effects . DESIGN R and omized controlled trial including 12-month follow-up . SETTING Telephone administration of psychotherapy with patients in their homes . PARTICIPANTS Participants had depression and functional impairments due to multiple sclerosis . INTERVENTIONS A 16-week T-CBT program was compared with 16 weeks of telephone-administered supportive emotion-focused therapy . MAIN OUTCOME MEASURES Hamilton Depression Rating Scale score , Structured Clinical Interview for DSM-IV diagnosis of major depressive disorder , Beck Depression Inventory score , and Positive Affect scale score of the Positive and Negative Affect Scale . RESULTS Of the 127 participants r and omized , 7 ( 5.5 % ) dropped out of treatment . There were significant improvement during treatment on all outcome measures ( P<.01 for all ) and an increase in Positive Affect Scale score . Improvements over 16 weeks of treatment were significantly greater for T-CBT , compared with telephone-administered supportive emotion-focused therapy , for major depressive disorder frequency ( P = .02 ) , Hamilton Depression Rating Scale score ( P = .02 ) , and Positive Affect Scale score ( P = .008 ) , but not for the Beck Depression Inventory score ( P = .29 ) . Treatment gains were maintained during 12-month follow-up ; however , differences across treatments were no longer evident ( P > .16 for all ) . CONCLUSIONS Patients showed significant improvements in depression and positive affect during the 16 weeks of telephone-administered treatment . The specific cognitive-behavioral components of T-CBT produced improvements above and beyond the nonspecific effects of telephone-administered supportive emotion-focused therapy on evaluator-rated measures of depression and self-reported positive affect . Attrition was low OBJECTIVE Rural areas account for approximately 6 % of AIDS cases in the United States . Many HIV-infected persons in rural areas live with elevated levels of psychiatric distress , suicidal ideation , and loneliness . This pilot study tested whether brief interpersonal psychotherapy delivered via telephone could reduce psychiatric distress among persons living with HIV-AIDS in rural areas in the United States . METHODS Seventy-nine participants were assigned r and omly to a usual care control condition or to a six-session , telephone-delivered , interpersonal psychotherapy intervention ( hereafter referred to as the teletherapy group ) ; participants in the teletherapy group continued to receive st and ard services available to them in the community . Participants completed self-administered surveys pre- and postintervention that assessed depressive and psychiatric symptoms , perceptions of loneliness , and social support . RESULTS Participants in the teletherapy group evidence d greater reductions in depressive symptoms and in overall levels of psychiatric distress , compared with those in the control group . Nearly one-third of teletherapy participants reported clinical ly meaningful reductions in psychiatric distress from pre- to postintervention . CONCLUSIONS The telephone-delivered interpersonal therapy intervention showed potential to reduce depressive and psychiatric symptoms among HIV-infected persons in rural areas . On the basis of these encouraging findings , additional research examining this intervention with this clinical population is warranted OBJECTIVE Multiple trials have found telephone-administered cognitive behavioral therapy ( T-CBT ) to be effective for the treatment of depression . The aim of this study was to evaluate T-CBT for the treatment of depression among veterans served by community-based outpatient clinics ( CBOCs ) outside of major urban areas . METHOD Eighty-five veterans meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; American Psychiatric Association , 1994 ) criteria for major depressive disorder were r and omized to receive 16 sessions of T-CBT over 20 weeks or treatment as usual through the CBOC . Veterans were assessed at baseline , 12 weeks , 20 weeks ( posttreatment ) , and 6-month follow-up using the Hamilton Depression Rating Scale ( Hamilton , 1960 ) , the Patient Health Question naire-9 ( Kroenke , Spitzer , & Williams , 2001 ) , and a st and ardized psychiatric interview . RESULTS There were no significant Time × Treatment effects ( ps > .20 ) . Patients were compliant , with 38 ( 92.7 % ) completing at least 12 sessions , and 32 ( 78.0 % ) having no missed sessions whatsoever . Ratings of audiotaped sessions showed the therapists to be highly competent . CONCLUSIONS This trial yielded negative results for an intervention that has been shown to be effective under other circumstances . We speculate that veterans served within the Veterans Affairs system are more refractory to treatment than other population s , and they may require a more rigorous intervention . TRIAL REGISTRATION clinical trials.gov NCT00223652 Given the burden of depression among those with HIV , and the impact of HIV on urban minority communities there is an urgent need to assess innovative treatment interventions that not only treat depression but do so in a way that allows for increased access to mental health care . This single site , uncontrolled , pilot study sought to determine the feasibility and depression outcomes of an 11-session telephone-based cognitive behavioral therapy intervention delivered over 14 weeks targeting low-income , urban-dwelling , HIV-infected African-American people with major depression . The diagnosis of major depression was made using the Mini International Neuropsychiatric Interview . The primary outcome was the Hamilton Depression Rating Scale ( HAM-D ) and the secondary outcome was the Quick Inventory of Depression Symptomatology-Self Report ( QIDS-SR ) . Feasibility and satisfaction were also assessed . Assessment s occurred at baseline , midpoint and at study conclusion ( 14 weeks ) . Fifteen people were screened for the study . Six HIV-infected , low-income , African-American people individuals ( five females and one male ) were eligible and participated in the study . All patients finished the study . On average , participants completed nine sessions . The sessions lasted for an average of 48 min ( SD = 11.5 ) . Compared to mean HAM-D score at baseline ( HAM-D = 22.8 ( SD = 3.1 ) , the mean HAM-D score was significantly reduced at study conclusion ( HAM-D = 9.8 ( SD = 7.4 ) ; ( t ( 5 ) = 4.6 , p = 0.006 ) ; ( Cohen d = 1.9 ) ) . Compared to the mean QIDS-SR score at baseline ( QIDS-SR = 15.5 ( SD = 4.2 ) the mean QIDS score was significantly reduced at study conclusion ( QIDS = 7.0 ( SD = 5.4);(t ( 5 ) = 3.2 , p = 0.02 ) ; ( Cohen d = 1.3)).The mean satisfaction scores across all participants at post-treatment was 5.7 ( SD = 0.3 ) with of a maximum score of 6 . Telephone-based CBT can be delivered to low-income , urban-dwelling ethnic minority HIV-infected people result ing in significant reductions in depression symptoms with high satisfaction . The efficacy of this intervention will be assessed in a planned r and omized control trial The purpose of this study was to determine the efficacy of a structured exposure-based behavior therapy program delivered by telephone to agoraphobic individuals who were isolated from specialized treatment centres . Forty-two individuals with a DSM-III-R diagnosis of panic disorder with agoraphobia who were living in rural areas of Ontario were assigned to either an eight-session telephone behavior therapy program or wait-list control condition . There were significant treatment x time interaction effects on several outcome variables . Patients originally in the wait-list group then received the same type of therapy and they also significantly improved . All treatment gains were maintained at three-month and six-month follow-up . Telephone behavior therapy appears to be a cost-effective and efficacious treatment for agoraphobics living in remote regions where specialized anxiety disorder services are not readily available 
    Output:
    
agent
***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: Rates of recurrent depression peak among women in their childbearing years , yet a large number of these women are not treated or do not seek maintenance treatment between episodes . Barriers to treatment include time constraints , dem and s of child care , and finances . A method for improving access to treatment of depression may be delivery of psychotherapy over the telephone . A 12‐week pilot controlled clinical trial with r and om assignment was conducted to test the feasibility and efficacy of Interpersonal Psychotherapy delivered over the telephone ( IPT‐T ) for depression in women ( N=15 IPT‐T and N=15 no treatment ) with a life‐time history of recurrent depression and low rates of previous treatment . Patients were interviewed at baseline and at 12 weeks by a blind and independent clinical evaluator to assess their symptom level and social functioning . IPT‐T as compared to no treatment was significantly better in lowering symptoms of depression as measured by the Hamilton Rating Scale for Depression ( p<.02 ) , improving global functioning ( GAS ) ( p<.02 ) , and improving work and social functioning ( p<.03–.05 , respectively ) . These preliminary findings support the feasibility and helpfulness of IPT‐T in preventing an increase in depressive symptoms among women with recurrent depression but current mild to moderately levels of depression .  Depression and Anxiety 16:114–117 , 2002 . © 2002 Wiley‐Liss , Background : Although face-to-face cognitive – behavioral therapy ( CBT ) was found to be beneficial for the treatment of depression in Parkinson disease ( dPD ) in a recent r and omized-controlled trial , access to care was identified as a critical issue that needs to be addressed in order to improve the management of this nonmotor complication in PD . The purpose of this study was to examine the feasibility and effect of telephone-based CBT for dPD . Methods : Twenty-one depressed people with PD participated in a National Institutes of Health – sponsored uncontrolled pilot trial of  telephone-based CBT  in an academic medical center from October 2009 to February 2011 . The Hamilton Depression Rating Scale was the primary outcome . Treatment was provided to people with PD for 10 weeks , modified for delivery over the phone , and supplemented with 4 separate phone-based caregiver educational sessions . Assessment s were completed at baseline and 5 ( midpoint ) , 10 ( end-of-treatment ) , and 14 weeks ( follow-up ) post-enrollment . Results : Twenty ( 95 % ) people with PD completed the study treatment  . Phone-based CBT was associated with significant improvements in depression , anxiety , negative thoughts , and coping . Mean Hamilton Depression Rating Scale change from baseline to week 10 was 7.91 points ( P < .001 , Cohen d = 1.21 ) . Conclusions : Telephone-based CBT may be a feasible and helpful approach for treating dPD and warrants further exploration in r and omized-controlled trials . Results were comparable to those observed in the few in-person cognitive – behavioral treatment studies for dPD conducted to date BACKGROUND There is substantial evidence that antidepressant medications treat moderate to severe depression effectively , but there is less data on cognitive therapy 's effects in this population . OBJECTIVE To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial . DESIGN R and om assignment to one of the following : 16 weeks of medications ( n = 120 ) , 16 weeks of cognitive therapy ( n = 60 ) , or 8 weeks of pill placebo ( n = 60 ) . SETTING Research clinics at the University of Pennsylvania , Philadelphia , and V and erbilt University , Nashville , Tenn. PATIENTS Two hundred forty out patients , aged 18 to 70 years , with moderate to severe major depressive disorder . INTERVENTIONS Some study subjects received paroxetine , up to 50 mg daily , augmented by lithium carbonate or desipramine hydrochloride if necessary ; others received individual cognitive therapy . MAIN OUTCOME MEASURE The Hamilton Depression Rating Scale provided continuous severity scores and allowed for design ations of response and remission . RESULTS At 8 weeks , response rates in medications ( 50 % ) and cognitive therapy ( 43 % ) groups were both superior to the placebo ( 25 % ) group . Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo , each with a medium effect size . The advantage was significant for medication relative to placebo , and at the level of a nonsignificant trend for cognitive therapy relative to placebo . At 16 weeks , response rates were 58 % in each of the active conditions ; remission rates were 46 % for medication , 40 % for cognitive therapy . Follow-up tests of a site x treatment interaction indicated a significant difference only at V and erbilt University , where medications were superior to cognitive therapy . Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction . CONCLUSION Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression , but this degree of effectiveness may depend on a high level of therapist experience or expertise BACKGROUND Several studies have shown that telephone-administered cognitive-behavioral therapy ( T-CBT ) is superior to forms of no treatment controls . No study has examined if the skills-training component to T-CBT provides any benefit beyond that provided by nonspecific factors . OBJECTIVE To test the efficacy of a 16-week T-CBT against a strong control for attention and nonspecific therapy effects . DESIGN R and omized controlled trial including 12-month follow-up . SETTING Telephone administration of psychotherapy with patients in their homes . PARTICIPANTS Participants had depression and functional impairments due to multiple sclerosis . INTERVENTIONS A 16-week T-CBT program was compared with 16 weeks of telephone-administered supportive emotion-focused therapy . MAIN OUTCOME MEASURES Hamilton Depression Rating Scale score , Structured Clinical Interview for DSM-IV diagnosis of major depressive disorder , Beck Depression Inventory score , and Positive Affect scale score of the Positive and Negative Affect Scale . RESULTS Of the 127 participants r and omized , 7 ( 5.5 % ) dropped out of treatment . There were significant improvement during treatment on all outcome measures ( P<.01 for all ) and an increase in Positive Affect Scale score . Improvements over 16 weeks of treatment were significantly greater for T-CBT , compared with telephone-administered supportive emotion-focused therapy , for major depressive disorder frequency ( P = .02 ) , Hamilton Depression Rating Scale score ( P = .02 ) , and Positive Affect Scale score ( P = .008 ) , but not for the Beck Depression Inventory score ( P = .29 ) . Treatment gains were maintained during 12-month follow-up ; however , differences across treatments were no longer evident ( P > .16 for all ) . CONCLUSIONS Patients showed significant improvements in depression and positive affect during the 16 weeks of telephone-administered treatment . The specific cognitive-behavioral components of T-CBT produced improvements above and beyond the nonspecific effects of telephone-administered supportive emotion-focused therapy on evaluator-rated measures of depression and self-reported positive affect . Attrition was low OBJECTIVE Rural areas account for approximately 6 % of AIDS cases in the United States . Many HIV-infected persons in rural areas live with elevated levels of psychiatric distress , suicidal ideation , and loneliness . This pilot study tested whether brief interpersonal psychotherapy delivered via telephone could reduce psychiatric distress among persons living with HIV-AIDS in rural areas in the United States . METHODS Seventy-nine participants were assigned r and omly to a usual care control condition or to a six-session , telephone-delivered , interpersonal psychotherapy intervention ( hereafter referred to as the teletherapy group ) ; participants in the teletherapy group continued to receive st and ard services available to them in the community . Participants completed self-administered surveys pre- and postintervention that assessed depressive and psychiatric symptoms , perceptions of loneliness , and social support . RESULTS Participants in the teletherapy group evidence d greater reductions in depressive symptoms and in overall levels of psychiatric distress , compared with those in the control group . Nearly one-third of teletherapy participants reported clinical ly meaningful reductions in psychiatric distress from pre- to postintervention . CONCLUSIONS The telephone-delivered interpersonal therapy intervention showed potential to reduce depressive and psychiatric symptoms among HIV-infected persons in rural areas . On the basis of these encouraging findings , additional research examining this intervention with this clinical population is warranted OBJECTIVE Multiple trials have found telephone-administered cognitive behavioral therapy ( T-CBT ) to be effective for the treatment of depression . The aim of this study was to evaluate T-CBT for the treatment of depression among veterans served by community-based outpatient clinics ( CBOCs ) outside of major urban areas . METHOD Eighty-five veterans meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; American Psychiatric Association , 1994 ) criteria for major depressive disorder were r and omized to receive 16 sessions of T-CBT over 20 weeks or treatment as usual through the CBOC . Veterans were assessed at baseline , 12 weeks , 20 weeks ( posttreatment ) , and 6-month follow-up using the Hamilton Depression Rating Scale ( Hamilton , 1960 ) , the Patient Health Question naire-9 ( Kroenke , Spitzer , & Williams , 2001 ) , and a st and ardized psychiatric interview . RESULTS There were no significant Time × Treatment effects ( ps > .20 ) . Patients were compliant , with 38 ( 92.7 % ) completing at least 12 sessions , and 32 ( 78.0 % ) having no missed sessions whatsoever . Ratings of audiotaped sessions showed the therapists to be highly competent . CONCLUSIONS This trial yielded negative results for an intervention that has been shown to be effective under other circumstances . We speculate that veterans served within the Veterans Affairs system are more refractory to treatment than other population s , and they may require a more rigorous intervention . TRIAL REGISTRATION clinical trials.gov NCT00223652 Given the burden of depression among those with HIV , and the impact of HIV on urban minority communities there is an urgent need to assess innovative treatment interventions that not only treat depression but do so in a way that allows for increased access to mental health care . This single site , uncontrolled , pilot study sought to determine the feasibility and depression outcomes of an 11-session telephone-based cognitive behavioral therapy intervention delivered over 14 weeks targeting low-income , urban-dwelling , HIV-infected African-American people with major depression . The diagnosis of major depression was made using the Mini International Neuropsychiatric Interview . The primary outcome was the Hamilton Depression Rating Scale ( HAM-D ) and the secondary outcome was the Quick Inventory of Depression Symptomatology-Self Report ( QIDS-SR ) . Feasibility and satisfaction were also assessed . Assessment s occurred at baseline , midpoint and at study conclusion ( 14 weeks ) . Fifteen people were screened for the study . Six HIV-infected , low-income , African-American people individuals ( five females and one male ) were eligible and participated in the study . All patients finished the study . On average , participants completed nine sessions . The sessions lasted for an average of 48 min ( SD = 11.5 ) . Compared to mean HAM-D score at baseline ( HAM-D = 22.8 ( SD = 3.1 ) , the mean HAM-D score was significantly reduced at study conclusion ( HAM-D = 9.8 ( SD = 7.4 ) ; ( t ( 5 ) = 4.6 , p = 0.006 ) ; ( Cohen d = 1.9 ) ) . Compared to the mean QIDS-SR score at baseline ( QIDS-SR = 15.5 ( SD = 4.2 ) the mean QIDS score was significantly reduced at study conclusion ( QIDS = 7.0 ( SD = 5.4);(t ( 5 ) = 3.2 , p = 0.02 ) ; ( Cohen d = 1.3)).The mean satisfaction scores across all participants at post-treatment was 5.7 ( SD = 0.3 ) with of a maximum score of 6 . Telephone-based CBT can be delivered to low-income , urban-dwelling ethnic minority HIV-infected people result ing in significant reductions in depression symptoms with high satisfaction . The efficacy of this intervention will be assessed in a planned r and omized control trial The purpose of this study was to determine the efficacy of a structured exposure-based behavior therapy program delivered by telephone to agoraphobic individuals who were isolated from specialized treatment centres . Forty-two individuals with a DSM-III-R diagnosis of panic disorder with agoraphobia who were living in rural areas of Ontario were assigned to either an eight-session telephone behavior therapy program or wait-list control condition . There were significant treatment x time interaction effects on several outcome variables . Patients originally in the wait-list group then received the same type of therapy and they also significantly improved . All treatment gains were maintained at three-month and six-month follow-up . Telephone behavior therapy appears to be a cost-effective and efficacious treatment for agoraphobics living in remote regions where specialized anxiety disorder services are not readily available 
    Output:
    